Breaking silence: New findings on native populations' overlooked skin health crisis
Acne, xerosis, hair loss, atopic dermatitis most common skin challenges for American Indian/Alaskan Natives (1,600 words, 8 minutes)
In the U.S., Indigenous people are 77% more likely to experience distress due to a skin condition than non-Hispanic White people, according to a presentation by Katie Wilson at the 4th annual Indigenous Skin Spectrum Summit on Oct. 4, 2024.
Wilson is a Luiseño/Payómkawichum third-year medical student at the University of Minnesota and recently completed a post-sophomore fellowship in pathology at the university's Department of Laboratory Medicine and Pathology. She serves as vice-chair of the American Medical Association’s Committee for American Indian Affairs and was recently selected as a Udall Foundation Native American graduate fellow in tribal policy.
In her presentation, Wilson reviewed several recent studies highlighting skin health among Indigenous people in the U.S.
Some of the findings she highlighted include:
Indigenous people have a more significant proportion of untreated skin disease, which can lead to decreased quality of life, disturbed sleep, learning difficulties, mood disorders, and school absenteeism
The most frequently reported skin conditions in American Indian/Alaskan Native (AI/AN) communities include acne with resultant scarring, xerosis, hair loss, and atopic dermatitis
Atopic dermatitis (AD) is three times as prevalent in the AI/AN population compared to the rest of the U.S. population
Factors contributing to high AD rates include dry climates, drought, lack of access to running water on reservations, overcrowding, and older housing
Rates of melanoma among AI/AN populations are much higher than previously thought (10.7 per 100,000 vs. previously estimated incidence rates of 4.5 to 5.5 per 100,000)
AI/AN patients have the second-highest rate of melanoma after non-Hispanic White patients
AI/AN individuals engage less frequently in sun-protective behaviours, such as seeking shade, wearing a hat, or using sunscreen. Those populations also regularly engage in indoor tanning and are more likely to burn. Skin cancer prevention efforts in AI/AN populations are insufficient, given the increased risk of melanoma
Although the rates of acne among AI/AN populations are similar to those recorded among other racial groups, the rate of scarring is higher
Because of food deserts on reservations, AI/AN populations are also likely to have a high glycemic index diet, which can make acne more severe and contribute to metabolic syndrome or the development of alopecia
AI/AN populations have limited access to dermatologic care, including telehealth programs
There is a vast disparity in health spending between AI/AN populations and the general population, with Indian Health Services (HIS) spending US$4,100 per user each year compared to the national expenditure of US$10,680 per user
The Purchase and Referred Care (PRC) program—which allows patients to leave IHS to seek specialist care— is also profoundly underfunded. PRC is also restricted by priority levels, meaning dermatology treatment is less likely to be covered
Those identifying as AI/AN only account for 0.2% of dermatologists in the U.S. compared to 67% identifying as White. There are fewer than ten physicians who are Native Hawaiian
Bottom line: In the U.S., Indigenous people are significantly more likely to experience distress due to a skin condition than non-Hispanic White people. They also more frequently have untreated skin disease. The most commonly reported skin conditions in AI/AN communities include acne with resultant scarring, dry skin, hair loss, and eczema. Melanoma is also more likely in this population than in non-Hispanic White individuals. There are wide disparities in health spending and representation in the medical profession for AI/AN populations compared to White populations.
From the literature on dermatology in skin of colour
Representation of diverse skin tones in Nelson's Textbook of Pediatrics
Investigators evaluated whether figures depicting cutaneous disease in a widely used pediatrics textbook reflect diverse skin tones.
Using the Fitzpatrick, Massey-Martin, and Colour Bar scales, researchers assessed figures depicting dermatologic findings in Nelson's Textbook of Pediatrics. They compared the distribution to the U.S. population using American National Election Survey 2012 data. Investigators also compared the three scales for concordance.
Of 515 figures, 484 were classifiable. Light skin tones were depicted in 453 (93.6%) by Fitzpatrick, 364 (75.2%) by Massey-Martin, and 406 (83.9%) by Color Bar, moderate tones in 92 (19.0%) by Massey-Martin and 53 (11.0%) by Color Bar, and dark tones in 31 (6.4%) by Fitzpatrick, 28 (5.8%) by Massey-Martin, and 25 (5.2%) by Color Bar. The textbook skin tone distribution did not reflect the U.S. population. The three scales yielded consistent proportions for light/moderate vs. dark tones (p=0.71). Certain conditions mainly were depicted on dark (burns, leprosy, urticaria pigmentosa) or light skin (psoriasis, acne, hemangioma, molluscum, herpes, keloid).
Skin cancer risk across racial/ethnic groups among solid organ transplant recipients in the U.S., 2000-2022
Solid organ transplant recipients (SOTRs) are at increased risk for developing skin cancer.
Investigators sought to characterize further the risk of keratinocyte carcinoma and melanoma among solid organ transplant recipients (SOTRs) stratified across six racial/ethnic groups using a U.S. nationwide transplant database.
They included data on 696,076 SOTRs (38% female, 38% non-White) between Jan. 1, 2000 and Sept. 30, 2022. Data were obtained from the United Network for Organ Sharing (UNOS) database.
The authors compared rates of post-transplant squamous cell carcinoma [SCC], basal cell carcinoma [BCC], and melanoma among six self-reported racial/ethnic groups through unadjusted incidence rates (IR) per 100,000 person-years and hazard ratios (HR) after adjustment for age, sex, type of transplant, and prior history of skin cancer.
