Skin and soft tissue infections in remote Canadian communities
More education, mentorship, and remote support are necessary for primary care practitioners supporting patients with skin infections (1,400 words, 7 minutes)
Primary care healthcare practitioners in Canada’s remote northern and Indigenous communities often must manage severe skin infections. More specific lessons in medical school about these types of cases and populations would benefit these doctors and nurses, said Rachel Johnson during a presentation at the second annual Indigenous Skin Spectrum Summit on June 11, 2022. Johnson, a primary care nurse practitioner in Saskatoon, said improved access to specialist advice and mentorship through virtual contact would also help.
“The scale and the severity of these conditions are unlike really anything I typically see and not what I studied,” said Johnson. She has worked extensively in remote northern communities in Canada.
She said that poor living conditions ultimately lead to more skin infections. In addition, some of the patients she has worked with had more than one course of antibiotics per month to treat recurring infections, and colonization with antibiotic-resistant bacteria such as MRSA is common.
She said that the skin infection problem is made worse by a lack of race-specific training material.
“I have heard many colleagues who are also primary care providers admit that [dermatology] is one of their weaker areas,” said Johnson. “And several medical and nursing students I work with often state that they do not feel they get enough dermatology training. Another observation I want to make is that most textbooks use photographs of various conditions on white Eurocentric people. So that becomes the reference point, which is not always useful when working with different populations.”
Johnson said one helpful development had been virtual care and telepresence robotics. Using a camera- and screen-equipped robot to work directly with a specialist benefited the patients but also allowed her as a nurse practitioner to benefit from coaching and mentorship.
“This increased our local team's capacity to manage more cases and allowed us to have more timely consultations when needed. And more importantly, when the patients needed it,” she said. “We felt less isolated, and the children got better care. It is hard to overemphasize [the importance of] access to virtual care for patients and the providers in the north.”
Bottom Line: Dermatologic conditions in remote northern communities can be more severe because of living conditions and the frequent use of antibiotics, leading to a vicious cycle of treatment and relapse and the widespread prevalence of resistant organisms such as MRSA. Tools including virtual care and robotics can be game-changers for skin treatment in these communities. However, primary care practitioners also need more dermatology and Indigenous health training.
From the literature on teledermatology and ethnodermatology training
Implementation of teledermatology in Alberta, Canada: A report of one thousand cases
This retrospective study examined 1,000 cases where patients received dermatology consultations through the ConsultDerm teledermatology platform.
The study investigators examined the patients’ demographic and clinical information and surveyed seven dermatologists who used ConsultDerm about their experiences.
Two-thirds (66.5%) of the patients had not received dermatology treatment before their referral. On average, they had been having symptoms for 489.5 days. Most of the remote consultations came from small communities. Family physicians made most of the referrals.
The most common diagnoses were:
Acneiform conditions 10.6%
Benign lesions or neoplasms 12.1%
The dermatologists who used the system said they found it easy to use, but the image quality could have been better, and they would prefer more detailed patient histories.
Opportunities and challenges of telehealth in remote communities: Case study of the Yukon Telehealth System
Researchers analyzed data from usage logs from the Yukon Telehealth System, questionnaires completed by nurses, and interviews with stakeholders to identify how the system was utilized and the challenges to its use.
The authors found there had consistently been about 1,000 telehealth sessions in the system each year since 2008.
Clinicians and patients said the system made it faster and less expensive to get medical care—due to not needing to travel. However, there was also a consensus that the system was underutilized and the equipment was outdated.
The investigators identified factors to consider for any plans to expand the system:
Stakeholders should consider patients' and clinicians' past experiences with telehealth to improve buy-in
Expanding telehealth services in orthopedics, dermatology and psychiatry in the Yukon system would be both valuable and feasible
Scheduling should be more automated to reduce the dependence on a small number of coordinators
Patients and clinicians should have access to up-to-date technology. Using mobile devices and other consumer electronics might help in this area.
There needs to be more investment in human resources and technology for telehealth to succeed.
Impact of diversity in training resources on self-confidence in diagnosing skin conditions across a range of skin tones: An international survey
Researchers surveyed the users of an international online teaching platform (www.dftbskindeep.com) and collected data including geographical location, ethnicity, profession, specialty, years of experience, training resources and confidence in diagnosing skin conditions. Participants included physicians, medical students, advanced nurse practitioners, nurses, paramedics, or other health care practitioners.
Of 600 participants, 74% reported that their training used educational resources featuring predominantly white skin. Participants said their confidence in diagnosing skin conditions was “generally uncertain” in 43% of cases, “sometimes uncertain but clinically safe” in 52%, and “confident across a range of skin tones” in 5%.
