A bibliometric analysis reveals how environmental exposures throughout life impact skin aging and health
Imagine two sisters growing up in the same household. One develops early wrinkles and sun spots in her 40s, while the other maintains youthful skin well into her 50s. Their genetic makeup is nearly identical, so what accounts for this dramatic difference? For decades, science would have struggled to answer this question. Today, dermatology has a new explanation: the skin exposome—the cumulative record of all environmental and lifestyle exposures throughout our lives that literally leaves its mark on our skin 1 2 .
The term "exposome" was first coined by epidemiologist Christopher P. Wild in 2005, who defined it as the lifelong totality of environmental exposures from conception onward 1 .
When applied to dermatology, this concept represents a revolutionary shift in how we understand skin health and aging. Rather than viewing skin conditions as primarily genetic in origin, the exposome approach reveals how our skin becomes a living ledger—continuously recording and responding to everything it encounters 3 .
Recent bibliometric analyses reveal that while dermatology was initially slow to adopt exposome approaches compared to fields like environmental science and toxicology, research in this area has dramatically accelerated following the pioneering 2017 publication "The Skin Aging Exposome" by Krutmann et al. 1 . This growing body of research is fundamentally changing how scientists, dermatologists, and skincare experts understand everything from wrinkles to skin cancer, opening new possibilities for prevention and treatment that extend far beyond our genetic destiny.
The skin exposome encompasses all internal and external factors that influence our skin health throughout our lives. Think of it as the complete story of your skin's journey—every sunburn, every stressful day, every pollutant encountered, every dietary habit—all leaving subtle biological impressions that accumulate over time 3 .
Our skin serves as the primary interface between our body and the outside world, comprising approximately 2 square meters of surface area constantly exposed to environmental factors 1 . This strategic position makes it both vulnerable to external assaults and perfectly positioned to reveal how these exposures biologically embed themselves in our tissues.
Particulate matter and gases like ground-level ozone penetrate skin, generating reactive oxygen species that break down collagen and accelerate aging 4 .
Temperature, humidity, and seasonal variations constantly challenge the skin's adaptive capabilities 1 .
Diet, tobacco use, alcohol consumption, and sleep patterns directly affect skin health through multiple biological pathways 3 .
Chronic stress triggers inflammatory responses that can exacerbate conditions like acne, eczema, and psoriasis 1 .
The very products we use to care for our skin become part of its exposure history 3 .
Hormonal fluctuations, metabolic processes, and our individual microbiomes complete the complex exposure picture 3 .
| Exposome Category | Specific Factors | Primary Skin Impacts |
|---|---|---|
| Environmental | Solar radiation (UV, visible light, infrared), air pollution, climate, temperature | Photoaging, pigmentation, collagen breakdown, inflammation |
| Lifestyle | Diet, sleep patterns, tobacco use, alcohol consumption, exercise | Oxidative stress, inflammation, accelerated aging |
| Psychosocial | Stress, emotional states | Compromised barrier function, exacerbated inflammatory conditions |
| Cosmetic | Skincare products, treatments | Protection benefits or potential irritation depending on formulation |
Bibliometric analysis—the quantitative study of scientific publications—reveals fascinating patterns in how dermatology has embraced the exposome concept. When researchers conducted a comprehensive bibliometric analysis of exposome literature up to September 2021, they found that dermatology was initially slow to adopt this approach compared to other fields 1 .
The data revealed 910 documents related to the general "exposome" concept but only 45 specifically addressing "skin exposome." Environmental sciences and toxicology dominated the research landscape, with dermatology representing a smaller but growing segment of this scientific literature 1 .
The real tipping point came in 2017 with the landmark publication "The Skin Aging Exposome" in the Journal of Dermatological Science. This paper, cited hundreds of times since its publication, effectively established a new framework for understanding how multiple environmental exposures collectively contribute to skin aging 1 2 . Following this publication, the number of dermatology studies evaluating exposome factors in conditions ranging from acne to skin cancer steadily increased.
| Year | Cumulative Exposome Publications | Cumulative Skin Exposome Publications |
|---|---|---|
| 2005 | 1 | 0 |
| 2010 | 8 | 0 |
| 2015 | 148 | 2 |
| 2017 | 279 | 7 |
| 2021 | 910 | 45 |
Through co-occurrence analysis of keywords in scientific publications, researchers can visualize the conceptual structure of the skin exposome field. This approach reveals nine major clusters of research focus, connecting concepts like "air pollution" with "skin aging," and "metabolomics" with "biomarkers" 1 .
The density mapping of these keywords shows that aging, cancer, respiratory allergies, and atopic dermatitis represent the most documented conditions in exposome research. The interconnections between these clusters highlight the interdisciplinary nature of the field, drawing from environmental science, dermatology, epidemiology, and molecular biology 1 .
