Atopic Dermatitis in Indigenous Communities in Canada

Indigenous communities in Canada experience higher prevalence and disease burden of atopic dermatitis (AD) alongside systemic barriers to dermatologic care. This scoping review synthesizes evidence on AD prevalence, assessment approaches, barriers to access, and intervention models for Indigenous populations, an area with a critical dearth of rigorous research. A PROSPERO-registered, PRISMA-compliant systematic search of 5 databases identified limited rigorous research: No randomized trials specific to AD management exist, and Indigenous participants remain underrepresented in clinical trials (0.91% vs population share). Barriers operate across 4 domains: systemic (historical and intergenerational trauma), geographic (distance from specialists, absent phototherapy), resource-related (unsafe water, mold exposure, medication costs), and cultural safety deficits. Together, these represent compounding barriers to dermatological care. Common dermatologic conditions including acne, psoriasis, seborrheic dermatitis, and eczema impose higher quality-of-life burden among Indigenous patients, yet receive less diagnostic inquiry and fewer follow-up recommendations than among non-Indigenous patients. Promising interventions include Indigenous Extension for Community Healthcare Outcomes telementoring, hybrid models combining community navigators with e-consult platforms, culturally grounded outreach rotations, and codesigned care pathways respecting traditional healing practices. Based on our synthesis of the included literature, we recommend that dermatologists, health system planners, and policymakers prioritize upstream determinants of health (housing, water quality), implement mandatory cultural safety training, establish documented Indigenous governance in program design, and adopt minimum viable evaluation metrics capturing wait times, disease control, and equity stratification. Dermatologists must advocate for clean water infrastructure, universal pharmacare, and mandatory cultural safety training, while adapting clinical protocols to patients facing housing instability, water insecurity, and geographic barriers that make standard AD recommendations unachievable.

Abstract from PubMed