Indigenous children face skin health challenges
National physician survey identifies most common skin diseases, barriers to care, and possible corrective steps (1,500 words, 7 minutes)
The most reported skin conditions among children in remote Indigenous communities are atopic dermatitis (AD), bacterial skin infections, and diabetic skin disease, noted Dr. Rachel Asiniwasis during a presentation at the 4th annual Indigenous Skin Spectrum Summit. These are just some dermatologic challenges facing this population.
Dr. Asiniwasis is a dermatologist and clinician researcher based in Regina. She founded Origins Dermatology Centre, a combined multidisciplinary model that serves the general population and provides outreach clinics for under-serviced remote and rural Indigenous communities. She is of Plains Cree, Saulteaux, and English background.
In her presentation, Dr. Asiniwasis detailed the findings of a national survey of 50 healthcare practitioners, primarily dermatologists, who deliver care in person or remotely to remote northern Indigenous communities.
The most reported skin condition among children was AD, second was bacterial skin infections, and third was diabetic skin disease. Most of these conditions were reported as poorly or only partially controlled and moderate to severe. Other prevalent conditions included hidradenitis suppurativa (HS), infestations such as scabies or lice, autoimmune conditions, psoriasis and other conditions such as acne, rosacea, and photodermatoses.
Other barriers to effective dermatologic care the survey identified include:
Poor access to dermatologic specialty care, including transportation costs and availability in rural and remote areas
Poor access to skin care products, including both availability and cost
Patients and caregivers find skin care instructions overwhelming
Cultural barriers to care-seeking and communication
Poor access to clean water and other sanitary needs
Some of the suggestions from the national survey of healthcare practitioners for addressing these issues included increasing the presence of dermatologists in remote communities, growing educational programs, having an employee or nurse supporting a physician to coordinate care, and increasing virtual care and cultural competence educational programs.
Bottom line: AD, bacterial skin infections, and skin complications from diabetes are the most common skin issues faced by Indigenous children in Canada. Addressing the challenges facing patients in remote and rural communities and improving communication resources are necessary to improve outcomes in these populations.
From the literature on dermatology in skin of colour
Racial and ethnic differences in healthcare access and utilization among U.S. adults with melanoma and keratinocyte carcinomas in the NIH All of Us Research Program
To gather data on racial and ethnic disparities relating to barriers to care in healthcare access and utilization in patients with cutaneous malignancies, researchers conducted a cross-sectional analysis of adults with melanoma, basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (cSCC) in the U.S. National Institutes of Health (NIH) All of Us Research Program.
They assessed data collected between May 2018 and July 2022 on adults aged 18 years or older with cutaneous malignancy who completed the Health Care Access and Utilization survey.
Among the 5,817 adults included, 67% were diagnosed with BCC, 28.9% with cSCC, and 23.9% with melanoma. Non-Hispanic Black (NHB) and Hispanic patients were more likely than non-Hispanic White (NHW) patients to delay a primary care visit due to cost (p=0.005 and p=0.015, respectively). NHB patients were also more likely to delay care due to lack of transportation (p<0.001). NHB and Hispanic patients were more likely to place importance on seeing a provider from the same background (NHB p<0.002; Hispanic p=0.002) and also were more likely to report never being able to see such a provider (NHB p<0.001; Hispanic p=0.002). Medicaid/Medicare patients, non-college graduates, and those with lower incomes also faced increased barriers to care, including delays due to cost and transportation issues.
Patient perspectives toward skin of colour clinics: results from a survey study
Researchers at the University of Michigan surveyed patients with skin of colour previously seen at the school’s dermatology department to assess their opinions toward skin of colour clinics (SOCC) that provide specialized care for patients with melanated skin.
For this study, investigators emailed a 14-question survey to patients of colour seen at a single institution between Jan. 1, 2015, and Dec. 31, 2021.
Out of 264 participants who completed the survey, 176 (66.7%) indicated they would prefer to be seen in a SOCC and 88 (33.3%) preferred to be seen in a general dermatology clinic (GDC). Clinic choice varied significantly by ethnicity, with Black/African American participants being the most likely to prefer SOCC over GDC than other races or ethnicities. Those interested in SOCC were primarily motivated by a search for expertise in the skin of colour (SOC) and did not have a preference for the skin colour of the SOCC dermatologist. Those interested in GDC were happy with their current care.
