Healthcare Disparities in Atopic Dermatitis in Latin America: A Narrative Review

Abstract

Introduction Atopic dermatitis (AD) is a chronic, pruritic skin disease caused by a mixture of genetic, immunological, and environmental factors, characterized by periods of inflammation and remission. In Latin America (LA), the prevalence of AD ranges up to 25% in children and 1–3% in adults. The natural history of the disease for most patients is that AD goes into remission in adolescence and adult life. Only 10–30% of patients continue to have symptoms of the disease in adulthood. There are patients (3–4%) who have the onset of AD during adolescence or after adulthood. Those with limited access to healthcare services, such as diagnosis and treatment, have increased difficulties coping with AD. Healthcare disparities are a complex topic that include social, political, racial/ethnic, and geographical factors. Publications about healthcare disparities in AD in LA are scarce. As a result, recognizing and resolving healthcare inequalities is critical to improving the treatment and quality of life (QoL) of individuals with AD. Methods A panel of Latin American experts in dermatology and allergies was provided with a series of relevant questions to address before a multiday conference. During this conference, the entire group discussed and edited each narrative through numerous drafts and rounds of discussion until they reached a consensus. Results This paper examines the barriers to equal access to care and recommends realistic actions to overcome them. Inadequate disease knowledge, cultural and linguistic barriers, stigmatization, maldistribution of resources, absence of local clinical practice guidelines, arduous patient journey, and limited consultation time were identified as causes of health inequality. Conclusions Among the suggested solutions are enhanced education for healthcare professionals, patients, and the general public, a focus on underprivileged communities, telemedicine and telementoring, translators, multidisciplinary teams, and local living clinical practice guidelines.

Physician practices and attitudes towards atopic dermatitis in Latin America: A cross-sectional study

“…In Latin American (LA) countries, economic conditions may limit access to some therapies, leading AD specialists to choose the best available and accessible treatment, which may not always be the preferred one. 7 , 8 , 9 For example, in Ecuador, Paraguay, and Cuba, access to therapies such as biologicals and small molecules is limited due to their unavailability or high cost to patients. Additionally, access to medical consultation is limited in some LA populations due to geographical conditions, health system restrictions, or sociocultural aspects, making it difficult to apply recommendations and conduct adequate medical follow-up.…”

“…Most accepted recommendations for AD diagnosis and treatment management are based on studies involving European and North American populations, with few clinical trials including LA patients. 7 , 8 , 9 Despite this, most local guidelines in LA replicate the recommendations of the European and North American guidelines, with little consideration of regional aspects. The SLAAI 15 , 17 has considered various regional characteristics, including sociodemographic factors and access to diagnostic tests and treatment, when making recommendations.…”

“…The study had a descriptive design without a prior hypothesis, so we did not perform a statistical sample size calculation. Nevertheless, based on the results of previous surveys, 7 , 8 we considered that the inclusion of at least 5 physicians from different centers in each country was necessary to more accurately interpret the information and compare the results from the specialists from different countries.…”

“…On the other hand, most Latin American countries have a low per capita income, and in most of them, patients pay for their heath treatment. 7 , 8 , 9 Owing to these and other social challenges (eg, sociocultural aspects, patient beliefs, and healthcare systems limitations), adhering to treatment guidelines is difficult in most LA populations, and many patients with AD receive ineffective or inappropriate care. 7 , 8 , 9 In this article, we present a descriptive evaluation of the attitudes towards the diagnosis and management of AD in LA, and we also describe possible medical barriers and healthcare system particularities.…”

Health disparities in allergic diseases

“…Allergists and dermatologists generally make up a small proportion of medical doctors in North America, as well as developing countries [ 39 ]. Croce et al [ 40 ] found that caregivers believed their child's atopic dermatitis to be under better control when receiving care of a dermatologist.…”