Sustainable dermatology: Perspectives and attitudes of dermatology residents and dermatologists in India

Dear Editor,

Climate change has been increasingly implicated in exacerbating dermatologic conditions such as psoriasis, pemphigus, acne vulgaris, atopic dermatitis, and photoaging, driven by rising temperatures, pollution, and ozone depletion.¹ The concept of intergenerational equity is particularly relevant, as younger populations face escalating environmental risks. Dermatology residents, as future leaders, are well-positioned to advance sustainable practices within healthcare.

The healthcare sector contributes to environmental degradation through greenhouse gas emissions, plastic waste, and pharmaceutical pollution. In dermatology, the use of non-biodegradable materials in medical and cosmetic products threatens aquatic ecosystems and carbon sinks. Procedural waste from single-use injectables, surgical drapes, and cryotherapy canisters, as well as harmful ingredients such as oxybenzone in sunscreens and microbeads in exfoliants, further contributes to this burden.¹ Energy-intensive treatments such as lasers and phototherapy contribute to the carbon footprint. For example, a single Mohs micrographic surgery centre in the United Kingdom was estimated to produce 26 kg of CO₂ annually.²

In response, initiatives have emerged across dermatology journals, academic curricula, and clinical settings to align the specialty with environmental sustainability.^3,4 A recent survey of 148 dermatologists from the United States reported that 99.3% acknowledged climate change, with 93.9% attributing it to anthropogenic causes. Although 79.6% acknowledged its relevance to patient care, only 37.2% felt confident discussing it in clinical settings. Most respondents supported awareness initiatives targeting patients (77.2%), providers (84.6%), and policymakers (88.6%). Notably, 81.8% sought further information, reflecting a persistent “practice gap” in sustainability-related education.⁵

To assess the current status of sustainable dermatology in the Indian context, we conducted an online survey using semi-structured questions administered via Google Forms among dermatology residents and practicing dermatologists in Pondicherry. The questionnaire explored four key domains: knowledge, attitudes, current practices, and perceived barriers related to sustainable dermatology. A summary of the responses has been presented in Supplementary Table 1.

Of the 120 individuals invited, 78 completed the survey, representing a wide range of dermatology professionals. Among them, 38 were postgraduate trainees (18 final-year, 12 second-year, and eight first-year), while the remaining included 14 faculty members, six private practitioners, four working in government hospitals, three senior residents, and three from corporate hospitals.

There was overwhelming support for sustainable dermatology, with 97.4% of respondents acknowledging professional responsibility and 84.6% expressing willingness to adopt sustainable practices. However, implementation remained limited. Although 92.3% adhered to hazardous waste disposal protocols, only 2.6% reported the use of biodegradable products, and just 6.4% made efforts to reduce single-use plastics. Practical interventions, such as the provision of recycling bins, reusable instruments, and targeted sustainability education, were identified as potentially impactful.¹

The main barriers cited were inadequate knowledge (79.5%) and limited availability of eco-friendly skincare products (64.1%). Notably, 82.1% of respondents identified the lack of formal training as a key impediment, underscoring the need for structured education.

An important finding was that 82% of respondents believed patients were indifferent to sustainability, which may discourage advocacy for eco-friendly alternatives. However, a United Kingdom-based survey reported growing patient awareness, with many willing to use recyclable products and support refillable dermatologic prescriptions.⁶ This suggests that Indian patients may also be receptive to sustainable options, warranting further research and targeted education efforts.

Telemedicine presents a promising strategy to reduce patient travel-related emissions, particularly in rural settings. A study during the COVID-19 pandemic found that 1,476 teleconsultations reduced travel by 55,737 miles, resulting in a carbon savings of 15.37 metric tons.⁷ However, 95% of our respondents reported not using telemedicine with sustainability as an explicit objective, indicating an underutilised opportunity. Similarly, virtual academic conferences may significantly reduce the carbon footprint associated with travel, without compromising educational value.

Although 90% of participants supported integrating sustainability into dermatology curricula, none reported prior formal exposure to the topic. Departmental policies and limited decision-making autonomy may prevent residents from implementing sustainable practices, despite interest and motivation.

Eco-friendly skincare options are essential, and pharmaceutical companies have a key role in developing and marketing sustainable formulations. Dermatologists, in turn, must advocate for greener alternatives in clinical practice. Table 1 outlines suggested measures that may be adopted at both individual and institutional levels to foster sustainability in dermatologic practice.

This study has limitations. The sample size was relatively small, potentially affecting generalisability. The survey relied solely on dermatologist responses, and the questionnaire was not externally validated. Inclusion of perspectives from sustainability experts and patients would enhance future studies. Nonetheless, the response rate was high, aided by distribution during an academic event, and the findings provide a valuable preliminary insight into sustainable dermatology practices in India.

In summary, while Indian dermatologists demonstrate a strong interest in sustainability, significant gaps remain in knowledge and implementation. Bridging these gaps will require integration of sustainability into dermatology training, research and practice. As the specialty evolves, dermatologists are uniquely positioned to align clinical care with global sustainability goals, promoting environmental responsibility alongside high-quality patient care.