Innovative partnership promises better dermatology care for urban indigenous youth
Australian plan would help address the dermatologic needs of urban Aboriginal children (Issue #216, 1,700 words, 8 minutes)
A groundbreaking study reveals a promising solution for bridging the gap in skin health care for Aboriginal youth in urban Australia: a partnership between dermatology experts and local community organizations. This collaborative approach could be the key to unlocking better access to vital skin care services for young Indigenous Australians living in cities, addressing a longstanding health disparity.
In this study, published online ahead of print in the Australasian Journal of Dermatology (Aug. 28, 2024), researchers note that at least one dermatologic diagnosis is made in more than one-quarter of primary care consultations for urban-living Aboriginal children and young people (CYP, 0–18 years).
They write that while many of these conditions can and should be managed in primary care, there is a need for timely and culturally sensitive specialist care to support the GPs treating Aboriginal CYPs with more complex skin health needs.
To describe clinic and patient data, including disease frequencies and associations, with the goal of informing dermatology service provision and advocacy, investigators collected data from 32 clinics over 19 months. There were 335 episodes of care and a mean attendance rate of 74%.
From 78 urban-living Aboriginal CYPs attending face-to-face new patient consultations, 72 (92%) were recruited into the study, and only one had previously received a dermatologist assessment.
In this sample, eczema, tinea, or acne accounted for 47% (34/72) of referrals, and 60% of patients received their first appointment within four weeks of referral. The GP referral and dermatologist diagnosis concurred in 47 (65%) consultations. The most frequent diagnoses (primary or secondary) at first consultation were atopic dermatitis (26%, 19/72), dermatophyte infections (25%, 18/72), acne (21%, 15/72), bacterial skin infections (18%, 13/72), and post-inflammatory dyspigmentation (18%, 13/72). Three categories of the 2022 Australasian College of Dermatologists (ACD) curriculum (infections, eczema/dermatitis, pigmentary disorders) accounted for 59% of all diagnoses.
The researchers suggest that integrating dermatology clinics with primary care within ACCHO (Aboriginal Community Controlled Health Organisation) settings can improve timely access and attendance. They emphasize the persistent demand for dermatological services, evidenced by a 250% rise in diagnoses during initial consultations. This increase has enabled the provision of knowledge and treatment to children and young people (CYP), with only 1% having previously consulted a dermatologist and one-third receiving their first precise diagnosis and treatment plan. Notably, three categories from the 2022 ACD curriculum— infections, eczema/dermatitis, and pigmentary disorders—comprise nearly 60% of all diagnoses, underscoring the need for dermatology trainees to develop expertise in these areas for effective clinical care and health advocacy.
From the literature on dermatology in skin of colour
Decreased treatment of acne among adolescents in skin of colour populations: An examination through the perspective of the National College Health Assessment
This study assessed acne care among young adults of different demographics in the U.S., especially in skin of colour populations.
Using data from the U.S. National College Health Assessment, investigators reviewed 195,965 American College Health Association survey responses from 2019 to 2021 to analyze acne trends. They excluded incomplete questionnaires for the isolated questions from the analysis. The investigators then stratified the questionnaire results by demographics and conducted descriptive statistics to compare results.
In total, 53,788 (27.4%) respondents indicated they had ever been diagnosed with acne by a health care professional. Of those diagnosed with acne, 21,119 (39.4%) of respondents sought care for their acne in the past 12 months; of those that sought care in the past year, 18,583 (87.9%) of these respondents received treatment for their acne.
Participants identifying as White had the highest proportion of their population ever being diagnosed with acne (30.2%), while Black or African American respondents had the lowest rates (20.4%). Middle Eastern/North African and Black/African American respondents had the highest rates for their population to seek care after receiving a diagnosis (40.6% and 40.1%, respectively). White respondents had a >10% higher treatment rate in the past year compared to other non-White respondents, with Native Hawaiian/Pacific Islander and biracial/multiracial groups having the lowest rates.
The authors write the high rates of initial diagnosis but a low rate of treatment follow-up for acne among non-White populations may be attributed to access to dermatologic care, patient knowledge of available treatment, cost of treatments, or physician knowledge of treating acne in these populations.
