Impact of Air Pollution on Acne Vulgaris: A Systematic Review
DOI:
https://doi.org/10.33192/smj.v78i9.282324Keywords:
Acne, air pollution, NO2, PM2.5, PM10, SO2Abstract
Objective: This study aimed to systematically review the existing evidence of the impact of air pollutants on acne vulgaris.
Materials and Methods: The studies assessed the relationship between air pollution and acne, in terms of the number of acne lesions, severity of acne, number of patients who visited the hospital with acne complaints, and impact on quality of life, which were the eligibility criteria for the outcome of this study. The studies that were not in the English language, case reports, conference abstracts, and studies with duplicate publication data were excluded. Risk of Bias in Non-randomized Studies (ROBINS-E) was used to assess the risk of bias. Descriptive analysis was conducted because of different outcomes reported among the studies.
Results: 226 articles were identified through the literature search. Four studies were included. El Haddad, et al, reported that NO₂ exposure aggravated acne vulgaris. Xiang Li, et al, presented that exposure to Particulate matter10 (PM10), sulfur dioxide (SO2), and nitrogen dioxide (NO2) in Xi’an, China, as well as PM2.5 in Chongqing, China showed inconclusive results regarding increases in outpatient visits of acne vulgaris. Wei Liu, et al. demonstrated that exposure to SO₂ decreases the outpatient visits of acne vulgaris.
Conclusion: PM2.5, PM10 and SO2 presented controversial outcomes. Since current studies had a risk of bias and methodological limitations, a prospective cohort or panel studies using personal or high-resolution exposure estimates, standardized measures of acne incidence and severity, prespecified lag periods, and adjustment of confounders were suggested for a better understanding of the correlation.
References
Fuller R, Landrigan PJ, Balakrishnan K, Bathan G, Bose-O'Reilly S, Brauer M, et al. Pollution and health: a progress update. Lancet Planet Health. 2022;6(6):e535-e547.
World Health Organization. Ambient (outdoor) air pollution [Internet]. Geneva: WHO;2024 Oct 24. Available from: https://www.who.int/news-room/fact-sheets/detail/ambient-(outdoor)-air-quality-and-health
Denisow-Pietrzyk M. Human Skin Reflects Air Pollution – a Review of the Mechanisms and Clinical Manifestations of Environment-Derived Skin Pathologies. Pol J Environ Stud. 2021;30(4):3433-44.
Abolhasani R, Araghi F, Tabary M, Aryannejad A, Mashinchi B, Robati RM. The impact of air pollution on skin and related disorders: A comprehensive review. Dermatol Ther. 2021;34(2):e14840.
Han HS, Seok J, Park KY. Air Pollution and Skin Diseases. Ann Dermatol. 2025;37:53-67.
Yang Y, Zhang J, Fu L, Jing D, Sun B, Chen Y, et al. Short-term exposure of PM2.5 and PM10 increases the number of outpatients with eczema in Guangzhou: A time-series study. Front Public Health. 2023;10:930545.
Afaq F, Zaid MA, Pelle E, Khan N, Syed DN, Matsui MS, et al. Aryl hydrocarbon receptor is an ozone sensor in human skin. J Invest Dermatol. 2009;129(10):2396–403.
Valacchi G, Sticozzi C, Pecorelli A, Cervellati F, Cervellati C, Maioli E. Cutaneous responses to environmental stressors. Ann N Y Acad Sci. 2012; 1271:75–81.
Sutaria AH, Masood S, Saleh HM, Schlessinger J. Acne Vulgaris. 2023 Aug 17. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan.
Heng AHS, Chew FT. Systematic review of the epidemiology of acne vulgaris. Sci Rep. 2020;10(1):5754.
Yazici K, Baz K, Yazici AE, Köktürk A, Tot S, Demirseren D, et al. Disease-specific quality of life is associated with anxiety and depression in patients with acne. J Eur Acad Dermatol Venereol. 2004;18(4):435-9.
Jirawattanadon P, Chularojanamontri L, Nanchaipruek Y, Chantrapanichkul P, Tuchinda P, Kulthanan K. Associated Factors of Quality of Life in Adult Female Acne Coexisting with Hyperandrogenism and Polycystic Ovarian Syndrome using the Dermatology Life Quality Index. Siriraj Med. J. 2023;75(10):744-51.
