The Impact of Tropical Weather on Patients with Atopic Dermatitis in Hurricane-Prone Areas

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The pathogenesis of atopic dermatitis (AD) is multifactorial, involving genetic predisposition, immunologic dysregulation, and environmental triggers.¹ For individuals residing in hurricane-prone regions, the environmental and psychosocial challenges associated with tropical weather can exacerbate AD, potentially leading to increased morbidity.² “As a medical provider raised in Florida, I have seen my fair share of hurricanes, as well as the damage they can cause. Everyone can be affected by hurricanes, and our AD patients often have it the worst,” Tiffani Botts Massey, PA-C, president of the Florida Society of Dermatology PAs, told Dermatology Times.

Environmental Stressors and Their Impact on AD

Tropical climates, particularly during hurricane season, present a range of environmental stressors that can aggravate AD. The increased humidity and heat characteristic of these regions contribute to heightened perspiration, which can compromise the skin barrier and promote microbial overgrowth.³ The resulting disruption in the epidermal barrier function can contribute to increased transepidermal water loss (TEWL), which is modulated by external temperature and humidity, in addition to skin barrier integrity. Disruptions in TEWL may facilitate the penetration of allergens and irritants, which are known to provoke AD flares.³ In findings from one study, a reduction in temperature and humidity led to compromised barrier function and enhanced the skin’s reactivity to irritants, allergens, and mechanical stress.⁴

In the aftermath of a hurricane, the prevalence of mold and mildew surges due to flooding and elevated moisture levels. Exposure to mold spores, a recognized allergen, can trigger or exacerbate AD symptoms.⁵ Additionally, the accumulation of dust and debris combined with the proliferation of allergens in the environment can lead to worsening disease severity.

“In Houston, we recently went through Hurricane Beryl, and the prolonged power outages in many areas of the city made it very challenging to manage AD. For some of my friends and patients, dealing with extremely hot weather and no air-conditioning meant a flare of their AD, due to both the temperature change and sweating. For some, the stress of damage to their homes and the uncertainty of when the power would come back also contributed to a flare of their disease,” said Rajani Katta, MD, clinical faculty at Baylor College of Medicine and McGovern Medical School in Houston, Texas.

Psychosocial Stressand AD Exacerbation

“Psychosocial stressors from the anxiety and uncertainty of impending storms, evacuation plans, caring for sick relatives, etc, also play a significant role in worsening both rash and itch. It is crucial for patients to maintain consistent medication use, especially during stressful times,” Botts Massey said. The stress associated with hurricane preparedness, the acute event, and poststorm recovery efforts can contribute to significant psychological distress.6 This heightened stress may dysregulate immune function and amplify inflammatory responses, precipitating AD flares. The disruption of daily routines, uncertainty about safety, and potential loss of property or life further compound stress levels, which in turn may aggravate AD symptoms.

Furthermore, the recovery phase often entails challenges, including housing displacement, loss of access to medical care, and altered hygiene practices. Patients with AD may encounter difficulties in maintaining access to their prescribed skin care regimens, necessary medications, and a hygienic living environment, which are all essential for disease management.

Disruption of Health Care Access and Medication Adherence

Hurricanes frequently result in extensive damage to infrastructure, including health care facilities and pharmacies, leading to disruptions in health care access. Patients with AD may face obstacles in obtaining essential medications, such as topical corticosteroids, emollients, and systemic therapies, during and after a hurricane. The interruption of treatment regimens can result in poorly controlled AD, with a consequent increase in disease activity. Displacement to shelters or temporary housing during the recovery period can further complicate disease management. Patients may experience barriers to maintaining consistent skin care practices due to limited access to clean water, inadequate hygiene facilities, and the absence of a controlled environment.

The Role of Allergens and Irritants in Posthurricane Environments

The posthurricane environment is often replete with allergens and irritants that can exacerbate AD. The cleanup process, which involves handling debris, using harsh cleaning agents, and exposure to particulate matter, may introduce a variety of skin irritants.⁷ These substances may come into direct contact with the skin, contributing to irritation and AD flares.⁷

Moreover, stagnant water and increased humidity can create favorable conditions for the proliferation of insects, such as mosquitoes. Insect bites not only irritate the skin but can also increase the risk of secondary infections, particularly in patients with a compromised skin barrier.⁸

Strategies for Managing AD in Hurricane-Prone Areas

For individuals with AD residing in hurricane-prone regions, strategic planning and proactive disease management are crucial for mitigating the impact of tropical weather on their condition. Prehurricane preparation should include collaboration with health care providers to ensure an adequate supply of medications, including topical therapies, antihistamines, and systemic treatments.⁸ Patients should also develop contingency plans for maintaining their skin care routines in the event of displacement or limited access to facilities.

Botts Massey explained, “In Florida, once the governor declares a state of emergency, patients are entitled to early refills of all their current medications. I strongly encourage my colleagues to remind their patients of this, which further ensures patients have an adequate supply on hand. Additionally, I recommend all patients with AD keep oral antihistamines on hand, and encourage them to start taking a daily dose the day the wind picks up, and do not stop taking daily until the debris is all cleared in their area. Staying prepared can make a significant difference in managing atopic dermatitis during stressful times.”

Isabella Tan is a third-year medical student at Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey.

References

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