When you think of pollution and its effects on children, the most common thought that comes to mind is respiratory issues—cold, cough, wheezing, asthma and more on those lines. An often not considered manifestation of pollution is that of the skin. Skin breaking out into Atopic Dermatitis as a response to pollution is not uncommon, but unfortunately not something that gets talked about much. In fact, Atopic Dermatitis is not given the kind of attention that other ailments caused by pollution get, because it is not considered a ‘serious’ ailment when in fact, extreme cases can be quite debilitating. Also, for young children, acute visible cases can be deterrent to self esteem and socialising.

“Air pollution occurs due to road dust, soot from vehicles, fumes from industries and fires. Polluted air and smog contain tiny particles called PMs, nitrogen dioxide (NO2) and chemicals such as polycyclic hydrocarbons (PAHs),” says Dr Jaishree Sharad, dermatologist, Medical Director, Skinfiniti Aesthetic & Laser Clinic and author, Skin Talks. She adds, “These agents cause oxidative damage to the skin cells. They increase the free radicals or toxins in the skin, leading to allergic rashes, itching, blotchy skin, dry skin and increased skin sensitivity seen in children too. Childhood eczemas are also on the rise due to pollution. Chronic inflammation of the skin also causes persistent redness of the face.”

Air pollution causes oxidative damage to the skin cells. They increase the free radicals or toxins in the skin, leading to allergic rashes, itching, blotchy skin, dry skin and increased skin sensitivity seen in children too. – Dr Jaishree Sharad

Says Dr Shweta Iyengar, Founder and Medical Director, SkinSense, “The primary cause of Atopic dermatitis is genetic predisposition. It is more prevalent in early childhood and the prevalence is on the rise. Some studies show worsening of atopic dermatitis with indoor and outdoor air pollutants. Temperature, humidity, rainfall,particulate matter in the air, nitrogen dioxide and ozone have been noted to aggravate atopic dermatitis. Air pollution is strongly suspected to aggravate symptoms but this is not investigated in detail and there are very limited studies.”

She adds, “Air pollution causes sensitivity to itch, scratching disrupts the skin barrier. This increases sensitivity to antigens and makes it very easy for antigens to penetrate and thus increases the predisposition to atopic dermatitis.”

Says Vaishali Mathur, editor at a publishing house and a Delhi resident, “My older daughter developed Atopic Dermatitis which got aggravated around October –November every year when pollution levels would peak.”

A study by the Tohoku University Graduate School of Medicine and Tohoku Medical Megabank Organization (ToMMo) showed the connection between some people developing atopic dermatitis, a kind of skin inflammation, as the result of air pollution. “We have discovered that AhR, a transcription factor activated by air pollutants, causes hypersensitivity to itch, through the expression of neurotrophic factor artemin,” says Dr. Masayuki Yamamoto, who led the research team with Drs. Takanori Hidaka and Eri Kobayashi. “Scratching makes things worse because the skin barrier gets disrupted and sensitization to antigens is enhanced. That’s why some people are predisposed to atopic dermatitis.”

Air pollution is strongly suspected to aggravate symptoms but this is not investigated in detail and there are very limited studies. – Dr Shweta Iyengar

According to the study, air pollution can trigger scratching, disrupting the skin barrier function and thereby enabling antigens to penetrate. According to the report, this allows the patients to get sensitised to antigens and predisposed diseases like asthma. Patients with atopic dermatitis have shown this allergic march. Says Dr Iyengar, “Controlling atopic dermatitis is important as it has a high prevalence of progressing into respiratory disease (asthma).”

While exposure to second hand smoke and indoor pollution (paints, etc) can also be triggers for Atopic Dermatitis, outdoor pollution is one major cause. Pollutants like carbon monoxide, nitrogen dioxide and sulphur dioxide are common in urban air, coming from varied sources like dust, industrial exhaust, vehicle exhaust, factories and more. In Taiwan, research has confirmed that exposure to traffic pollution increases the risk of eczema. School children reported increased itching when outdoor pollution levels increases in Korea. Childhood eczema levels were reported to be higher in Germany amongst those children who lived within 50 meters of main roads with heavy vehicular traffic. According to research, the toxic exhaust from vehicles on the roads in cities may play a major role in the development of eczema.

My older daughter developed Atopic Dermatitis which got aggravated around October –November every year when pollution levels would peak.- Vaishali Mathur.

A paper on Atopic dermatitis in infants and children in India by Sandipan Dhar and Raghubir Banerjee, Department of Pediatric Dermatology, Institute of Child Health, Kolkata, India found that pollution does play a significant role in the precipitation of Atopic Dermatitis.

In cities like Bangalore where air pollution is on the rise, paediatricians have reported a rise in the reporting of cases with Atopic Dermatitis and Psoriasis amongst school going children.

