Indigenous psoriasis prevalence unknown
Little hard data exists on how common psoriasis may be in North American Indigenous populations, complicating care and policy (1,300 words, 6 minutes)
The Skin Spectrum Weekly e-newsletter is supported by Bausch Health Canada
Psoriasis can have significant physical, mental, social and economic impacts on individuals, but there is a shortage of information regarding the prevalence of this condition among North American Indigenous populations. This lack of information makes scoping and planning psoriasis management in these populations more difficult, said Dr. Rachel Netahe Asiniwasis during a talk at the 2022 Indigenous Skin Spectrum Summit.
As part of her presentation on the most common inflammatory skin conditions in Canada’s Indigenous population, Dr. Asiniwasis described the difficulty of finding reliable information on psoriasis prevalence while conducting a scoping review.
“I was looking for information on psoriasis and Indigenous people in Canada in North America, and I had to stretch my search. It was not easy to find.”
Her search brought her to an article on the medical news and commentary site Medscape in which the authors mentioned that psoriasis is nearly absent in North American Indigenous people, Dr. Asiniwasis said.
“I ask, is psoriasis nearly absent in these populations, or is it that we do not know much about it? If medicine believes this, and there is no way to document it, the potential for psoriasis complications and the comorbidities might be ignored, as well as the struggles of the clinicians trying to help these individuals.”
Another search revealed a news article that noted a U.S. National Psoriasis Foundation survey had found that 1% of all psoriasis cases in the U.S. were in Indigenous peoples.
However, when Dr. Asiniwasis read the referenced study, the 1% represented the number of survey participants who were Indigenous.
“I think we need more information on this topic.”
Dr. Asiniwasis noted several papers that discuss psoriasis prevalence in different North American populations and cited one report published in Medical Hypotheses (April 1987; 22(4):421-8) that discussed, among other things, a low prevalence of psoriasis in “Eskimos.”
“That is an outdated term now,” Dr. Asiniwasis said. Reading through that paper, she found the claim of low prevalence was based on personal observations, hypotheses around dietary factors and data from studies done in Greenland.
“There was no primary data on Indigenous psoriasis prevalence,” she said. “So again, what literature are we quoting?”
Dr. Asiniwasis and some of her colleagues in Saskatchewan surveyed medical practitioners in the province’s remote Indigenous communities. Most of the respondents were nurses and nurse practitioners.
“They are reporting that they are seeing psoriasis. And in my conversations with colleagues in the Canadian West, they report psoriasis. We need more information [on psoriasis prevalence in Indigenous populations].”
Bottom line: Most of the existing estimates of the prevalence of psoriasis in North American Indigenous populations are from studies with poor samples or that make estimates based on non-North American populations. New, robust studies are needed to understand the true scope of this condition in these populations.
From the literature on psoriasis in skin of colour
Promoting diversity, equity, and inclusion for psoriatic diseases
This paper discusses known health and healthcare disparities in psoriatic diseases (PsD), including the limited understanding of the prevalence and severity of PsD in racial and ethnic minorities. The paper also touches on quality of life by summarizing a program of talks initially presented at the 2021 annual meeting of the Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA).
Topics discussed include:
Educational gaps and lack of diversity in the dermatology workforce and how those gaps may be contributing to challenges in appropriately diagnosing and treating psoriasis in darker skin types
Inadequate representation of racial and ethnic minorities in clinical research for PsD, including trial recruitment and participation
How GRAPPA can better ensure racial and ethnic diversity, equity and inclusion in their educational, research, and clinical missions
Racial representation in clinical trials for dermatologic new molecular entities
This study aimed to determine if there had been an equitable representation of Black individuals in the clinical trials for new molecular entities (NMEs) for skin conditions including plaque psoriasis, acne vulgaris, actinic keratosis and squamous cell carcinoma.
To do this, they analyzed data on NMEs from the U.S. FDA Drug Trials Snapshots program from Jan. 2015 onward.
