Asha C. Bowen

Description:Recent interest in the diverse ecosystem of bacteria, fungi, parasites, and viruses that make up the skin microbiome has led to several studies investigating the microbiome in healthy skin and in a variety of dermatological conditions. An imbalance of the normal skin flora can cause some skin diseases, and current culture techniques are often unable to detect a microorganism to further our understanding of the clinical-microbiological correlates of disease and dysbiosis. Atopic dermatitis and rosacea are presentations that GPs often manage that may have an infective or microbiological component and can be challenging to treat. We aim to discuss the implications of the skin microbiome including the impact of dysbiosis on conditions such as these. We will also discuss some clinical pearls for initial and future directions of the management of conditions such as atopic dermatitis, rosacea, and hidradenitis suppurativa. Further research using culture-independent techniques is needed for conditions involving microbial dysbiosis to advance our knowledge of skin disease pathophysiology and guide future management.

Description:Aboriginal children and families contend with higher rates of preventable infectious diseases that can be attributed to their immediate living environment. The environments in which children spend most of their time are their homes and schools. We aimed to understand the opportunities in the school setting to support student skin health and wellbeing through environmental health activities, how these activities were completed, and the barriers to their implementation. Recognising the importance of healthy skin for educational success, this work was embedded within a larger cluster randomised stepped-wedge Trial aimed at reducing the rate of skin infections among Aboriginal children living in the Kimberley region of Western Australia by 50 %. We used qualitative data collected via a culturally appropriate yarning methodology during trial evaluation interviews. The data from 35 yarns with 41 individuals were thematically analysed. Data indicated that schools serve as a hub of health and hygiene support and maintenance, with school staff balancing teaching responsibilities while also meeting the basic health and wellbeing needs of students. Uncertainties regarding funding and policies governing these activities remained; ongoing exploration is required. Staff in remote Kimberley schools devote substantial time and resources to supporting student hygiene needs, often stepping in when health infrastructure at home is inadequate. These activities are seen as necessary to support student wellbeing and participation in learning. While schools are well-positioned to respond in this way, these responsibilities extend beyond their core role and place additional pressure on staff and budgets. There is a need to better understand how such work is resourced and to consider how policy and funding frameworks might more formally support it.

Description:Background and Objectives: Despite increasing urbanisation, little is known about skin health for urban-living Aboriginal children and young people (CYP, aged <18 years). This study aimed to investigate the primary care burden and clinical characteristics of skin conditions in this cohort. Method: A one-year retrospective cohort study of urban-living Aboriginal CYP presenting for general practitioner (GP) consultation at an Aboriginal Community Controlled Health Organisation (ACCHO) was conducted. Results: At least one dermatological diagnosis was made in 27% (253/939) of GP face-to-face consultations for the 585 urban-living Aboriginal CYP included. Infections and dermatitis accounted for 54% (152/284) and 18% (50/284) of all dermatological diagnoses, respectively. Bacterial skin infection (BSI) cumulative incidence was 13% (74/585; 95% CI 10-16%), with recurrent BSI affecting <1% (5/585; 95% CI 0.3-2%) and hospitalisation required in 1% (1/82; 95% CI 0.06-7%) of incident BSI cases. Discussion: We present a culturally secure, multidisciplinary skin health assessment model within an urban ACCHO, where dermatological conditions account for a significant proportion of GP workload.

Description:Background: The skin is the largest and most visible organ of the human body. As such, skin infections can have a significant impact on overall health, social wellbeing and self-image. In 2019, we published a systematic review of the treatment, prevention and public health control of skin infections including impetigo, scabies, crusted scabies and tinea in resource-limited settings where skin infections are endemic. This current review serves as an update to assess the evidence for treatment of these conditions as well as atopic dermatitis, molluscum contagiosum and head lice in endemic settings. The data from this systematic review have supported an update to the Australian National Healthy Skin guidelines. Methods: A systematic review was conducted using two separate searches in MEDLINE, PubMed, Embase, CINAHL, Cochrane and Web of Science. The first search was an update of the 2018 systematic review using the same search strategy for the same skin conditions to identify emerging literature from 2018 to 2022. The second search strategy used the same key terms but with the addition of atopic dermatitis, head lice and molluscum contagiosum from 1960 to 2022. Eligible studies included Indigenous peoples and populations in resource-limited settings with a diagnosis of impetigo, scabies, crusted scabies, tinea capitis, atopic dermatitis, molluscum contagiosum or who presented with head lice. Studies conducted in high-income countries were excluded. Articles were screened for inclusion independently by one author with a second group of reviewers independently double screening. Data extraction and an in-depth quality assessment conducted by one author and checked by two others. Results: Of 1466 original articles identified, 68 studies were included and key findings outlined for impetigo, scabies, crusted scabies, atopic dermatitis, head lice and molluscum contagiosum. Recommendations for each condition based on the available evidence are provided. Conclusions: The importance of assessing literature relevant to the populations with heavy burden of skin infections is outlined in this systematic review. We have summarised updates to this literature, which may benefit in developing guidelines for skin infection management similar to the National Healthy Skin Guidelines for Australia.

Description:Skin conditions most frequently encountered in paediatric practice include infections, infestations, atopic dermatitis, and acne. Skin of colour refers to skin with increased melanin and darker pigmentation, and reflects global racial and ethnic diversity. Managing skin conditions in skin of colour requires health equity nuance, which is rarely explicitly taught. Awareness of the demographic factors, social determinants of health, and cultural practices that affect prevalence, morphological differences, and treatment of skin conditions is imperative. In this Review, we present the burden and clinical features of the common childhood skin conditions impetigo, scabies, head lice, tinea, atopic dermatitis, and acne in skin of colour. Paediatricians play an important role in diagnosis and management of these conditions to improve quality of life and prevent downstream complications, but they require education around skin of colour. We also discuss the systemic and structural racism, and the environmental and socioeconomic disadvantage, that perpetuate skin health inequity in communities with skin of colour.