Likitwattananurak C, Chularojanamontri L, Tuchinda P, Kulthanan K. Clinical features of adult male acne in a tropical country: a prospective cross-sectional study. Siriraj Med J. 2023;75(2):85-91.
Adebamowo CA , Spiegelman D, Danby FW, Frazier AL, Willett WC, Holmes MD. High school dietary dairy intake and teenage acne. J Am Acad Dermatol. 2005;52(2):207-14.
Roengritthidet K, Kamanamool N, Udompataikul M, Rojhirunsakool S, Khunket S, Kanokrungsee S. Association Between Diet and Acne Severity: A Cross-sectional Study in Thai Adolescents and Adults. Acta Derm Venereol. 2021;101(12):569.
El Haddad C, Gerbaka N, Hallit S, Tabet C. Association between exposure to ambient air pollution and occurrence of inflammatory acne in the adult population. BMC Public Health. 2021;21(1):1664.
Li X, An SJ, Liu XL, Ji AL, Cao Y, Xiang Y, et al. The Association Between Short-Term Air Pollution Exposure and Post-Adolescent Acne: The Evidence from a Time Series Analysis in Xi'an, China. Clin Cosmet Investig Dermatol. 2021;14:723-31.
Li X, Zhou LX, Yang LL, Huang XL, Wang N, Hu YG, et al. The relationship between short-term PM2.5 exposure and outpatient visits for acne vulgaris in Chongqing, China: a time-series study. Environ Sci Pollut Res Int. 2022;29(40):61502-11.
Liu W, Pan X, Vierkötter A, Guo Q, Wang X, Wang Q, et al. A Time-Series Study of the Effect of Air Pollution on Outpatient Visits for Acne Vulgaris in Beijing. Skin Pharmacol Physiol. 2018;31(2):107-13.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
Higgins JPT, Morgan RL, Rooney AA, Taylor KW, Thayer KA, Silva RA, et al. A tool to assess risk of bias in non-randomized follow-up studies of exposure effects (ROBINS-E). Environment International. 2024;186:108602.
Paik K, Na JI, Huh CH, Shin JW. Particulate Matter and Its Molecular Effects on Skin: Implications for Various Skin Diseases. Int J Mol Sci. 2024;25(18):9888.
Piao MJ, Ahn MJ, Kang KH, Ryu YS, Hyun YJ, Shilnikova K, et al. Particulate matter 2.5 damages skin cells by inducing oxidative stress, subcellular organelle dysfunction, and apoptosis. Arch Toxicol. 2018;92(6):2077-91
Eberlein-König B, Przybilla B, Kühnl P, Gebefügi I, Kleinschmidt J, Ring J, et al. Influence of airborne nitrogen dioxide or formaldehyde on parameters of skin function and cellular activation in patients with atopic eczema and control subjects. J Allergy Clin Immunol. 1998;101(1):141-3.
Janvier X, Alexandre S, Boukerb AM, Souak D, Maillot O, Barreau M, et al. Deleterious Effects of an Air Pollutant (NO2) on a Selection of Commensal Skin Bacterial Strains, Potential Contributor to Dysbiosis? Front Microbiol. 2020;11:591839.
Liang J, Liu L, Kang X, Hu F, Mao L. Mechanism underlying the effect of SO2-induced oxidation on human skin keratinocytes. Medicine (Baltimore). 2020;99(48):e23152.
Published
How to Cite
License
Copyright (c) 2026 Siriraj Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Authors who publish with this journal agree to the following conditions:
Copyright Transfer
In submitting a manuscript, the authors acknowledge that the work will become the copyrighted property of Siriraj Medical Journal upon publication.
License
Articles are licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0). This license allows for the sharing of the work for non-commercial purposes with proper attribution to the authors and the journal. However, it does not permit modifications or the creation of derivative works.
Sharing and Access
Authors are encouraged to share their article on their personal or institutional websites and through other non-commercial platforms. Doing so can increase readership and citations.
