Dermatology clinics in Iqaluit
Ottawa physicians and medical students continue the legacy of Dr. Robert Jackson (Issue #232, 1,400 words, 7 minutes)
Dermatology clinics in Iqaluit operated by doctors from Ottawa are an essential way to address the skincare needs of residents and to empower local healthcare practitioners, Dr. Reetesh Bose said in a presentation at the fourth annual Indigenous Skin Spectrum Summit on Oct. 4, 2024, in Toronto.
Dr. Bose is the director of the skin of colour dermatology clinic at the Ottawa Hospital. He is a Canadian board-certified dermatologist and an active faculty member in the dermatology division at the University of Ottawa.
Dr. Robert Jackson (1926-2019), a dermatologist in Ottawa, was the driving force in establishing the post-graduate dermatology program in Ottawa and served medical clinics in Iqaluit throughout his career, said Dr. Bose. He would triage patients with severe skin conditions to see which needed to be transferred to urban centres such as Ottawa. For more than 10 years, Dr. Jackson brought medical residents to these clinics for training. He would also hold training seminars on dermatologic topics twice a year and a four-day clinical dermatology meeting in Iqaluit to empower local healthcare practitioners to recognize and treat skin conditions and use community resources.
Dr. Jackson was also the author of many books, including the textbook Morphological Diagnosis of Skin Disease, which taught students how to use morphology to reach more accurate dermatologic diagnoses and apply that knowledge to diverse skin types.
Dr. Bose said that physicians from Ottawa still provide two weeks of service each year at the general dermatology clinics at the Iqaluit hospital: one week each in January and May. A store-and-forward teledermatology system Dr. Jackson established is also still in operation.
Dr. Jacqueline Shukle currently runs the program, but Dr. Bose said it is looking to recruit younger doctors and recent graduates such as himself to ensure its future.
Dr. Bose said that attempts to increase the amount of time the clinics are open have been met with resistance from the government and a lack of available space at the clinic location. Investigations into the possibility of having additional clinics in other locations are ongoing. There is potential for a teledermatology platform.
Dr. Bose said research and educational initiatives continue to develop and progress. These include translating patient education handouts into Inuktitut and other dialects, conducting survey-based needs assessments, and developing better ways to work with Inuit communities.
Bottom Line: Dermatology clinics in Iqaluit created by Ottawa dermatologist Dr. Robert Jackson continue today with educational initiatives to help local healthcare practitioners and residents. Attempts are underway to expand clinic availability and locations, as well as to establish a teledermatology platform.
From the literature on remote and rural dermatology
Multi-methods process evaluation of the SToP (See, Treat, Prevent) trial: A cluster randomized, stepped wedge trial to support healthy skin
Noting that remote-living Australian Aboriginal children contend with disproportionally high rates of Streptococcus pyogenes (Group A streptococcus) infected impetigo, researchers conducted a large stepped-wedge cluster randomized trial of See, Treat, and Prevent (SToP) skin health activities implemented between 2019 and 2022 in the Kimberley region of Western Australia. This paper evaluates the implementation of the SToP Trial activities and the relationship between the trial methodologies and outcomes observed.
Nine Kimberley communities participated in the SToP Trial between September 2018 and November 2022. During visits at the end of Steps 1 and 2 (Oct. 2021 and Oct. 2022, respectively), 152 people, including 46 community members, 69 school staff members, 29 clinic staff members and eight other service providers, participated in a combination of individual and group interviews/yarns.
Researchers report that the SToP Trial and associated activities were completed within a culturally complex context with competing health and socioeconomic priorities while retaining specificity to each involved community. Acceptance and uptake of community activities were high, which was reflected in a marked decrease in skin infection during the trial period. However, investigators could not individually link trial activities, including increased skin surveillance, staff training, availability of study treatment, environmental health initiatives and health promotion to this improvement in skin health.
Teledermatology and virtual visits for acne management: A review
In this review, the authors describe the current state of teledermatology in the context of acne management and assess patient satisfaction, adherence to virtual care, and the experiences of healthcare providers in delivering remote dermatologic services.
To do this, they systematically searched articles in the Medline, Embase, and PubMed databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews.
After screening 1,103 articles based on title and abstract review, investigators included 21 studies.
Researchers found that teledermatology is well-suited to the effective management of acne vulgaris. Teledermatology resulted in similar outcomes on several acne-grading scales compared to in-person care. Additionally, patient satisfaction was comparable, with many patients preferring virtual care over traditional in-person visits. However, compliance was found to be lower for virtual care. The authors also note several secondary benefits to telemedicine, including time savings and greater healthcare accessibility for rural patients.
