Lower-income countries are bearing the brunt of climate-related changes in skin disease, according to a global study spanning 136 nations.
Climate change is already reshaping the global burden of skin disease, with more than 40% of countries reporting changes in prevalence or severity and poorer nations disproportionately affected.
The international study was presented at the European Academy of Dermatology and Venereology (EADV) Congress 2026 in Vienna.
Researchers invited representatives from 194 World Health Organization (WHO) member countries to participate in the Global Access to Skin Health Observatory (SkinObservatory) study, a collaboration between the International League of Dermatological Societies (ILDS) and L’Oréal Dermatological Beauty.
Participants shared insights on climate impacts and the prevalence of climate change-related skin diseases in their countries.
Data were collected from 136 countries spanning all four World Bank income groups. Overall, 42.6% reported changes in the prevalence and/or severity of skin disease due to climate change, with significant differences according to income level.
But the burden was far from evenly distributed. More than half of low-income countries (55.6%) and lower-middle-income countries (52.5%) reported changes, compared with 43.8% of upper-middle-income countries and just 28.3% of high-income countries.
Study author Dr Esther Freeman, from Massachusetts General Hospital and Harvard Medical School, said the disparity was one of the study’s most important findings.
“The most important finding for our study is that climate change today is already associated with negative impacts on skin disease, and the bulk of these negative effects disproportionately burden lower-income settings,” she said.
“In the study, more than 40% of countries reported changes in the prevalence and/or severity of skin disease related to climate change, but these effects are not evenly distributed.
“More than half of low- and lower-middle-income countries noted alterations in skin disease patterns compared with only 28% of high-income countries.
“Despite contributing the least to climate change, countries with fewer resources were more likely to report climate-related dermatologic changes.
“This is especially alarming since these are often the same countries with the least capacity to adapt in response to climate change.”
Another standout feature was the overall scale of the problem, said Dr Freeman.
“We frequently think about extreme weather events’ impacts on heatstroke, cardiovascular problems, and respiratory disease, but as the organ system that protects us from the outside world, the skin serves as our front line to climate change,” she said.
“With our respondents documenting changes across the spectrum of heat-related rashes, inflammatory conditions, and infectious disease, it helps put into perspective the wide-reaching impacts of climate change on skin health.”
Regional differences were substantial. Almost two-thirds of countries in the Western Pacific Region (64.7%) reported changes, as did 60% in both the Eastern Mediterranean and South-East Asian regions, with 16.1% in the European Region.
In Africa, however, 42.9% of respondents were unsure whether climate change was affecting skin disease, raising questions about gaps in surveillance and access to dermatological expertise.
“An important point is that uncertainty does not necessarily mean there is no impact. It may mean we do not yet have enough information to see it clearly,” said Dr Freeman.
“In regions with limited dermatology services or disease surveillance, changes in skin disease may be harder to detect, document, or attribute to climate change.”
She said researchers knew from recent work on the distribution of dermatologic workforce around the world, published in JAMA Dermatology in August, that there are very few dermatologists in Africa compared with other regions of the world, with less than three dermatologists per million population across the continent.
“That makes strengthening surveillance particularly important. We cannot respond to a problem if we cannot reliably see where and how it is changing,” she said,
Of the 58 countries reporting climate-associated effects on skin health, 81% reported increases in heat rashes and 75.9% reported increases in inflammatory skin disease.
The study did not identify individual inflammatory conditions, but Dr Freeman said several mechanisms could be involved.
“There are several ways climate change can aggravate inflammatory skin disease. Higher temperatures and humidity can increase sweating and skin irritation, while heat, air pollution, and changing environmental exposures may trigger or worsen inflammation.
“Extreme weather can also disrupt access to medicines and routine care, making existing disease harder to control.
“The key point is that climate change can affect the skin both directly, by creating environmental conditions that contribute to new or exacerbated skin disease, and indirectly, by making it harder for people already living with chronic skin conditions to manage their disease.”
Infectious disease was another major concern. Among countries reporting climate-associated effects, 62.1% reported changes in infectious diseases and 50% reported changes in vector-borne diseases.
Related
Again, the researchers did not collect data on individual diseases, meaning the findings could not establish which infections were increasing or moving into new geographical areas.
“Among countries reporting climate-associated skin effects, 62.1% described changes in the epidemiology of infectious diseases and 50% reported changes in vector-borne diseases,” said Dr Freeman.
“Although more granular country and regional work needs to be done to characterise the specific infectious and vector-borne diseases, a key concept is that climate change can alter where infectious diseases and vectors are able to spread.
“Changes in temperature, rainfall and humidity can affect the habitats of mosquitoes, ticks, and other disease vectors, potentially allowing them to survive in places where they were previously uncommon.
“Flooding, displacement, and disruption of sanitation and healthcare can also increase the risk of some skin infections. As such, we are concerned not only about more disease, but also about diseases appearing in populations and regions that may be less familiar with recognising, treating, and responding to them.”
The disparity between richer and poorer countries was likely to reflect both greater climate exposure and weaker capacity to respond, Dr Freeman said.
“Many lower-income countries are in regions that experience extreme heat, flooding, changing rainfall patterns, and other climate pressures,” she said.
“We know that not only have these events become more frequent and severe, but lower-income settings also have more limited access to healthcare, dermatologists, medicines, and public-health infrastructure.
“However, our study focused on demonstrating the scope of climate change’s impact, rather than determining the drivers of the disparities we are seeing.
“Regardless, what we are seeing is a compounding vulnerability for people in low-income settings where the populations facing the greatest health risks from climate change live in health systems with fewer resources to prevent, identify and treat people in need.”
The researchers said the findings strengthened the case for incorporating dermatology into climate-health planning rather than treating skin disease as a secondary consequence of climate change.
“More broadly, the scale of the problem means that dermatological consequences of climate change should be considered within public health policy rather than treated solely as an issue for specialist dermatology services or a lower priority,” said Dr Freeman.
The EADV Congress is being held in Vienna, Austria, and online until 3 October 2026. See here for more information.