During this period, the investigators found a significant under-representation of Black participants in clinical trials for NMEs treating acne vulgaris, plaque psoriasis, actinic keratosis and squamous cell carcinoma.
They conclude their findings highlight a need to prioritize the representation of ethnic minorities in clinical trials, both to enhance clinical dermatology practice and improve the care and health of minorities.
Racial/ethnic differences in treatment efficacy and safety for moderate-to-severe plaque psoriasis: A systematic review
In this systematic review, investigators identified all clinical trials that focused on biological treatment outcomes up to March 5, 2021.
The investigators included studies that provided data on racial or ethnic differences in biologic skin clearance efficacy using the Psoriasis Area and Severity Index (PASI) and “clear/almost clear” scores.
Of 1,220 studies identified, 24 were included in this review. These studies included a total of 9,745 White, 2,740 Asian, 138 Black, and 728 Latino individuals.
The researchers found that ixekizumab provided the highest “clear/almost clear” and PASI 75 scores for Asian and Latino patients. Guselkumab had the highest “clear/almost clear” score for White patients, while Black patients had the highest “clear/almost clear” and PASI 75 scores for brodalumab.
The authors note that this study was limited by the small number of studies that reported outcomes based on race and ethnicity and a lack of patients with skin of colour in psoriasis clinical trials.
Mental health outcomes in White patients versus patients with skin of colour with psoriasis
This U.S. nationwide cross-sectional study examined the relationship between psoriasis and mental health in 7,519,662 patients using the 2004-2017 Medical Expenditure Panel Survey (MEPS).
The investigators found that psychological distress, measured on the Kessler 6-item Psychological Distress Scale, was similar between White patients and patients with skin of colour (SOC). Depression, overall mental health and perceived mental health state were also similar between the two groups.
They concluded that there were no significant differences in mental health outcome scores between White and SOC patients with psoriasis. Clinicians should screen for and manage mental health comorbidities in psoriasis patients of all racial backgrounds.
VIDEO: Diversity in clinical trials (CME)
From the literature on skin and society
The Honourable Murray Sinclair, LLB MSC IPC, former senator, judge and chairperson of the Truth and Reconciliation Commission of Canada (TRC)—has been named Concordia University’s 23rd Loyola Medal recipient.
The Medal, first awarded in 1963, is awarded every second year to someone whose character, philosophy and contributions have enriched the heritage of Canada and humanity.
“I appreciate the significance of the honour that I’ve been bestowed with,” said Sinclair, in a press release from the University.
After retiring as a senator in Jan. 2021 to mentor young Indigenous lawyers and write his memoirs, Sinclair became chancellor of Queen’s University in July 2021 and was named Companion of the Order of Canada in the following December.
“It marks an opportunity for this institution to acknowledge that it exists within a system that needs to change to move on the path to reconciliation,” Sinclair said. “By honouring me in this way, Concordia has recognized that it can contribute to the conversation and call upon all Canadians to listen to Indigenous views on reconciliation.”
In the release, Concordia President and Vice-Chancellor Graham Carr said that Sinclair has been a champion for Indigenous peoples in Canada and a “tireless advocate not just for truth and justice but also for education and action.”
“His leadership as chairperson of the Truth and Reconciliation Commission challenged all Canadians to learn, reflect upon and confront this country’s long history of oppression, violence and discrimination against Indigenous peoples,” said Carr.
“In every respect, Justice Sinclair is emblematic of what the Loyola Medal aims to honour.”
During Concordia's annual Homecoming celebrations, a virtual award ceremony will be held on September 15, 2022.
This week
June 27 to July 1 is World Wellbeing Week
June 27 is National Sunglasses Day in the U.S.
June 29 is International Day of the Tropics
In two weeks
Due to the Canada Day holiday, there will be no Skin Spectrum Weekly next week. Watch for us to return on July 11, when we will cover a presentation by Winnipeg’s Dr. Marni Wiseman on the history of the treatment of skin conditions by Indigenous peoples before colonization.
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