Their self-confidence was associated with location [higher in Africa (29%) and Latin America (11%), (p<0.001)]; diversity of training resources [higher with a mix (10%) or darker tones (20%) (p<0.001)]; clinical experience [six to 10 (5%) or >10 years of practice (11%) (p<0.001)] and specialty [highest in dermatologists (53%, p<0.001)]. Self-confidence was lowest among pediatricians, emergency medicine and pediatric emergency medicine specialists (<5%).
Pediatric teledermatology: A tool for combating dermatology care disparities
In this commentary article, the authors discuss lessons learned in the US related to the adoption of teledermatology during the Covid-19 pandemic. Studies have shown that pediatric teledermatology offers cost-efficiency and convenience to families that would otherwise be required to take time off work and travel to one of the few cities with a specialist.
The article discusses some conditions for which teledermatology is particularly valuable, including atopic dermatitis.
However, the authors also note that a lack of access to computers and communication infrastructure in remote or poorer communities can represent a challenge to effective teledermatology.
VIDEO: On the frontlines of rural & remote health care in Saskatchewan
At the intersection of skin and society
The club is hosted in Hamilton, but members can participate virtually from anywhere, said the club’s founder, Tanya Lee.
“I’m starting the Black Romance Book Club … and what I’m promoting is Black romance writers,” Lee told the CBC.
Lee, a certified life skills coach, told the news outlet that the idea for the club grew out of the frustration she experienced regarding the lack of romance novels written by Black Canadian authors.
“You walk through the bookstores . . . and you look in the romance section and . . . there are very few Black romance novels,” she said.
Lee said another reason for a Black Romance Book Club is that most romance novels are set in the Caribbean or Europe and not in Canada, even though Canada has some great locations.
“I am always baffled. I don’t hear about romance novels taking place in Alberta—with Black people,” Lee said.
In 2017, Lee founded the A Room Of Your Own Book Club for high-risk teen girls in Toronto, where she lives. That program now runs nationally.
The new Black Romance Book Club will be hosted at the Art Gallery of Hamilton (AGH). Live events such as author readings and writing workshops will be held at the AGH, which manages club subscriptions.
While the club will have its home in Hamilton, it is open to all in Canada.
“We have four in-person [events] planned for the Art Gallery of Hamilton [but] my goal is to actually have other book clubs across Canada as well,” Lee said. “Additionally, there will be an online book club every month.”
The first club event is a workshop on September 18, 2022, which will be accessible live at the AGH and online.
Lee said the first speaker is Jessica P. Pryde, the Arizona-based author of Black Love Matters: Real Talk on Romance, Being Seen and Happily Ever Afters.
July 28 is World Hepatitis Day
July 30 is the International Day of Friendship
Something to think about in the week ahead…
In a talk at the 2022 Indigenous Skin Spectrum Summit, Dr. Rachel Netahe Asiniwasis described some challenges of treating patients with systemic immune-modulating treatments in remote communities.
Upcoming events and learning opportunities
Registration is open for the 2022 Summer of Dialogue: Focus on Black Skin, which will be held virtually on Wed. August 17, 7:00 PM to 8:30 PM EDT.
In recognition of persistent gaps in dermatologic training regarding skin of colour, the Summer of Dialogue colloquium, Focus on Black Skin, will discuss recent progress on advancing the inclusion of diverse skin tones in research and medical education.
This 90-minute live discussion will address treatment challenges specific to Black skin (Fitzpatrick Types V & VI), including phenotypic variations from standard training models and the necessity of cultural competence.
This non-accredited program will be available to attend at no charge, thanks to the support of our sponsors.
Highlights of the event include:
The Dr. Mercy Alexis Keynote Lecture: Gaps in Aesthetic Treatment for Richly Pigmented Skin by Dr. Pearl Grimes of Los Angeles
Moderator: Dr. Andrew F. Alexis
Educating new and existing HCPs on optimal skincare for Black patients
Register for the 2022 Summer of Dialogue: Focus on Black Skin here:
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A report on choosing a biologic therapy for the treatment of AD, with Dr. Aaron Drucker of Toronto
How new IL inhibitors can improve response in patients with psoriasis, featuring interviews with Dr. Jaggi Rao (Edmonton), Dr. Ben Barankin (Toronto), Dr. Catherine Zip (Calgary), and Dr. Kerri Purdy (Halifax) and Dr. Kyle Cullingham (Saskatoon).
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Enjoy podcasts? In the third episode of season two of the Vender on Psoriasis Podcast, Canadian dermatologist Dr. Ronald B. Vender talks about a link between psoriasis and non-alcoholic fatty liver disease, vaccine hesitancy in psoriasis patients, and bimekizumab safety profiles.