Burden of Disease and Unmet Needs in the Diagnosis and Management of Atopic Dermatitis in Diverse Skin Types in Australia

Abstract

Atopic dermatitis (AD) is a common, chronic, inflammatory skin disease affecting Australians of all ages, races, ethnicities, and social classes. Significant physical, psychosocial, and financial burdens to both individuals and Australian communities have been demonstrated. This narrative review highlights knowledge gaps for AD in Australian skin of colour. We searched PubMed, Wiley Online Library, and Cochrane Library databases for review articles, systematic reviews, and cross-sectional and observational studies relating to AD in Australia for skin of colour and for different ethnicities. Statistical data from the Australian Institute of Health and Welfare and the Australian Bureau of Statistics was collected. In recent years, there has been substantially increased awareness of and research into skin infections, such as scabies and impetigo, among various Australian subpopulations. Many such infections disproportionately affect First Nations Peoples. However, data for AD itself in these groups are limited. There is also little written regarding AD in recent, racially diverse immigrants with skin of colour. Areas for future research include AD epidemiology and AD phenotypes for First Nations Peoples and AD trajectories for non-Caucasian immigrants. We also note the evident disparity in both the level of understanding and the management standards of AD between urban and remote communities in Australia. This discrepancy relates to a relative lack of healthcare resources in marginalised communities. First Nations Peoples in particular experience socioeconomic disadvantage, have worse health outcomes, and experience healthcare inequality in Australia. Barriers to effective AD management must be identified and responsibly addressed for socioeconomically disadvantaged and remote-living communities to achieve healthcare equity.

Access to Dermatological Services in the Brazilian Public Health System: a literature review

“…Por exemplo, viver numa comunidade rural ou ser um australiano das Primeiras Nações ou um imigrante recente [13] pode limitar o acesso a cuidados especializados. Essas comunidades muitas vezes enfrentam grandes barreiras ao atendimento especializado oportuno e apropriado [13].…”

“…A educação sobre cuidados com a pele é dificultada devido ao tempo de atenção primária e às restrições de acesso, devido a uma escassez crítica de clínicos gerais rurais [13].…”

“…A dermatite atópica (DA) é uma doença inflamatória crônica da pele que afeta muitas comunidades e indivíduos australianos, levando a encargos físicos, psicossociais e financeiros [13]. A DA é particularmente comum em populações indígenas e multiétnicas, e existem lacunas de conhecimento sobre a DA em peles negras [13].…”

The Psychology of Atopic Dermatitis

“…AD is a chronic inflammatory skin condition characterised by relentless pruritus and recurrent eczematous plaques [ 1 ]. It can severely impact sleep, schooling, work, and family relationships; visible disfigurement from redness, flaking, and bleeding excoriations can result in social stigmatisation, withdrawal, and reduced QOL [ 2 , 3 ].…”

“…AD is the leading cause of skin disease worldwide, affecting approximately 20% of children and 10% of adults [ 5 ]. It is caused by complex interactions between genetic, environmental, and socioeconomic factors [ 1 ]. Important determinants include skin barrier dysfunction, neuroinflammation, immune dysregulation/activation especially of the Th2 axis, microbiome abnormalities, noxious environmental stimuli, and genetic variations (particularly of filaggrin and immune activation-associated genes) [ 6 ].…”