Atopic dermatitis in Indigenous children
Pediatric atopic dermatitis common in children, more severe and under-managed in Canada’s Indigenous communities (1,400 words, 7 minutes)
Nearly 1.3 million Canadian children have been diagnosed with atopic dermatitis, with a third of that cohort facing moderate to severe cases, according to Dr. Danielle Marcoux. Yet, for many, particularly those in remote Indigenous communities or immigrant families, accessing proper care remains a frustrating hurdle. Dr. Marcoux, a Montreal pediatric dermatologist, presented these concerning findings at the recent Skin Spectrum Summit, raising concern about disparities in eczema treatment across Canada.
Dr. Marcoux is an associate professor in the Department of Pediatrics at the University of Montreal and a dermatologist at CHU Sainte-Justine.
The population of Canada in 2023 is close to 40 million, and about 6.4 million, or more than 16%, of those residents are under 15 years of age, said Dr. Marcoux. That percentage is even higher in Nunavut, northern Saskatchewan and Alberta, and Newfoundland & Labrador. This population growth is largely due to immigration and an increased birth rate among Indigenous peoples. She noted that at least 22% of the population have skin of colour, 24% are first-generation Canadian, and 21% have a first language other than English or French.
Indigenous children tend to have more severe AD than their non-Indigenous counterparts, and the areas affected by AD are often infected, Dr. Marcoux said. In her hospital, patients from Nunavut with AD are often hospitalized because of the distance they must travel for care and the severity of their condition.
According to PEDISTAD, an ongoing international study begun in 2018, comorbidities were present in two-thirds of pediatric AD patients, said Dr. Marcoux. More than half were not adequately treated, and most children had severe itch on multiple days of the week. There was also a heavy impact on the families of children with moderate to severe AD, with emotional stress and a fear of expenses, she said.
Bottom line: There is a high number of Indigenous children with AD in Canada. These children often have more severe disease and less access to proper care. Pediatric patients with AD frequently have comorbidities and are often not adequately treated.
From the literature on atopic dermatitis
Rural and urban exposures shape early life immune development in South African children with atopic dermatitis and nonallergic children
To explore the impact of environmental exposures on early immune development, researchers performed RNA-Seq on peripheral blood mononuclear cells (PBMCs) from 150 children with atopic dermatitis (AD) and healthy nonallergic children. The children came from rural and urban settings from the same ethnolinguistic AmaXhosa background in South Africa. Investigators also measured environmental exposures using questionnaires.
The authors observed a distinct PBMC gene expression pattern in children with AD. However, the predominant influences on the immune cell transcriptome were related to early life exposures including animals, time outdoors, and types of cooking and heating fuels. Sample clustering revealed two rural groups (Rural_1 and Rural_2) that separated from the urban group. The most significantly regulated pathways in Rural_1 children were related to innate activation of the immune system (e.g., TLR and cytokine signalling), changes in lymphocyte polarization (e.g., TH17 cells), and immune cell metabolism (i.e., oxidative phosphorylation). The Rural_2 group displayed evidence for ongoing lymphocyte activation (e.g., T cell receptor signalling), with changes in immune cell survival and proliferation (e.g., mTOR signalling, insulin signalling).
Lower socioeconomic status may help explain racial disparities in asthma and atopic dermatitis prevalence: A mediation analysis
Investigators sought to identify racial disparities in childhood atopic disease prevalence and determine what proportion of those disparities is mediated by socioeconomic status.
To do this, researchers used data from the U.S. National Health Interview Survey (2011-2018) to investigate atopic dermatitis (AD), asthma, and respiratory allergy prevalence in Black and White children and the extent to which measures of socioeconomic status explain any identified disparities.
They identified prevalences by race: AD, White 11.8% (95% CI: 11.4%, 12.2%) and Black 17.4% (95% CI: 16.6%, 18.3%); asthma prevalence, White 7.4% (95% CI: 7.0%, 7.7%) and Black 14.3% (95% CI: 13.5%, 15.0%); respiratory allergy, White 11.4% (95% CI: 11.0%, 11.9%) and Black 10.9% (95% CI: 10.3%, 11.6%).
The percentage of the disparity between racial groups and disease prevalence explained by a multivariable measure of socioeconomic status was 25% (95% CI: 15%, 36%) for Black versus White children with AD and 47% (95% CI: 40%, 54%) for Black versus White children with asthma.
Solving the health disparity of eczema assessment: A role for skin tape soluble protein?
The authors of this paper note the difficulty of perceiving erythema in Black patients with atopic dermatitis (AD) has led to an underestimation of AD severity in these patients.
To see if skin tape soluble protein might be a useful diagnostic marker, researchers compared the concentration of this protein collected from AD lesions against common clinical signs of AD.
Researchers included 50 children with AD in this study. They extracted skin tape total soluble protein was AD lesions and analyzed it against validated AD clinical signs, including erythema, excoriation, edema, oozing, and lichenification.
The results showed the concentration of skin tape soluble protein was positively correlated with acute signs of AD, especially erythema. Researchers conclude that determining the concentration of skin tape protein is a potential tool for grading the erythema of AD lesions, potentially improving the health disparity of eczema severity assessment in Black patients.
