Cultural competence in pediatric AD
Good communication and patient education can help reduce outcome discrepancies for pediatric patients with skin of colour (1,500 words, 7 minutes)
Communication is vital for ensuring good outcomes for children with darker skin types and atopic dermatitis (AD), said Dr. Danielle Marcoux as part of a presentation at the 9th annual Skin Spectrum Summit.
Dr. Marcoux is a Clinical Professor at the University of Montreal and Sainte-Justine University Medical Centre, Department of Pediatrics, Dermatology. She is also past president of the Canadian Dermatology Association.
Cultural competence is also important to communication, she said. Patients “might have certain beliefs or fears that a physician has to explore. And what are the patient’s expectations?”
Dr. Marcoux described a case where she had treated a child’s AD with biologics and had achieved good clearance. “I was telling the father, “Look at this skin. It is soft, it's so nice.”
The parent, however, thought the results were not nice at all, as he was concerned about persistent hyperpigmentation.
Physicians also need to partner with patient families to share the burden of disease and involve them in shared decision-making, she said. She also noted it is beneficial if a translator can be arranged if necessary, or if the physician can accommodate patients bringing a family or friend who can speak with both the physician and the patient.
Dr. Marcoux emphasized that patient and caregiver education itself is a therapeutic intervention. “It has been shown to improve the course of the disease. It promotes patient autonomy and improves patient quality of life and satisfaction with care. And it also helps to prevent complications.”
Pamphlets, Treatment Action Plans, videos, and well-designed websites are all options that can be used to support patient education, she said. She and her colleagues have recently developed a video for children with moderate to severe AD who may be being considered for treatment with biologics or systemic small molecules.
Bottom line: Communication and education are indispensable for achieving the best possible outcomes in young patients with AD with any skin type. Taking into account language barriers and cultural competence is part of a good education plan. Education should be considered a therapeutic intervention.
From the literature on atopic dermatitis in skin of colour
Burden of disease and unmet needs in the diagnosis and management of atopic dermatitis in diverse skin types in Australia
This narrative review highlights knowledge gaps for atopic dermatitis (AD) in skin of colour in Australia. Investigators searched PubMed, Wiley Online Library, and Cochrane Library databases for review articles, systematic reviews, and cross-sectional and observational studies relating to AD in Australia for skin of colour and for different ethnicities. They also collected statistical data from the Australian Institute of Health and Welfare and the Australian Bureau of Statistics.
Researchers found there has been substantially increased awareness of and research into skin infections, such as scabies and impetigo, among various Australian subpopulations in recent years. Many of these infections disproportionately affect First Nations Peoples. Data for AD itself in these groups are limited.
The investigators also found little written in the literature regarding AD in recent, racially diverse immigrants with skin of colour. They identify several areas for needed future research, including AD epidemiology and AD phenotypes for First Nations Peoples and AD trajectories for non-Caucasian immigrants.
They note the disparity in both the level of understanding and the management standards of AD between urban and remote communities in Australia related to the relative lack of healthcare resources in marginalized communities.
Atopic dermatitis in Latin America: Considerations regarding epidemiology, clinical and laboratory features, ethnic/racial variations, and therapeutic management
The authors of this paper note that Latin America encompasses about 8.5% of the world's population, and exhibits ethnic and racial heterogeneity and social inequality.
They conducted a review of 20 years of literature from 2004 to 2023) on the epidemiology, diagnosis, clinical and laboratory features, quality of life and management of atopic dermatitis (AD) in Latin America.
Researchers found the highest prevalence of AD for children aged six to seven years was reported in Ecuador (22.5%) and Colombia (20.9%), for adolescents in Colombia (24.6%) and for all ages in Brazil (20.1%).
Regions with a predominantly Black population in Latin America had significant variation in AD prevalence, ranging from 4.4% in Northern Brazil to 10.1% in Cuba, and the authors say this indicates genetic variation among African subgroups. Variants of filaggrin loss-of-function mutations usually seen in Europeans were observed in 9.3% of Chilean patients. Studies in Brazil revealed impaired expression of filaggrin and claudin-1 in the skin but increased expression in conjunctival epithelia of AD patients.
The most reported AD features included erythema, pruritus, and dry skin, with marked lichenification. Investigators report severe pruritus was reported by 54.4% of patients and a high impact on quality of life was detected in 50% of adults with AD. In Brazilian referral hospitals, 65.6% of patients were classified as having severe AD, and 56% had one or more hospitalizations during their lifetime, indicating a need for better disease control.
