Dermatological Disease in North American Indigenous Peoples: A Systematic Scoping Review

Structured Summary: Limited published literature and media raise serious concerns surrounding atopic dermatitis (AD) and skin infections in both pediatric and adult patients in a Canadian context (Abedi 2019; Asiniwasis et al., 2020; CBC News 2019; Dehaas 2016; Forsey 2014; FNIGC 2012/2018). A retrospective study completed by Jeong et al. (2020) published in BMC identified a high level of antibiotic prescription in adults for skin infections in remote Canadian Indigenous communities, and the authors concluded that, “this population is currently hard to reach and under-represented in standard surveillance systems, and randomized retrospective chart reviews can offer complimentary methodology for monitoring disease burden, treatment, and prevention”. Although Indigenous peoples of North America are unique and diverse in geography, culture and language, they face well documented unique disparities in social determinants of health and health disparity challenges related to social and historical contexts such as residential schools, reserves as legislated segregation, and other government policies (Allan & Smylie, 2015; Waldram, 2006). As a medical dermatologist with an academic interest in dermatology and health disparities, the author (RA) has informally noted a significant gap in inclusion surrounding Indigenous health disparities in skin disease in North American dermatology literature and virtual/in-person continuing medical education events such as conferences, as well as North American clinical trial representation in common inflammatory skin diseases (eg. moderate to severe psoriasis, AD). To date, no unified body of literature exists on North American Indigenous skin disease, thus we chose a systematic scoping review to further explore this topic by providing a ‘lay of the land’. This project involves a systematic scoping review of dermatologic conditions in North American Indigenous peoples using PRISMA-ScR guidelines (Tricco et al., 2018). In keeping with Truth and Reconciliation calls to action (www.trc.ca), our objective is to systematically and formally document dermatologic disease in North American Indigenous peoples, using findings as a launchpoint for discussion, awareness, informing of future research designs, and as a part of the translational research spectrum with the ultimate and hopefully eventual goal of reducing gaps in health disparities. Sources of evidence include a systematic search of North American Indigenous skin disease using MEDLINE, CINAHL, EMBASE, and CENTRAL, with an extended search of guideline repositories of AAD, CDA, AAAI/ACAAI, CSACI, ATS, and CTS and a scoping review of Indigenous representation in Phase II, III, and IV North American clinical trials involving small molecule and biologic therapy in moderate to severe psoriasis and atopic dermatitis. Charting methods include using Rayyan platform and Excel for data entry. Once data is gathered and analyzed, results will be discussed in context of our objectives and research questions. Rationale: We chose a systematic scoping review (ScR) as the topic of North American Indigenous skin disease has not yet been comprehensively reviewed, and includes a sizable, complex and heterogenous nature (TUL, 2021). Other rationales for ScR in this context include detecting gaps in existing literature, clarifying working definitions, and organizing literature from time, location (country and context), and source (Khalil et al., 2016; Temple University Library, 2021). Objectives: To conduct a systematic scoping review using PRISMA-ScR guidelines (Tricco et al., 2018) of North American Indigenous peoples, including all age groups/sex, urban/rural with skin disease. Epidemiological patterns of Indigenous skin disease, co-morbidities and outcomes will be explored. A scoping review of Indigenous representation in North American dermatologic and atopic guidelines and in moderate to severe psoriasis and atopic dermatitis clinical trials in small molecule and biologic therapy will be completed. Research questions include: 1. What is the prevalence/epidemiological patterns of skin disease among North American Indigenous peoples? 2. What kind of research is being done in North American Indigenous Peoples? 3. Frequency of guideline and clinical trial Indigenous representation See detailed attachment for further information. What terminology/language is being used? ADDITIONAL NOTE: Our database search terminology example on MEDLINE is currently being revised as of Feb 2, 2022.

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