Dermatologic challenges in circumpolar regions
Travel and communication barriers experienced by Greenland’s Inuit population (Issue #247, 1,600 words, 8 minutes)
Populations in circumpolar regions, particularly Indigenous peoples, face particular challenges in receiving dermatologic care.
This was the message of a presentation by Dr. Carsten Sauer Mikkelsen at the first-annual Indigenous Skin Spectrum Global Summit in Montreal in April 2025. Dr. Mikkelsen used Greenland as an example of some of the challenges to dermatologic care in circumpolar regions. He noted that providing healthcare in Greenland, where 89% of the population is Inuit, is complicated by the island’s size, climate, the distance between the many small and isolated settlements, the lack of roads, and limited access to hospitals. Emergency medical evacuations can also be difficult and expensive.
Dr. Mikkelsen has been a board-certified dermatologist in Denmark and Norway since 1999. He has a passion for global dermatology, an interest in minority groups, and a special interest in the Inuit culture and Arctic dermatology.
Outside of regional hospitals, physicians in Greenland are often alone and must deal with medical issues from every specialty, said Dr. Mikkelsen. Teledermatology is frequently used in Greenland; however, there can be issues with diagnosis due to the lack of dermatologists on the island, as many physicians are employed on short-term contracts from Denmark.
Patient empowerment must be supported in Greenland, especially for those with chronic dermatologic conditions, said Dr. Mikkelsen. This means helping patients gain control over their own lives and conditions and increasing their capacity to act on issues they define as important. This is challenging because most doctors do not understand the Greenlandic Inuit language or the local cultural practices.
Bottom Line: There is a lack of evidence-based medicine and data in dermato-venereology in Greenland and the Arctic and circumpolar regions. There is a lack of patient and doctor literacy, and communication is made more difficult because most doctors do not understand the Greenlandic Inuit language or the local cultural practices.
From the literature on dermatology in skin of colour
The prevalence and severity of hand eczema among adults in Tasiilaq, East Greenland
To help clarify the epidemiology and severity of hand eczema in Greenland, researchers conducted a cross-sectional study in Tasiilaq, East Greenland, in May 2022. The investigators invited adults aged 18 years or older and those from neighbouring settlements, provided they travelled to Tasiilaq. In total, 1,311 individuals were invited, 295 were accepted, and 66 were diagnosed with hand eczema. Of the participants with hand eczema, 97% were Inuit, 1.5% were mixed Inuit and Danish, and 1.5% were “other.”
The point prevalence of hand eczema was 22.4% (95% confidence interval [CI]: 18.0–27.5, n=66/295) and 5.0% based on the total invited population (n=66/1,311). The median age of participants with hand eczema was 40 years (interquartile range [IQR]: 30–54), and the median age at disease onset was 25 years ([IQR]: 19–40). Females were more frequently affected than males (65.2%, n=43/66). Atopic dermatitis was diagnosed in 7.6% of participants with hand eczema. The mean Hand Eczema Severity Index (HECSI) score was 21 (range 2–112), and exposure to wet work was reported by 57.4% of the participants with HE.
The authors conclude that hand eczema is common in East Greenland, with a point prevalence similar to that in Nordic countries. The severity and distribution of hand eczema in relation to age, sex, and occupation were comparable to those reported in other European studies.
Subtype and racial erythema variation for cutaneous lupus trials
Investigators conducted this cross-sectional study to assess variability in erythema presentation across cutaneous lupus erythematosus (CLE) subtypes and among different racial and ethnic groups, to determine whether these potential differences affect patient eligibility for erythema trials.
Researchers included 377 adult patients with CLE enrolled in the University of Pennsylvania Cutaneous Lupus Erythematosus Database from January 2007 to December 2023.
The study cohort had a mean [Standard deviation (SD); range] age of 45.2 [14.8; 18.4-88.8] years and included 305 females [80.9%] and 72 males [19.1%]; 115 Black [30.5%], 228 White [60.5%], 34 patients of other races [9.0%; Asian, multiple races, Native American/Pacific Islander, or unknown], and 11 of Hispanic/Latino ethnicity [2.9%]).
Investigators calculated mean erythema per the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI)-Activity total score divided by areas affected; then, they categorized the result as pink (1.00-1.49) or red (≥1.50) as surrogate estimates of scores per the Cutaneous Lupus Activity Investigator Global Assessment (CLA-IGA).
