Inflammatory skin conditions in Indigenous children
Review clarifies prevalence of skin conditions, barriers to effective care (1,500 words, 7 minutes)
Inflammatory dermatoses are extremely common in remote Indigenous communities, especially among children, Dr. Rachel Netahe Asiniwasis said in a presentation during the 8th annual Skin Spectrum Summit on Sept. 17, 2022. Numerous barriers to healthcare in remote communities make treating these skin conditions even more challenging.
Dr. Asiniwasis is a dermatologist in Regina, Sask. She and her team serve remote northern First Nations communities through fly-in visits and teledermatology clinics.
During her talk, Dr. Asiniwasis said she recently completed a systematic scoping review of existing literature on skin conditions and Indigenous peoples. Most of the studies focused on Indigenous people in remote and rural communities.
The literature showed that inflammatory dermatoses, especially atopic dermatitis, were highly prevalent in Indigenous communities and patients had relatively poor outcomes, she said. Not much is documented about psoriasis or hidradenitis suppurativa in Indigenous patients. Still, Dr. Asiniwasis noted that based on her own experience, the conditions are much more common than the data indicates.
Other major concerns in her practice include skin and soft tissue infections, diabetes and wounds, and autoimmune connective tissue disease, she said.
Dr. Asiniwasis said her scoping review also found an increasing prevalence of skin and soft tissue infections, particularly bacterial, among Indigenous populations. These included MRSA, MSSA and invasive strep. She said the incidence is much higher in remote and rural northern communities among adults and children than in the general population.
There are many barriers to patients getting the best dermatology care in remote communities, and these barriers contribute to infection risk, Dr. Asiniwasis said. These barriers include:
A lack of physicians
A lack of infrastructure to support follow-up
Residential overcrowding and poor housing conditions contribute to communicable diseases
Poor water quality leads to reduced bathing and clothes washing
Delivery times to labs are too long for swab testing, and samples expire
Travel out of the community may be limited seasonally
Communication barriers between the healthcare provider and patient
To address communication challenges with Indigenous patients, Dr. Asiniwasis suggested that physicians keep skincare instructions as simple as possible and perhaps refer to the Eczema Society of Canada website for suggestions. She said that physicians treating Indigenous patients should be familiar with the Non-Insured Health Benefits program, which provides medications and medical product coverage to registered First Nations and recognized Inuit.
She stressed the importance of booking follow-up appointments and addressing secondary infections. While teledermatology and virtual care could help with follow-up, infrastructure limitations can make this impossible in some cases. Dr. Asiniwasis said a report showed only 24% of households in Indigenous communities have access to the internet speed required for telemedicine.
Bottom Line: Inflammatory dermatoses are highly prevalent in remote Indigenous communities, and patients tend to have worse outcomes. There are numerous barriers to healthcare in remote Indigenous communities, including overcrowding, lack of safe water, cost, transportation, and lack of healthcare providers. Teledermatology may help if the infrastructure can be improved.
From the literature on Indigenous health
Characteristics of non-melanoma skin cancers in Native American patients treated with Mohs micrographic surgery
This retrospective case review study was designed to evaluate the characteristics of non-melanoma skin cancers—basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)—in North American Indigenous patients treated with Mohs micrographic surgery between Jan. 2015 and Aug. 2020 at a single academic centre.
A total of 26 patients with 28 tumours were identified. Those included 12 SCC (92% well-differentiated) and 16 BCC (94% nodular).
Most of the tumours were on the head and neck, with mean sizes of 563 mm2 (SCC) and 350 mm2 (BCC).
Researchers found that 75% of tumours were cleared with one stage of Mohs surgery, and two patients with SCC had a recurrence. While there was no mortality in the sample, the authors note that follow-up was limited.
In this sample, the SCCs were more significant and lower risk, while the BCCs were mostly nodular. The average time from biopsy to Mohs micrographic surgery was three months.
The authors conclude that more studies are needed better to characterize non-melanoma skin cancers in North American Indigenous people and to identify barriers to prompt care.
Access to dermatologic care in Indigenous American communities
The authors of this letter note that in the U.S., dermatology physician assistants (DPAs) are being used to supplement an undersupply of dermatologists. To clarify whether this change has sufficiently improved dermatologic health care accessibility, they studied the density of dermatologists and DPAs in American Indian and Alaskan Native (AIAN) homelands.
They found that access to dermatologic care in AIAN communities mirrors that of the least dermatologist-dense areas in the U.S., and their location likely influences this in rural areas.
Only five of the included AIAN homelands had more than two practitioners, and all five included an urban centre.
Adapting child health knowledge translation tools for use by Indigenous communities: Qualitative study exploring health care providers’ perspectives
Researchers from Alberta conducted this study to explore if and how a set of knowledge translation (KT) tools they developed could be adapted for use with Indigenous communities. The tools are a set of videos meant to help parents understand how to manage common acute childhood illnesses at home and when to contact emergency healthcare.
