 Dermatological
Effects
What is the concern regarding environmental effects on children’s
skin?
Skin is an important "organ" in the context of environmental
exposures. It is the only body system that is perpetually exposed
to the environment. Skin is both a crucial physical barrier and
a significant route of absorption of toxic substances. The skin
is also an important site of excretion and biotransformation of
toxins and plays a role in the body’s immune system.
A baby’s skin is more permeable than an adult’s is, and skin is
thinner in the very young. As a result, it absorbs more and is more
susceptible to damage from environmental agents. The fact that children
are smaller in size means that their skin presents a large surface
area relative to their body weight for absorption of environmental
substances.
What substances can affect a child’s skin?
There are a vast number of environmental factors that can affect
skin or that enter the body primarily by dermal absorption. This
unit focuses on specific physical or chemical agents wherein children
are exposed involuntarily and the degree of exposure has been largely
influenced by human behaviour:
- UV radiation
- Persistent organochlorine pollutants (such as dioxins, PCBs
some pesticides)
- A variety of chemicals (such as solvents, formaldehyde, vinyl
chloride, some pesticides, ingredients in cosmetics or other substances
applied directly to skin)
- Metals (such as nickel, chromium, etc.)
How are children exposed to toxins and agents that affect skin?
Percutaneous absorption of foreign substances is largely a passive
phenomenon. It does vary, however, depending on factors such as
the concentration and nature of the substance, the composition of
the vehicle, the properties and state of the stratum corneum, including
its thickness, the anatomical region, its integrity and skin occlusion,
and finally, the area of exposure. Dermal absorption is also a route
of exposure to contaminants that are found in soil, air and water
but make contact with skin.
What are the potential effects on skin from environmental exposures?
Most of our understanding of primary dermal effects or of systemic
toxicity that affects the skin comes from knowledge of the circumstances
for adults. Skin symptoms can be immediate or may occur days, months
or even years after initial exposure. Clinical signs of environmentally
induced dermal effects will vary depending on the environmental
agent involved. The most common such skin disorders, or those most
readily recognized as being related to environmental exposure, include:
- rash
- dermatitis
- pigmentary changes
- photosensitivity reactions
- urticaria
- scleroderma-like conditions
- chloracne lesions
- malignancy
Why are children more vulnerable to dermal effects?
Because the infant’s skin is immature developmentally, it provides
a less effective barrier to absorption of harmful substances. A
child’s skin is thinner compared to an adult’s and therefore is
also subject to greater damage from environmental agents such as
ultraviolet radiation. (Such damage will not manifest as malignancy
until adulthood. )
The absorption of compounds through the child’s skin may be more
problematic because metabolic differences in childhood make such
substances more toxic to children. There may also be greater risk
of health effects from dermal absorption due to the windows of vulnerability
of developing systems such as reproductive tissues and the brain.
How does one personally prevent such exposures?
Because of the complexity of dermatological effects and the variety
of associated exposures, personal and primary prevention is a challenge.
In the case of allergic or immune-mediated skin responses, personal
protection, avoidance and hygiene are strategies to reduce the risk
of such afflictions in the future. Patient education and awareness
is another important strategy to prevention.
Because there is a wealth of information and ongoing public awareness
aimed at reducing the risks of skin cancers from sun exposure, this
area of prevention is generally well understood by the public. However,
since the thinning of the ozone layer has resulted in higher exposures
to UV, reinforcing prevention and skin protection messages to parents
and young patients is a worthwhile endeavour nonetheless.
What do we do as a society to prevent these exposures?
CAPE joins other health advocacy organizations in Canada and the
United States in calling for precaution in health policies and environmental
regulations to prevent harm to children’s health from contaminants
and agents to which they are involuntarily exposed. As a society
and as individuals we need to be mindful of the effects of our behaviour
on the ecosystem and consequently on our own health. For example,
consumers should avoid purchasing products that use or have been
produced with ozone-depleting substances and should support appropriate
alternative technologies.
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