Attitudes on, practices, and recommendations for visible light protection amongst dermatology practitioners
Researchers distributed an electronic survey to dermatology practitioners to evaluate those practitioners' counselling practices for visible light protection with sunscreen products.
The investigators found that 91.68% of 974 respondents actively counsel patients about visible light protection, primarily emphasizing its role in exacerbating pigmentation in patients with melanin-rich skin (70.92%). Of these, 10.34% recommended sunscreens with visible light protective additive ingredients specifically for patients with melanin-rich skin, and 48.89% recommended them for managing melasma or post-inflammatory hyperpigmentation. Iron oxide additive ingredients were most frequently recommended (90.92%), followed by antioxidants (69.08%) and pigmentary TiO2 (58.85%). Some 8.32% of respondents reported not counselling patients about visible light protection, with significant reasons encompassing the lack of standardized guidelines (50.62%), challenges in recommending suitably tinted sunscreens (27.16%), limited availability of sunscreen options (23.46%), and insufficient supportive data (18.52%).
The authors conclude that increased education and awareness regarding visible light protection strategies and identifying patients who may benefit the most from a targeted photoprotective strategy are needed. Establishing standardized guidelines and broadening the availability of sunscreen options conferring visible light protection may help address these gaps.
At the intersection of skin and society
A new report commissioned by an employee group within the Canadian federal government has identified a pattern of systemic anti-Black discrimination inside Canada’s federal public service.
According to a press release from the Black Class Action Secretariat, the report reveals that Black leaders have faced a hostile environment marked by threats, abuse, cruelty, subjugation, insubordination, intimidation, baseless complaints, and relentless harassment.
The report highlights accounts of psychological trauma stemming from these toxic workplace conditions. Black women, in particular, reported severe and sustained harassment, resulting in chronic depression, reliance on antidepressant medications, and, in some cases, attempts to take their own lives.
The Black Executive Network, the commissioning group, is housed in Innovation, Science and Economic Development Canada.
Authored by Dr. Rachel Zellars and delivered to officials this week, the peer-reviewed study was conducted over two years and funded by the Government of Canada. According to the release, this is the first comprehensive examination of the systemic barriers and discriminatory practices Black leaders face in the federal public service.
Dr. Zellars’ study recounts several incidents, including the police being called on an executive for a “stolen governmental laptop” when she had merely taken it with her after moving to another division. Another recalled an incident where a White colleague raised a chair at him and threatened to “beat the ni**er out of him” in front of others without recourse. Both men and women reported being called the N-word at some point in their careers in public service.
“These accounts are disturbing but not surprising because they echo what we have been hearing from Black public service workers for years,” said Nicholas Marcus Thompson, CEO of the Black Class Action Secretariat, in the release. “Even when Black workers make it into executive positions, they are met with unbearably hostile working environments, insubordination from direct reports, and career stagnation.”
The report found that 62% of Black leaders experienced workplace harassment, intimidation, or the threat of reputational harm from supervisors or senior leaders. Some 51% spoke at length about ways they were explicitly denied career-advancing opportunities. Nearly one-third described being severely punished for mistakes, unlike their White counterparts. They also described the complaints process being used as a tool for intimidation and harassment, with lengthy and intrusive investigations primarily deemed to be unsubstantiated.
The Black Class Action Secretariat calls on the Government of Canada to implement Dr. Zellars' 15 recommendations, including a long-standing call for a Black Equity Commissioner, and to redress decades of harm inflicted on Black workers through the resolution of the landmark class action.
This week
Nov. 18 to 24 is World AMR Awareness Week
Nov. 20 is World Children’s Day
Nov. 20 is Black Consciousness Day
Something to think about in the week ahead . . .
—Eleanor Roosevelt, U.S. First Lady, diplomat, and activist (1884 to 1962)
Next week
Researchers Emerson D Basch and Grace C Hillyer, EdD, MPH, explore how the high cost and lack of availability of sunscreen for patients with melanated skin represents an overlooked risk to skin health.
If you value 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.
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.