The impact of phototherapy on itch intensity and itch-related quality of life amongst different skin diseases, skin phototypes and genders—A prospective study with 102 patients
In this prospective, single-center study, researchers analyzed the effect of phototherapy on itch intensity and itch-related quality of life among patients with different skin diseases, skin phototypes and genders after a treatment duration of four weeks. All patients were allowed on-demand treatment with topical corticosteroids, topical calcineurin inhibitors, or antihistamines.
Of 102 patients (age 53.0±18.7, 56 females [54.9%]), 72 (78.3%) reported a significant reduction of itch intensity—a change of -2.76 on a 0-10 Numerical Rating Scale (NRS), p=<0.001, 95% CI [2.2; 3.3]. This reduction of itch intensity was paralleled by a significant improvement in itch-related quality of life as measured by the German version of the ItchyQoL, a change of 7.3, p=<0.001, 95% CI [4.4; 11.6].
The best improvement of itch intensity and itch-related QoL was reported by patients with pruritus on non-diseased skin (-3.5 on the NRS; 9.7 Ger-ItchyQoL points), followed by patients with atopic dermatitis and psoriasis. The investigators found no statistical differences in the response to phototherapy among Fitzpatrick phototypes I-VI. Women had higher itch intensities at baseline but itch-related quality of life impairment at baseline and phototherapy treatment response did not significantly differ between genders.
VIDEO: Doctor explains what eczema looks like on Black skin—plus photos, diagnosis, and treatment
James O’Donovan, PhD, MBBS, describes the appearance of atopic dermatitis on Black skin, including photographic examples to assist with the recognition of the common skin condition.
At the intersection of skin and society
On Feb. 5, 2024, CBC/Radio-Canada unveiled its first-ever National Indigenous Strategy, titled “Strengthening Relations, Walking Together.” The public broadcaster also announced the creation of a new Indigenous Office.
The announcement took place at the Canadian Museum for Human Rights in Winnipeg, located on Treaty 1 Territory, on the National Homeland of the Red River Métis and home to many Inuit.
According to a press release, Strengthening Relations, Walking Together is the public broadcaster’s three-year plan to work with First Nations, Inuit, and Métis to better reflect and serve them. The plan creates a framework to actively engage in four key areas:
Narratives: The broadcaster will ground principles of the Truth and Reconciliation Commission in the stories and content development processes.
People: CBC/Radio Canada will increase Indigenous representation at all levels of the organization.
Relationships: The organization will cultivate good relations with Indigenous Peoples.
Truth and Reconciliation: The national broadcaster will take meaningful actions toward reconciliation.
“Strengthening Relations, Walking Together honours the rich and diverse perspectives of First Nations, Inuit, and Métis and reaffirms the national public broadcaster’s commitment to strengthening relationships across this vast land and advancing Truth and Reconciliation,” said Catherine Tait, President and CEO of CBC/Radio-Canada, in the release. “This strategy provides an important framework to measure our commitment to amplifying the voices of Indigenous creators and communities, as well as our own employees and leaders at CBC/Radio-Canada. While the public broadcaster cannot right the wrongs of the past, this strategy provides us a roadmap for greater learning, collaboration, and understanding for the future.”
More details of the new strategy are available in the press release.
This week
Feb. 12 to 16 is Sexual Health Week
Feb. 12 is International Day for the Prevention of Violent Extremism as and When Conducive to Terrorism
Feb. 15 is International Childhood Cancer Day
Something to think about in the week ahead. . .
—Hans Hofmann, German artist (1880 to 1966).
Next week
Skin Spectrum Weekly will return on Feb. 26 with coverage of a recent study into racial bias in photography-based dermatologic diagnosis.
Next Monday (Feb. 19), is Family Day in many Canadian provinces, so we’ll take the opportunity to go tobogganing with the kids.
If you like Skin Spectrum Weekly, why not check out Chronicle’s other publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Drs. Lauren Lam (Calgary), Sam Hanna (Toronto), Benjamin Barankin (Toronto), and Renée A. Beach, (Toronto) discuss many of the new therapeutic options that arrived in 2023.
Dr. Andrew F. Alexis (New York) details pigmentary disorders in patients with skin of colour.
An essay from Dr. Sheila Wang (Montreal) submitted to the 2022 Dermatology Industry Taskforce on Inclusion, Diversity and Equity (DiTiDE) short essay contest. Dr. Wang wrote about the development of new imaging technology to detect and assess ‘beneath-the-skin’ inflammation, perfusion, and tissue oxygenation in any skin phototype.
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Read a recent digital edition of The Chronicle of Skin & Allergy here. To apply for a complimentary* subscription or to receive a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates new findings concerning dermatologic issues that affect women and the female dermatologists who care for them. Read the current issue here.
Season three of the Vender on Psoriasis podcast with Dr. Ron Vender has begun. Listen to the new season here. In episode five, Dr. Vender discusses whether or not vitamin D has any impact on psoriasis severity, sex differences in psoriatic inflammation itch, and the risk of psychiatric disorders associated with acitretin.
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