The investigators asked 18 healthcare practitioners to review KT tools on croup and acute otitis media, complete a demographic survey and participate in a one-on-one interview. Of those practitioners, seven self-identified as Indigenous.
Through the study, the authors identified four important themes when considering how to adapt KT tools for use by Indigenous communities: accessibility, relatability, KT design, and relationship building.
The authors conclude their findings will help to develop a greater understanding of what healthcare practitioners consider important when designing or adapting KT tools for use by Indigenous families.
Tinea imbricata among the Indigenous communities: Current global epidemiology and research gaps associated with host genetics and skin microbiota
The authors of this paper note that managing Tinea imbricata, a fungal skin disease that primarily affects Indigenous populations in Southeast Asia, Oceania, and Central and South America, is challenging. Remote locations, some traditional practices, and malnutrition issues complicate care.
To address the limited understanding of this disease and to find possible long-term effective treatments among the affected indigenous communities, the researchers reviewed the status of tinea imbricata among indigenous communities. They also reviewed published findings on the possible underlying reasons for its specific distribution among these communities.
VIDEO: Indigenous Health Research
This playlist from the University of Saskatchewan introduces contextualizing information on Indigenous Healthcare in Canada and resources for research.
At the intersection of skin and society
According to a press release, the second annual Vancouver International Black Film Festival is shifting from an all-virtual format to a mix of online and in-person screenings.
This year the festival runs from Dec. 16 to 20, with in-person screenings and events at the VIFF Vancity Theatre and Studio Theatre in Vancouver.
“What a thrill to be back in the Hollywood of the North with the 2nd annual Vancouver International Black Film Festival,” said Fabienne Colas, President and Founder of the Black Film Festivals in Montreal, Toronto, Halifax, Ottawa, Calgary, and Vancouver, in the release. “It’s a true privilege to showcase exceptional work and authentic Black stories that do not always make it to the silver screen. We invite everyone to join us in spreading diversity off and on camera from coast to coast to celebrate the differences that make us unique and the shared values that bring us together.”
The Fabienne Colas Foundation created the festival and is co-presented by Canada Media Fund and Global BC.
“At the Fabienne Colas Foundation, we’re proud to continue to bring our unparalleled expertise, our strong eco-system and network, and our savoir-faire along with our 18 years of experience to Vancouver, a beautiful city that is waiting to implement inclusion, diversity, and change in the film industry,” said Colas.
This year’s festival opens at 7 p.m. PST with Jennifer Njeri Gatero’s NAIROBBY at the Vancity Theatre. The film is “a suspenseful film about friendship and loyalty as six university students who have just pulled off a daring heist are put to the test.” At 9 p.m. PST, all films will be accessible online.
The festival’s website offers an online all-access pass and single in-person tickets.
“As part of our mandate to enable more voices and bring more visibility to underrepresented creators, the Canada Media Fund is proud to support the second annual Vancouver International Black Film Festival,” said Tamara Dawit, VP of Growth & Inclusion, Canada Media Fund, in the release. “We are excited to work alongside the Fabienne Colas Foundation as they continue their groundbreaking work to amplify Black voices, stories, and perspectives and empower Black creators.”
More details on the festival and the film program are available on the Festival website.
This week
December is International Sharps Injury Prevention Awareness Month
Dec. 12 is International Universal Health Coverage Day
Dec. 18 is International Migrants Day
Something to think about in the week ahead…
Anton Chekhov, Russian Dramatist 1860-1904
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Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper in print providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Dr. Lyn Guenther (London, Ont.) discusses the benefit a fixed-dose combination calcipotriol/betamethasone dipropionate (Cal/BD) foam can have at alleviating psoriasis-related impairment of work productivity and activity
A review of recent literature on acne treatments, featuring interviews with Dr. Michelle Pratt (St. John’s, NL), Dr. Ben Barankin (Toronto), Dr. Maha Dutil (Toronto), and Dr. Yuka Asai (Kingston, Ont.)
Plus regular features, including the popular column “Vender on Psoriasis” by Hamilton, Ont. dermatologist Dr. Ron Vender
Read the latest online edition here. To apply for a complimentary* subscription or to receive a sample copy, please email health@chronicle.org with your contact information.
The Women in Dermatology e-newsletter updates new findings concerning dermatologic issues that affect women and the female dermatologists who care for them. Read the current issue here.
Season two of the Shear Listening Pleasure podcast with Dr. Neil Shear has launched. Listen to the second episode here, where Dr. Shear speaks with Rachael Manion, Executive Director of the Canadian Skin Patient Alliance, about treatment revolutions in skin conditions, publishing patient advocacy reports on skin conditions, and the mental impacts of living with a skin, nail, or hair condition.
And if you’re looking for a web destination for all things derm, please visit derm. city, “Where Dermatology Lives.” Please like it, rate it and share it with your colleagues.