Atopic dermatitis in Ethiopian children: A multicenter study of clinical severity, characteristics, and sociodemographic factors
This hospital-based, cross-sectional study included 461 children diagnosed with atopic dermatitis (AD) and their caregivers in four selected Southern Ethiopia hospitals from Oct. 2022 to Sept. 2023. Investigators used a systematic sampling technique to enroll study participants.
Of the 461 AD-diagnosed children, 212 (46%) were girls and 249 (54%) were boys. In the sample of pediatric patients, 149 (32.3%) exhibited mild AD, 231 (46.2%) presented with moderate, and 99 (21.5%) showed signs and symptoms of severe AD. All patients had itching. The AD signs the researchers most often observed were skin dryness, excoriation, and erythema, followed by lichenification. Statistical analysis showed age onset of the disease [AOR 95% CI 1.95 (1.3-2.94)], sex of caregiver or family [AOR 95% CI 0.61 (0.41-0.90)], family atopy history [AOR 95% CI 0.64 (0.44-0.93)], mother education status [95% CI 2.45 (1.1-5.47)], and use of herbal medication [AOR 95% CI 0.50 (0.33-0.79)] were significantly associated with the severity of AD.
Metabolic comorbidities in pediatric psoriasis: A comparative cross-sectional study in South-Asian children
Researchers conducted a hospital-based, comparative, cross-sectional study to examine metabolic comorbidities among South Asian children older than 19 months with and without psoriasis.
The investigators collected anthropometric, clinical, and metabolic comorbidity details, including disease extent and severity scores, obesity, systemic hypertension, diabetes mellitus, lipid abnormalities, and metabolic syndrome.
In total, the researchers recruited 58 children with psoriasis (25 males/33 females, age 11.3±3.0 years, range 4 to 17 years) and 62 children without psoriasis (37 males/25 females, age 11.0±3.6 years, range 4 to 18 years).
The study findings showed the prevalence of obesity (31.0% versus 14.5%, p=0.031, odds ratio 2.65) and metabolic syndrome (18.6% versus 4.6%, p=0.044, odds ratio 4.68) were higher in children with psoriasis than without. The prevalence of other metabolic comorbidities (systemic hypertension, pre-diabetes, lipid abnormalities, elevated serum alanine aminotransferase, and non-alcoholic fatty liver disease) was not different between children with and without psoriasis and between obese and non-obese children with psoriasis. Among children with psoriasis, those with abdominal obesity had significantly lower disease severity and extent scores than those without.
The authors conclude that screening for metabolic comorbidities is essential even in non-obese children with psoriasis. Disease extent and severity are less in obese compared to non-obese South Asian children with psoriasis.
PODCAST: GPnotebook episode 64: Primary care dermatology: skin of colour
In this episode of the GPnotebook podcast, Dr. James Waldron (Nottingham, U.K.) and Dr. Thuva Amuthan (GP with an Extended Role in Dermatology, Birmingham, U.K.) explore dermatological presentations, treatments and complications in skin of colour patients.
At the intersection of skin and society
On Sept. 26, 2024, the Rideau Hall Foundation (RHF), in collaboration with Canadian Geographic, released a feature story focusing on three Canadian Indigenous educators who discuss why Indigenous teacher education programs are crucial to transforming Canada's education landscape.
The article is available online in 10 Indigenous languages, English and French. It was also published in the September/October print edition of Canadian Geographic.
According to a press release, the languages used for this project represent geographically diverse First Nations, Métis, and Inuit communities. Some are high-usage languages selected for accessibility, while others were chosen to instill hope for their survival and inspire language revitalization.
“Having an Indigenous teacher in the classroom benefits all students. The sharing of our stories and experiences within the education system is a true testament to the resilience of Indigenous people and the importance of creating more culturally inclusive learning environments,” said Rachel Mishenene, RHF's Director of the Indigenous Teacher Education Initiative. “Representation is crucial for students to feel empowered in their identities and what dream they want to pursue in education.”