Racial and ethnic differences in sociodemographic, clinical, and treatment characteristics among patients with atopic dermatitis in the United States and Canada: Real-world data from the CorEvitas Atopic Dermatitis Registry
This study included adults with dermatologist- or dermatology practitioner-diagnosed AD enrolled in the CorEvitas AD Registry between July 2020 and July 2021. All patients initiated systemic therapy within 12 months prior to or at enrollment or had moderate-to-severe AD at enrollment.
Among 1,288 patients, 64% were White, 13% Black, 10% Asian, 8% Hispanic, and 6% were Other/Multiracial.
Investigators found statistically more severe EASI lichenification among Black compared with White patients at the head and neck, trunk, upper extremities, and lower extremities. Similarly, they saw statistically more severe EASI lichenification among Asian vs White patients in the head and neck, trunk, and lower extremities. and SCORing for AD lichenification.
Black and Hispanic patients had significantly higher mean pruritus over the past seven days than White patients did.
Researchers found facial erythema was significantly lower in Black patients compared to White patients.
A 1% colloidal oatmeal OTC cream is clinically effective for the management of mild to moderate atopic dermatitis in Black or African-American children
In this study, 49 Black or African American children aged two to 15 years with mild or moderate atopic dermatitis (AD) were randomized to 1% oatmeal cream or prescription barrier cream twice daily or as needed for three weeks. Researchers assessed Eczema Area and Severity Index (EASI) scores, Investigator's Global Atopic Dermatitis Assessment (IGADA) scores, and patients'/caregivers' assessment of eczema signs and symptoms.
At week three, researchers observed mean (SD) changes from baseline in EASI scores of -2.4 (1.7) with 1% oatmeal cream and -2.1 (2.3) with barrier cream. Improvements were observed from week 1. At week three, the mean (SD) changes from baseline in IGADA scores were -0.6 (0.7) and -0.7 (0.6), respectively. Researchers observed improvements in subjective ratings of the signs and symptoms of eczema, and both study treatments were well tolerated.
VIDEO: International Dermatology Education Foundation educational series: Mild to moderate atopic dermatitis in skin of colour patients
At the intersection of skin and society
Mi'kmaq law professor Naiomi Metallic said in an interview that Indigenous communities can improve their situation by revitalizing their traditional laws that have been suppressed since colonial times.
As reported by The Hamilton Spectator, Prof. Metallic, a faculty member of the Schulich School of Law at Dalhousie University in Halifax, said she’s trying to spread a positive message about Indigenous beliefs and value systems. Metallic was raised in Listuguj Mi'gmaq First Nation Quebec, just across the border from Campbellton, N.B., and is still a practising lawyer with the firm Burchell Wickwire Bryson LLP.
“We’re working with communities to help them revitalize their legal orders,” she said in advance of a lecture called Taking Back our Law that she delivered at St. Thomas University in Fredericton, N.B. on Thursday, Oct. 26, 2023. “All Indigenous people had legal orders, just like any society. Before Europeans came, for thousands of years, when you built a community together and lived together, there had to be rules, expectations and norms about how we behaved and treated each other. So there’s great work happening around the country right now, that shows there was value in those systems before they were infected by colonialism.”
The news outlet reports that Metallic and her students—part of an aboriginal law research unit at Dalhousie—have been consulting with communities in New Brunswick, Nova Scotia, and Quebec for several years about what kind of laws they could pass, in keeping with their traditions and the federal act governing them.
Metallic said there were already several good examples, such as in Neqotkuk (Tobique First Nation) in northwestern New Brunswick, where leaders have created their own laws governing child welfare in the aftermath of the violence and upheaval communities faced during the era of residential schools and the “Sixties Scoop.”
Nov. 7 is National Retinol Day in the U.S.
Nov. 8 is National Aboriginal Veterans Day in Canada
Nov. 10 is World Science Day for Peace and Development
Something to think about in the week ahead. . .
—Philip James Bailey, English poet, 1816-1902
Coverage of the 9th annual Skin Spectrum Summit continues with excerpts from a talk by Dr. Rachel Asiniwasis on psoriasis in skin of colour.
Registration is open for the 2023 Indigenous Skin Spectrum Summit. First held in 2021, the Indigenous Skin Spectrum Summit is a special session of the Skin Spectrum Summit addressing specific challenges in treating Canada’s Indigenous community. This year’s virtual meeting will be held on November 25, 2023. Register at the following link:
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