A Bangalore parent, whose daughter has been suffering from Atopic Dermatitis talks about how her six year old daughter suffers because of it. “Not only is it at a visible place right on her face and hands, but when it gets aggravated it can be very itchy and annoying. Worse is that the other children tease her about her and won’t let her play with them because they say it will spread to them. This really affects her mentally and emotionally.” Also, when her daughter was younger she says, it was really difficult to constantly prevent her from scratching and aggravating the flare up, which in turn made it worse.

Says Dr Sharad, “Constant itchy skin can be traumatic to the child. Besides itching leads to dark marks and blemishes which makes the child conscious especially in school and among friends. Redness and flaky skin can also cause a lot of psychological distress to the child.”

Vaishali shifted her daughter to all cotton and natural fibres in her clothing. “We removed anything synthetic from her wardrobe because it aggravated the Dermatitis and made it flare up. Now, of course, as she’s grown older, she’s grown out of the dermatitis.” They also opted for homeopathic treatment for the Atopic Dermatitis over traditional allopathic treatment.

Constant itchy skin can be traumatic to the child. Besides itching leads to dark marks and blemishes which makes the child conscious especially in school and among friends. – Dr Jaishree Sharad

Treatment for Atopic Dermatitis involves topical corticosteroids as well as hydrating products to hydrate the skin, but these topical corticosteroids can have long term effects. The treatment also involves the use of antibiotics to control secondary infection and antihistamines. The child also needs to use mild soaps and cleansers, medicated and fragrance free preferably, wet compresses and wet wraps on severe cases. Sometimes, atopic dermatitis can be helped removing the child from the environment that triggers the outbreaks. For children living in cities like Delhi and Mumbai which have consistently high levels of air pollution, reducing exposure to triggers might be difficult in the course of daily life which requires a child to go out to school, etc. Some parents try to do this by going out of town in the periods when they know pollution levels will be at an all time high. For Vaishali, this meant they spent the Diwali vacation in Simla for many years when their daughters were young.

One major shift Vaishali made was shifting completely to organic food and cutting out packaged foods completely. “We made a major dietary change as a family, we shifted completely to organic foods, fruits, vegetables and pulses. We completely cut out carbonated drinks, packaged foods from our diets. My kids haven’t been to a doctor in over ten years now. If they snack, they won’t reach out for any chips or packaged stuff. At the max we might have salsa chips with a dip. We also have a great collection of leak proof Tiffin boxes and mugs and carry food from home rather than eating out in the course of the day.”

Next make sure you apply a good moisturizer which has ingredients like vitamin e, olive oil, coconut oil, squalene, ceramides in them. Pollution dehydrates the skin, leaving it dull and more exposed to environmental damage. – Dr Sharad

Dr Sharad gives these tips for parents to deal with atopic dermatitis. “Always cleanse the child’s skin well after returning from any outdoor place, even school for that matter. Use a baby face wash which can remove all the dirt and grime from the skin surface as well as the pollutant particles which sit on the skin. Baby oil will also help to remove the grime.

Next make sure you apply a good moisturizer which has ingredients like vitamin e, olive oil, coconut oil, squalene, ceramides in them. Pollution dehydrates the skin, leaving it dull and more exposed to environmental damage. A moisturizer will protect the lipid barrier layer of the skin.

Do not forget to apply a sunscreen with both UVA & UVB protection. Opt for physical sun blocks which will also form a protective layer on the skin, making it difficult for the smog particles to reach the deeper layers of skin

Do not forget to ask your child to wear a mask which not only covers the nose and mouth but the entire face except the eyes. Physical protection is the best method of protection from pollutant particles.

We made a major dietary change as a family, we shifted completely to organic foods, fruits, vegetables and pulses. We completely cut out carbonated drinks, packaged foods from our diets. – Vaishali Mathur.

Make sure the child drinks enough water, a minimum of one litre per day and has a lot of brightly coloured fruits such as all the berries, pomegranate, dark grapes which are all rich in antioxidants. In extreme conditions, you must have an air purifier at home, so at least your child breathes in clean oxygen.”

Living in cities is tough enough, for adults and children. The lack of open spaces, the constant rush and pressure, incessant honking, and to add to this, the no getting away from the pollution that drapes over everything like a toxic cloak. For children who suffer from skin ailments brought on by the pollution in the air, there is perhaps nothing that can help except medical treatment and waiting to grow out of their susceptibility because the air doesn’t seem to be improving its quality anytime soon. Till then, flaking, cracking, bleeding, shedding, they suffer skin that is painful to live with and often the cause of much cruel teasing and bullying for no fault of theirs.

Also Read: Toxic Cities: When People Are In Mood To Celebrate, Mothers Like Me Are Anxious

Kiran Manral is the Ideas Editor at SheThePeople.TV

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