Improving skin health outcomes

We want Aboriginal and Torres Strait Islander peoples to have equal opportunities to thrive and to experience good skin health.

At the Australasian College of Dermatologists we believe that increasing Aboriginal and Torres Strait Islander participation in our workforce and in our decision-making processes will enrich all our perspectives, strengthen strategies to address inequitable skin health outcomes, and help promote more accessible and culturally safe dermatology care for Aboriginal and Torres Strait Islander patients and communities.

We are pursuing a number of strategies to improve Aboriginal and Torres Strait Islander peoples’ access to culturally safe dermatology care.

Increasing the number of dermatologists and Indigenous dermatologists in Australia Advocating for funding to extend dermatology outreach services Building the cultural competency of our workforce
Providing training, education and CPD in Aboriginal and Torres Strait Islander skin health Supporting Aboriginal Health Workers Raising awareness of skin health in Aboriginal and Torres Strait Islander communities
Building respectful relationships with Aboriginal and Torres Strait Islander organisations Increasing Aboriginal and Torres Strait Islander participation in our decision-making

Why does this matter?

  • Most skin conditions are chronic conditions. Almost 1 million people in Australia – over 4.5% of the population – suffer from a long-term condition of the skin1 and skin disorders rank sixth of all disease groups for non-fatal disease burden.2
  • Access to specialist dermatology services leads to improved patient outcomes3 and drives efficiencies within the health system.4 However, with just 550 dermatologists in Australia, many Australians experience difficulties accessing timely and geographically convenient care.
  • The incidence of skin infestations and infectious skin disease among Aboriginal and Torres Strait Islander communities is high. This is associated with resource-poor environments5,6 and the ‘normalisation’ of infections in communities7,8. Risk factors for skin infections include: perinatal risk factors , family income, overcrowding, quality of water supply and housing, access to affordable healthy food, hygiene, adherence to treatment programs and cultural sensitivities. 10,11
  • The most common skin infections affecting Aboriginal and Torres Strait Islander children are scabies12 and impetigo, the latter of which has a prevalence of up to 44.5% in children living in remote Indigenous communities.13
  • These endemic skin infestations and infections in infancy can lead to long term quality of life, life expectancy and public health costs associated with chronic heart and kidney disease stemming from Streptococcal and Staphylococcal bacterial skin infections.
  • Early diagnosis and treatment of pyoderma, such as impetigo, and scabies could be an important primary health intervention to reduce serious bacterial infections in childhood but also to reduce downstream health complications.
  • Skin infections are a major reason for presentation to primary health clinics and contribute to the high burden experienced by children in remote Aboriginal communities in the first 2 years of life.14
What about non-infectious skin disease?
  • There is little available information on the burden of non-infectious skin disease in the Aboriginal and Torres Strait Islander population. A 2014 literature review15 found that Aboriginal and Torres Strait Islander Australians have a reduced prevalence of psoriasis, type 1 hypersensitivity reactions and skin cancer but increased rates of lupus, kava dermopathy and vitamin D deficiency when compared to the non-Indigenous Australian population.
  • The review highlighted the paucity of information we have on Indigenous skin disease and in particular the burden of non-infectious skin disease on Aboriginal and Torres Strait islanders. The authors concluded that, to address the skin health of Indigenous Australians, research is needed into the burden of these non-infectious diseases and why they are occurring in Indigenous populations.

References

1   Australian Bureau of Statistics, 4364.0.55.001 – National Health Survey: First Results, 2017-18, December 2018, https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0012017-18?OpenDocument, accessed Aug 2018.

2     Australian Institute of Health and Welfare, Australian Burden of Disease Study: impact and causes of illness and death in Australia 2011, Canberra: AIHW, May 2016.

3     Tran H, Chen K, Lim AC, et al., ‘Assessing diagnostic skill in dermatology: A comparison between general practitioners and dermatologists’, Australas J Dermatol. 2005 Nov;46(4):230-4.

4     Australian Government Department of Health (DoH), Australia’s Future Health Workforce – Dermatology, May 2017, http://www.health.gov.au/internet/main/publishing.nsf/Content/australias-future-health-workforce-dermatology-report, accessed Aug 2018.

5     Parks, T., Smeesters, P. R., & Steer, A. C. (2012). Streptococcal skin infection and rheumatic heart disease. Current Opinion in Infectious Diseases, 25(2), 145-153.

6     Romani, L., Steer, A. C., Whitfeld, M. J., & Kaldor, J. M. (2015). Prevalence of scabies and impetigo worldwide: a systematic review. The Lancet Infectious Diseases, 15(8), 960-967.

7     Thomas, S., Crooks, K., Taylor, K., Massey, P. D., Williams, R., & Pearce, G. (2017). Reducing recurrence of bacterial skin infections in Aboriginal children in rural communities: new ways of thinking, new ways of working. Australian Journal of Primary Health, 23(3), 229-235.

8     Amgarth-Duff, I., & Hendrickx, D. (2019). Talking skin: attitudes and practices around skin infections, treatment options, and their clinical management in a remote region in Western Australia. Rural and Remote Health, 19(3). Retrieved from: https://doi.org/10.22605/ RRH5227

9     Barnes, R., Bowen, A. C., Walker, R., Tong, S. Y. C., McVernon, J., Campbell, P. T., . . . Moore, H. C. (2019). Perinatal risk factors associated with skin infection hospitalisation in Western Australian Aboriginal and Non‐Aboriginal children. Paediatric and Perinatal Epidemiology, 33(5), 374-383.

10     Amgarth-Duff, I., & Hendrickx, D. (2019). Talking skin: attitudes and practices around skin infections, treatment options, and their clinical management in a remote region in Western Australia. Rural and Remote Health, 19(3). Retrieved from: https://doi.org/10.22605/ RRH5227

11     Nepal, S., Thomas, S. L., Franklin, R. C., Taylor, K. A., & Massey, P. D. (2018). Systematic literature review to identify methods for treating and preventing bacterial skin infections in Indigenous children. Australasian Journal of Dermatology, 59(3), 194-200.

12     Lokuge B, Kopczynski A, Woltmann A, et al, ‘Crusted scabies in remote Australia, a new way forward: lessons and outcomes from the East Arnhem Scabies Control Program’, Med J Aust, 2014 Jun 16;200(11):644-8.

13     Bowen AC, Mahé A, Hay RJ, et al., ‘The Global Epidemiology of Impetigo: A Systematic Review of the Population Prevalence of Impetigo and Pyoderma’, PLoS ONE, 2015; 10(8): e0136789.

14   McMeniman E, Holden L, Kearns T, et al. Skin disease in the first two years of life in Aboriginal children in East Arnhem Land. Australasian Journal of Dermatology. 2011;52(4):270‐273. doi:10.1111/j.1440-0960.2011.00806.x 

15           Heyes C, Tait C, Toholka R, Gebauer K. Non-infectious skin disease in Indigenous Australians. Australasian Journal of Dermatology. 2014;55(3):176‐184. doi:10.1111/ajd.12106