The authors conclude that teledermatology is an evolving, promising medium for acne management for clinicians and patients. They say research is warranted comparing the effectiveness of different teledermatology platforms, the limitations and pitfalls of teledermatology for acne, and integrating patient and physician preferences to improve treatment outcomes.
Macro vs micro skin imaging: Finding an affordable approach for dermatological care access in rural/remote areas
Researchers explored alternative methods for photographing skin lesions without specialized instruments, such as dermatoscopes, with the goal of enhancing remote diagnostic capabilities.
Investigators used two lenses attached to a smartphone camera, one macroscopic and the other microscopic, to study images of nevus formations from one individual. They captured the images and, without collaboration with a dermatologist, subsequently labelled the lesions as melanoma or non-melanoma using a Convolutional Neural Network (CNN). The CNN was trained with dermoscopic images of melanoma and non-melanoma formations to see which image set would perform better.
The authors found that CNN demonstrated better performance on microscopic images, with 75% of the dataset being labelled correctly, compared to the macroscopic one, with 63% of the dataset being labelled correctly. Researchers conclude that the findings highlight the potential of smartphone-based imaging with specialized microlenses to improve diagnostic accuracy for melanoma and other dermatologic conditions in remote healthcare settings.
VIDEO: 4 Tele Derm Conversations. Dr. Rachael Foster
Australian dermatologist Dr. Rachael Foster explains her interest in remote and rural dermatology and her experience delivering care to remote regions of Western Australia.
At the intersection of skin and society
Global News reports that three Canadian national Indigenous leaders say Indigenous Peoples should be at the centre of any discussions on how the country should respond to incoming U.S. president Donald Trump’s threats on tariffs and Canada’s territorial sovereignty.
On Jan. 15, 2025, National Chief Cindy Woodhouse Nepinak, Inuit Tapiriit Kanatami President Natan Obed and Métis National Council President Victoria Pruden raised this issue during a meeting with Prime Minister Justin Trudeau.
Those same leaders were not permitted to join a subsequent meeting with premiers.
“If we’re trying to unite against an external threat, the idea that provinces, territories and the federal government are the total of governance in this country is just an outdated and wrong-headed approach,” Obed said in an interview with The Canadian Press on Jan. 16, 2025. The news outlet reports that Obed noted the decision for their exclusion laid with the premiers themselves despite Trudeau advocating for their inclusion.
Among threats of severe trade tariffs and comments about Canada becoming the 51st state, Donald Trump has suggested the U.S. could purchase Greenland, which is part of the Inuit homelands.
Obed, whose organization is a member of the Inuit Circumpolar Council, which represents Inuit in Canada, Alaska, Greenland, and Russia, said Inuit have largely mobilized at times like these to support each other and that he also expects to work closely with Greenlandic and Alaskan Inuit to ensure they collaborate.
“We are ready to play as significant a role as we possibly can to articulate the positions of Canada, and ultimately, that’s where we want this story to land,” Obed said.
“From a diplomatic sense, we want to ensure that the Government of Canada is taking this threat seriously and that our interests are fully articulated and met.”
This week
Jan. 27 is International Day of Commemoration in memory of the victims of the Holocaust
Jan. 29 is National Day of Remembrance of the Québec City Mosque Attack and Action against Islamophobia in Canada
February is Raynaud's Awareness Month in the U.K.
Something to think about in the week ahead . . .
—Dwight D. Eisenhower, U.S. president (1890–1969)
Next week
Quebec city-based dermatologist Dr. Joël Claveau details the diagnosis and treatment of melasma in skin of colour.
Register now for the first Global Indigenous Skin Spectrum Summit in Montreal
Skin Spectrum Weekly readers are invited to register for the first Indigenous Skin Spectrum Global Summit, which will be held in Montreal on April 5, 2025.
The summit will allow attendees to learn more about the unique dermatologic challenges facing Indigenous populations worldwide. Experts worldwide will provide insights on how physicians can support equitable health for these populations.
Summit chair Dr. Rachel Asiniwasis (Regina) leads a world-renowned faculty that includes Dr. Rachel Pugh (Australia), Dr. Carsten Sauer Mikkelson (Denmark), Dr. Monique Mackenzie (New Zealand), Dr. Anna Chacon (Florida), Dr. Dana Slape (Australia), Dr. Carolyn Jack (Montreal), and other thought leaders.
More details on the Global Summit will appear in future editions of Skin Spectrum Weekly.
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:
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Dr. Irina Turchin (Fredericton, NB) describes findings from recent research on the safety and efficacy of topical roflumilast 0.3% in treating psoriasis.
Drs. Yuka Asai (Kingston, Ont.), Benjamin Barankin (Toronto), Fiona Lovegrove (London, Ont.), and Sam Hanna (Toronto) review some of the significant dermatologic treatment approvals of 2024.
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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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