Overall, they found non-White SOTRs had a significantly lower risk of SCC, BCC, and melanoma compared to Whites. The authors note their findings are comparable to prior studies but provide more granular detail on risk across racial/ethnic groups. “Our findings of lower melanoma risk for non-White SOTRs align with previously published literature,” they reported.
The investigators say their findings support the need for the evaluation of the impact of current race-specific screening recommendations on the morbidity and mortality of non-White SOTRs.
Multiple aggregated yellow-white globules: a basal cell carcinoma dermoscopic feature in skin of colour
This study's focus was on clarifying the dermoscopic features of pigmented basal cell carcinomas (BCCs) in Moroccan patients, particularly multiple aggregated yellow-white (MAY) globules, and correlated them with the degree of pigmentation and the BCC subtype.
Researchers evaluated clinical and dermoscopic images of histopathologically confirmed BCCs collected at the Dermatology Department of the Ibn Sina University Hospital in Rabat, Morocco, for 24 months. This included 120 BCCs in 92 patients (57 men, 35 women, mean age 59±14.55 years). The predominant Fitzpatrick skin phototype was phototype IV (39 patients). There were 76 nodular BCCs (63%), 35 superficial BCCs (29%), seven infiltrating BCCs (6%), and two morpheaform BCCs (2%). All the BCCs included in this study were pigmented, and 79 (65.8%) were heavily pigmented, with a pigmentation involving more than 75% of the lesion. Some 43 (35.8%) BCCs were located in the nasofrontal zone and 34 (28.3%) in the peri-orbital area. The most frequent dermoscopic criterion was arborizing vessels found in 95 of the cases (79.2%), followed by grey-blue ovoid nests, ulcerations/erosions, and shiny white structures found in 63.3%, 57.6%, and 33.3% of the cases respectively. MAY globules were found in 11 BCCs (9.2%). They were present in nine (12%) of the nodular BCCs and two (5.9%) of the superficial subtype. Investigators did not find this dermoscopic criterion in infiltrating or morphea form subtypes and noted no association with any specific anatomical site or degree of pigmentation.
The authors conclude that MAY globules are also a dermoscopic feature in pigmented BCCs among patients in a dark-skinned population and low-risk BCC subtypes, not only in high-risk subtypes as described elsewhere in the literature.
At the intersection of skin and society
A new report highlights the contributions of Black music in Canada and the barriers Black artists and professionals face in the industry, as reported by an entertainment industry news source, Billboard.
The “Industry Analysis & The Value of Black Music” report was undertaken by ADVANCE Canada’s Black Music Business Collective and the Ted Rogers School of Management's Diversity Institute at Toronto Metropolitan University (TMU). It is co-written by Dr. Charlie Wall-Andrews, Dr. Wendy Cukier, and Dr. Mohamed Elmi of TMU.
“This report came after many conversations that referenced obvious dichotomy between the impact of Black music in Canada and the number of Black people working within the music industry,” ADVANCE Executive Director Keziah Myers told the news outlet.
For the report, researchers surveyed 1,702 respondents about their experiences as Black artists and professionals in the Canadian music industry.
Some findings in the report include:
Black music has accounted for a majority of streams (65%) of the top Canadian charts on Apple Music and Spotify between 2019 and 2022
Subscription streaming's value in 2022 was $521.79 million, of which Black music represents $339.16 million
The most frequent survey response to a question on what is needed to succeed in the industry was access to funding
Financial instability was identified as the number one barrier to entering the industry
Nearly half (47.5%) of respondents who run their own business reported receiving no assistance in funding their business
98.4% of respondents said they had never applied for public or private grant funding
Applications to Black music genres have frequently been less successful at receiving support compared to other genres. Hip-hop, in the five years examined (2017-2022), had a consistently lower funding approval rate for applications than the overall average
55.3% of respondents report experiencing discrimination based on ethnicity in the industry, while 54.7% report discrimination based on race
42.1% responded that they were often the only person of their race or skin colour in a work environment
Respondents reported high rates of a sense of belonging in the industry, and a substantial majority (60.5%) felt that the music business is prioritizing diversity and inclusion
The full report can be read here:
This week
December is Universal Human Rights Month
Dec. 2 is International Day for the Abolition of Slavery
Dec. 3 is International Day of Persons with Disabilities
Something to think about in the week ahead . . .
—Christian Nestell Bovee, U.S. author (1820 – 1904)
Next week
A new study assesses the efficacy and safety of risankizumab in diverse racial and ethnic patient populations with moderate-to-severe psoriasis.
If you enjoy Skin Spectrum Weekly, why not check out the 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:
Dr. Jennifer Beecker (Ottawa) discusses the treatment of alopecia areata, including a range of therapies recently approved in Canada.
Dr. Cathryn Sibbald (Toronto) reviews the treatment of atopic dermatitis in children, with particular attention to the biologics and other systemic agents approved in Canada for use in young patients.
Drs. Jenn Tran (Toronto), Jennifer Lipson (Ottawa), Jessica Asgarpour (Toronto), and Maxwell Sauder (Toronto) provide an overview of essential news in acne therapy, including a new topical hormonal therapy and new combination treatments.
Plus regular features, including the popular column “Vender on Psoriasis” by dermatologist Dr. Ron Vender.
You can read a recent digital edition of The Chronicle of Skin & Allergy 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.
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