The most common CLE subtype was chronic CLE (CCLE), affecting 243 patients (64.5%), followed by subacute CLE (SCLE) in 103 patients (27.3%) and acute CLE (ACLE) in 31 patients (8.2%). Researchers observed significant differences in average erythema across subtypes, with a mean (SD) score of 1.62 (0.39) for SCLE and 1.78 (0.25) for hypertrophic CCLE, the only subtypes routinely classified as red. They also observed significant differences by race and ethnicity: mean (SD) erythema score in White patients was red (1.58 [0.45]) more frequently than in Black patients (1.36 [0.40]) and patients of other races (1.30 [0.39]), in whom, on average, it was scored as pink. Notably, among patients who would meet typical CLASI entry criteria (score ≥8) for clinical trials, erythema in more Black patients than in White patients was classified as pink (42% [96 patients] vs 24% [28 patients]), which suggests exclusion from trial participation when a baseline of red lesions is required.
“Given the critical need to standardize CLE trial outcome measures and increase diverse representation in clinical trials, our findings support using the CLASI as the primary scoring tool to determine erythema trial eligibility,” the authors conclude.
Systematic review of pediatric photoprotection in children of colour
This paper investigates the risks, benefits, and needs for sun protection and education in children of colour.
Researchers from the U.S. and Canada conducted an English-language systematic literature review, including data on children of colour and content relevant to photodamage and photoprotection.
The review findings showed that photoprotection is necessary for children of all skin tones who exhibit photosensitivity. Individuals with darker skin tones have more innate photoprotection than those with lighter skin tones, but both groups have incomplete photoprotection. The risks of nevus formation, skin cancer, and dyspigmentation are universal, though they vary between populations. Hispanic and Black communities are less likely to practice sun protection. Studies demonstrate a need for early, culturally appropriate education about sun exposure in all communities.
The authors conclude that photoprotection benefits all patients, and the benefits of photoprotection should be taught early to children, caregivers, and parents of all skin tones using culturally appropriate approaches.
VIDEO: Remote Reflections: Dermatologists in Action with Dr. Marni Wiseman
In this video from the Canadian Dermatology Association, Winnipeg-based dermatologist Dr. Marni Wiseman shares her experience providing care in remote and rural communities.
At the intersection of skin and society
The Assembly of First Nations (AFN) and Conference Board of Canada have released new findings highlighting the significant socio-economic benefits of closing the First Nations infrastructure gap—the difference in access to housing, education, healthcare, and connectivity between First Nations communities and the Canadian average.
The findings come from a report titled Benefits for All Canadians (Part 2): Long-term Socio-economic Impacts of Closing the Infrastructure Gap by 2030
According to a press release from the AFN, previous analyses confirmed that a federal investment of $349.2 billion to close this gap would contribute more than $635 billion to the Canadian economy and create 300,000 jobs.
“We welcome the Prime Minister’s commitment to nation-building infrastructure,” National Chief Cindy Woodhouse Nepinak said in the release. “Based on the findings in Benefits for All Canadians (Part 2), we propose that the new government begin by closing the First Nations infrastructure gap, which has perpetuated deep-rooted inequality in Canada. This blueprint not only positions Canada as a G7 leader and mitigates the impact of U.S. tariffs but also significantly improves the quality of life for First Nations people, particularly in housing, education, and clean water.”
The AFN has released three reports in collaboration with the federal government and the Conference Board of Canada over the past year. The first, released in April 2024, captured the first national investment required to close the gap at $349.2 billion. The second, released in November 2024, estimated the economic benefits over seven years to be more than $635 billion and the creation of 330,000 jobs. The new report concludes these significant financial impacts are the ‘tip of the iceberg’ regarding the multi-generational, socio-economic benefits for First Nations.
“Critical infrastructure gaps have led to poorer health outcomes, limited education opportunities, and much less prosperity for First Nations compared with non-Indigenous Canadians,” added National Chief Woodhouse Nepinak. “Later this year, we will commemorate the 10th anniversary of the historic Truth and Reconciliation Commission’s Final Report and Calls to Action. As King Charles III stated in yesterday’s [May 27, 2025] Speech from the Throne, we must honour truth and reconciliation in both word and deed. What better way for Canada to reaffirm its support for reconciliation than by making the closure of this infrastructure gap the country’s top national priority?”
The AFN will share the report with the Prime Minister and Minister of Finance this week for consideration in the fall budget. Copies will also be distributed to Ministers, Senators, and Members of Parliament from all parties for immediate action.
This week
June 4 is International Day of Innocent Children Victims of Aggression
June is Filipino Heritage Month in Canada
June is Age Without Apology Month in the U.K.
Something to think about in the week ahead . . .
—Rabindranath Tagore, (1861-1941), Indian poet.
Next week
A new study from Thomas Jefferson University in Philadelphia examines the quality of life and patient experience in Black women with alopecia.
If you enjoy Skin Spectrum Weekly, why not check out the Chronicle’s other publications, podcasts, and portals?
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:
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Drs. Ben Barankin (Toronto), Jaggi Rao (Edmonton), and Jason Rivers (Vancouver) provide an update on managing rosacea in 2025.
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