To understand how the skin exposome field has evolved, let's examine the pivotal 2022 bibliometric analysis that mapped this scientific territory 1 :
Researchers conducted two parallel searches in the Web of Science database—one for "exposome" and another for "skin exposome"—including all documents published up to September 2021.
From the initial 910 documents identified for "exposome" and 45 for "skin exposome," researchers manually selected and retrieved 26 key dermatology-related papers for in-depth analysis.
Using specialized bibliometric software, the research team employed:
The team created intuitive maps and graphs to represent the complex relationships within the literature, making the vast body of research more accessible to other scientists and the public.
The analysis revealed that dermatology represented just 27 of the 910 exposome documents (approximately 3%) at the time of the study, indicating both the novelty of the approach in skin research and its significant growth potential 1 .
of exposome publications focused on dermatology
Significant growth potential
More importantly, the study identified the pivotal role of key publications in advancing the field. The 2017 paper "The Skin Aging Exposome" served as what sociologists of science call a "tipping point," fundamentally reshaping how dermatologists conceptualize environmental influences on skin health 1 2 .
The bibliometric analysis also revealed that the principal research areas impacted by exposome concepts were environmental sciences (253 publications) and public/environmental occupational health (227 publications), followed by toxicology (131 publications) 1 . This distribution highlights the interdisciplinary collaboration required to fully understand the complex relationships between our environment and our skin.
| Research Area | Number of Publications | Percentage of Total |
|---|---|---|
| Environmental Sciences | 253 | 27.8% |
| Public/Environmental Occupational Health | 227 | 24.9% |
| Toxicology | 131 | 14.4% |
| Biochemistry/Molecular Biology | 87 | 9.6% |
| Dermatology | 27 | 3.0% |
The primary database for bibliometric analysis, allowing researchers to track publication trends and citation networks across multiple disciplines 1 .
Epigenetic tools that measure biological aging in skin cells by tracking chemical modifications to DNA that change with age and environmental exposures 5 .
Devices that measure concentrations of particulate matter (PM), ozone, and other pollutants to correlate environmental data with skin health parameters 4 .
Long-term research following large groups of people with diverse environmental exposures to identify patterns in how different factors affect skin health over time 1 .
Advanced analytical platforms including genomics, proteomics, and metabolomics that provide comprehensive profiles of how exposures alter skin at the molecular level 1 .
Tools like VOS Viewer that transform complex bibliometric data into intuitive maps, revealing connections between concepts and research areas 1 .
The most exciting implication of skin exposome research lies in its potential to transform dermatology from a reactive discipline to a predictive and preventive one. By understanding how specific exposures lead to particular skin changes, we can develop personalized prevention strategies tailored to an individual's unique environmental risk profile 1 .
of chronic disease manifestations attributed to exposome factors
of chronic disease manifestations attributed to genetic factors
The emerging research indicates that exposome factors contribute up to 80% of chronic disease manifestations, while genetic factors account for only about 20% 3 . This striking statistic underscores the tremendous potential for interventions that modify environmental and lifestyle factors rather than attempting to change our genetic makeup.
The future of dermatology lies in understanding the complex interactions between our genome, microbiome, and exposome 3 . Advanced digital models are now being developed to simulate how these different elements interact, helping researchers identify key leverage points for interventions.
Our genetic blueprint
Our microbial ecosystem
Our lifetime of exposures
The complete picture of skin health
This holistic approach—sometimes called the "skin interactome"—recognizes that our needs and the factors influencing our skin health change throughout our life journey 3 . What damages or protects your skin at age 20 may be different from what affects it at 40 or 60, requiring dynamic, personalized approaches to skincare.
The skincare industry is already responding to exposome research with new product categories and formulations. Dermstore identifies the "faceification of body care" as a major 2025 trend, with active ingredients previously reserved for facial skincare now being incorporated into body products 6 . This recognizes that the skin on our body faces similar environmental assaults as facial skin.
Similarly, Allure reports a shift toward multitasking products that provide multiple benefits and simplify routines, reflecting growing consumer awareness that effective skincare must address multiple environmental factors simultaneously 7 .
The science of the skin exposome represents a fundamental shift in our relationship with our skin. We're moving from seeing skin issues as predetermined by genetics or simple aging to understanding that our skin tells the story of our lifelong interactions with our environment. This narrative is complex, nuanced, and uniquely personal.
What makes this perspective truly revolutionary isn't just the scientific insight—it's the empowerment it offers. While we can't change our genetics, we have significant control over many aspects of our exposome.
From sun protection and pollution defense to stress management and nutritional choices, we can actively shape the environmental factors that influence our skin health.
The bibliometric analysis of skin exposome research reveals a field in its adolescence—already productive but with tremendous growth potential. As scientists continue to unravel the complex interactions between our environment and our skin, we edge closer to a future where personalized, preventive dermatology can help each of us write a healthier, more radiant skin story for years to come.