This article celebrates the legacy of Indigenous Teacher Education programs and aims to raise awareness of their impact and the importance of having Indigenous teachers in the classroom. By highlighting these programs, the hope is that it will inspire more First Nations, Inuit, and Métis youth to choose teaching as a career.
Last chance to register for the 2024 Indigenous Skin Spectrum Summit and the 10th annual Skin Spectrum Summit
Join your colleagues at the Art Gallery of Ontario this Friday, Oct. 4, and Saturday, Oct. 5, for this pair of landmark educational congresses of healthcare professionals dedicated to providing better dermatologic care for Canada's diverse population.
The Skin Spectrum Summit is a full-day event providing education on treating patients across all six Fitzpatrick skin types, emphasizing care for Types IV to VI.
The Indigenous Skin Spectrum Summit is a half-day event dedicated to improving the cultural competence of Canadian healthcare providers and giving practical advice on providing dermatologic care to Indigenous patients.
Some of the world-class faculty for this year’s events include:
Dr. Rachel Asiniwasis (Regina): Founder of Origins Dermatology Centre, a combined multidisciplinary model that services both the general population and provides outreach clinics (in-person and virtual care) for underserviced remote and rural Indigenous (First Nations and Metis) communities.
Dr. Andrew Alexis (New York): Professor of Clinical Dermatology and Vice-Chair for Diversity and Inclusion at Weill Cornell Medicine in New York City. He is the former Chair of the Department of Dermatology at Mount Sinai Morningside and Mount Sinai West.
Dr. Reetesh Bose (Ottawa): Director of the Skin of Colour dermatology clinic at the Ottawa Hospital.
Dr. Renée A. Beach (Toronto): A dermatologist practicing medical and cosmetic dermatology, she enjoys treating a range of skin conditions and the therapeutic challenge of effectively treating the same condition in different skin types.
Dr. Anna Chacon (Miami): Dr. Chacon is the only dermatologist serving the secluded Alaskan Bush region, often travelling by bush plane for patient care. She also provides vital dermatology services to Indigenous tribes across Florida, Alaska, and California and offers teledermatology services. She also founded Indigenous Dermatology, a nonprofit focusing on dermatologic health in rural and tribal areas.
Dr. Carolyn Jack (Montreal): Founder of the McGill University Hospital Network Center of Excellence for Atopic Dermatitis, Canada's first tertiary care centre dedicated to adult atopic dermatitis.
This week
Sept. 30 is National Day for Truth and Reconciliation in Canada
Oct. 1 is Urticaria Day
Oct. 1 to 7 is HPV Prevention Week in Canada
Something to think about in the week ahead . . .
—Johann Wolfgang von Goethe, German writer (1749-1832)
Next week
At the Colloquium on the Black Patient in Dermatology in August, Dr. Monica Li discussed differences in colour and itch in atopic dermatitis among skin types.
If you value Skin Spectrum Weekly, why not check out Chronicle’s other publications, podcasts, and portal?
The Chronicle of Cosmetic Medicine + Surgery is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Dr. Geeta Yadav (Toronto) advises on managing melasma using fractionated lasers.
Drs. Andrei Metelitsa (Calgary), Lisa Kellett (Toronto), and Vince Bertucci (Woodbridge, Ont.) review new and upcoming soft tissue filler products that may benefit Canadian practitioners.
Dr. Zaki Taher (Edmonton) shares his thoughts on the importance of lasers, radiofrequency microneedling, and platelet-rich plasma treatments in a cosmetic dermatology practice.
Plus, regular features, including the popular “Cosmetic Update,” which provides a rapid overview of important news in the cosmetic space.
You can read a recent digital edition of The Chronicle of Cosmetic Medicine + Surgery here. To apply for a complimentary subscription or to request a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates readers with new findings concerning dermatologic issues affecting 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 vitamin D influences psoriasis severity, sex differences in psoriatic inflammation itch, and the risk of psychiatric disorders associated with acitretin.
And if you’re looking for a web destination for all things derm, visit derm.city, “Where Dermatology Lives.” Please like, rate, review, and share it with your colleagues.