Prescribing for the Planet: Integrating Life Cycle Analyses Into Therapeutic Decision‐Making in Dermatology

Unofficial AI-generated summary based on the public title and abstract. Not an official translation.

🔬研究者:医療分野のカーボンフットプリント研究やLCA手法の標準化に示唆を与える。

🏢実務担当者:製薬企業や医療機関が環境情報開示を進める際の参考になる。

🏛政策担当者:医薬品のLCA開示義務化を検討する際の政策根拠となる。

Healthcare contributes 5% of global greenhouse gas emissions, with the supply chain and pharmaceutical manufacturing representing 80% of this footprint [1]. Adopting a circular economy model with consideration for lifecycle assessments (LCAs) of healthcare-related products could reduce greenhouse gas emissions and enhance system resilience. Given the adverse effects of climate change on cutaneous diseases, the carbon footprint of therapeutics also warrants consideration, beyond drug efficacy, safety, and cost, in clinical decision-making [2]. Providing LCAs for medications could equip healthcare providers, institutions, and guideline committees with the necessary emissions information to integrate carbon footprint data into therapeutic algorithms. Such analyses would highlight therapies with significant climate impact, informing more deliberate treatment choices to balance patient outcomes with environmental sustainability. Lifecycle assessments are systematic analyses quantifying carbon emissions of products starting at raw material extraction, through manufacturing, distribution, use, and ending with disposal. Historically, safety, efficacy, monitoring requirements, and cost have been the primary considerations of clinical trials and clinical guidelines, rarely taking carbon emissions into account [3]. Since the choice of therapy also influences the environmental impact throughout the course of disease management—and because climate change affects individual and public health—we advocate for inclusion of LCAs in decision-making frameworks as the new standard in dermatology to achieve a more sustainable provision of healthcare. Among skin diseases, atopic dermatitis (AD) has the greatest global burden and is uniquely sensitive to climate change and environmental stressors [2]. Climatic hazards, including air pollution, extreme weather events, heat, and wildfire smoke, along with their downstream impacts, are documented to exacerbate AD, so this dermatosis serves as an ideal case study [2]. With likely distinct impact profiles, assessment of the environmental implications of commonly used oral and injectable AD treatments is essential. In this context, the oral Janus kinase (JAK) inhibitors upadacitinib [4], baricitinib, and abrocitinib, as well as the subcutaneously administered biologic, dupilumab [4], have demonstrated safety and efficacy for managing moderate-to-severe AD. Yet, the carbon footprint produced by the manufacturing, distributing, and disposal of these medicines is not readily available, underscoring a missing link in our broader therapeutic decision-making. In addition to the essential considerations of safety, efficacy, and cost, incorporation of LCAs into therapeutic decisions affords a more holistic evaluation of the risks and benefits of AD management and can establish a precedent for the inclusion of environmental impacts of treatment in other climate-sensitive, chronic cutaneous diseases, such as psoriasis, hidradenitis suppurativa, and autoimmune blistering diseases. Currently, however, very few pharmaceutical companies provide publicly accessible LCAs for individual drugs. Stability requirements for biologics and oral medications differ, influencing environmental impact. Oral drugs typically involve straightforward storage and transport, necessitating minimal packaging and standard conditions. Conversely, biologics present complex logistical challenges, requiring cold chain transportation, energy-intensive temperature control, and large amounts of Styrofoam and plastic packaging to maintain medication integrity during delivery (Figure 1). Water usage is the predominant contributor to environmental impact in batch manufacturing, with biologics consuming 100 times more water than small-molecule oral drugs, accounting for >90% of the environmental footprint as measured by process mass intensity [5]. Evaluating the LCAs of injectable biologics in relation to pills offers insight into their broader climate impacts and potential downstream effects on human health. As environmental degradation and climate change are increasingly linked to the exacerbation of chronic skin diseases [2], integrating LCAs into treatment guidelines and therapeutic algorithms ensures that planetary and population health are considered alongside treatment efficacy, safety, and cost; although adverse event profiles and drug effectiveness should remain of paramount consideration in therapeutic prescribing. Therapeutic choices can create feedback loops that intensify climate-sensitive dermatoses such as AD, a disease with substantial global prevalence and high vulnerability to environmental stressors. AD severity and exacerbations are closely linked to exposure to air pollution, wildfire smoke, and elevated aeroallergen levels due to global warming [2]. Additionally, climate factors such as heat, humidity, and precipitation contribute to microbiome disruption and heightened infection risk, while both the disease itself and many therapeutics for pruritus reduce thermoregulatory capacity [2]. These environmental stressors amplify health disparities by disproportionately impacting vulnerable and marginalized populations who face greater AD disease severity and delays in diagnosis due to structural inequities [2]. Published surveys in the British Journal of Dermatology and International Journal of Dermatology have highlighted that most dermatologists are concerned about the impacts of climate change [2]. Similarly, a number of studies across medical specialties demonstrate that the majority of patients are interested in green healthcare options and sustainable treatment choices, assuming those choices do not compromise quality of care or outcomes. Consequently, the incorporation of LCAs within clinical guidelines should facilitate decision-making that prioritizes therapeutic efficacy, safety, and cost in the context of patient autonomy and shared decision-making, while also balancing climate impacts and promoting environmentally sustainable, equity-focused care to minimize healthcare's broader impact [3]. An important limitation to consider is that LCA results can vary due to differences in methodology and scope, which may lead to misinterpretation or inconsistent comparisons of dermatologic therapies. Therefore, standardization of LCAs in the pharmaceutical, medical supply, device manufacturing, and cosmeceutical industries is crucial. Additionally, a comprehensive LCA would also require accounting for the costs of laboratory monitoring, which may be higher for certain treatments, such as JAK inhibitors, due to increased patient travel, laboratory testing, and the footprint of managing adverse effects. Financial feasibility is also a challenge, as LCA implementation risks justifying drug-related price increases for already costly treatments and may lead insurers to deprioritize coverage for sustainable options due to perceived inflation in cost. However, it is important to note that conducting LCAs for a therapeutic intervention is not an ongoing cost. Rather, it is a one-time expenditure that may need to be reevaluated at specific time intervals to account for changes in supply chains, manufacturing processes, or distribution. Increased inclusion in clinical guidelines, regulatory incentives, and voluntary adoption by pharmaceutical companies to better align with their corporate environmental, social, and governance principles would collectively establish LCAs as an industry standard over time. Future research and policy should prioritize establishing standardized metrics for carbon footprint reporting and mandatory LCA disclosure, which could be accessible via digital links, manufacturers' websites, or inclusion in package inserts. Additionally, this approach should support responsible, ethical, and cost-effective integration of environmental sustainability considerations into therapeutic decisions, enabling prescribers and healthcare systems to reduce planetary harms while also prioritizing patient outcomes, promoting health equity, and improving long-term individual and population health. M.R./E.R.P. are cochairs of the American Academy of Dermatology's Expert Resource Group on Climate Change and Environmental issues; they are speaking for themselves and not on behalf of the AAD. E.R.P. receives honoraria from L'Oréal. Data sharing is not applicable to this article as no new data were created or analyzed in this study.

• openalex https://doi.org/10.1111/ijd.17929first seen 2026-08-02 17:00:38