The Impact of Global Health Disparities on Atopic Dermatitis in Displaced Populations: Narrowing the Health Equity Gap for Patients with Skin of Color

Abstract

Atopic dermatitis (AD) is a relatively common inflammatory skin disease marked by eczematous lesions and pruritus often leading to significant morbidity and quality of life impairment for those affected. Recent studies have shown that patients with skin of color (SOC) carry a larger disease burden than patients of European descent. In the USA, these disparities are partly due to structural, environmental, and interpersonal racism. From a global perspective, there is a paucity of research on the burden of atopic dermatitis and other inflammatory skin diseases experienced by the record numbers of refugees, migrants, and asylum seekers around the world. Although it is still unclear whether the true prevalence of AD in displaced communities is higher compared with the general population, those who are displaced suffer from unique risk factors that render them especially vulnerable. In this review, we outline a number of factors contributing to AD susceptibility and/or aggravation in displaced communities. These include poor living conditions, climate change events, psychological stress, and lack of access to medical care and health-related behaviors.

Impact of climate change on atopic dermatitis: A review by the International Eczema Council

“…For example, displaced people, including refugees, migrants, asylum seekers, and internally displaced people, are at the “frontlines of the climate emergency” according to the United Nations High Commissioner for Refugees 65 . Climate change both increases the number of displaced people and can exacerbate health issues for this population who have more limited resources and are less prepared to handle extreme weather events 66 . Studies suggest that the prevalence of dermatitis/eczema ranges from 10.5% in a study conducted in rural Sudan 67 to as high as 33% of Syrian refugees in Jordan 68 .…”

“…Increasing incidence of extreme weather events disrupts predictable seasonal patterns and consequently challenges patients' self‐management of AD 35 . At community level, interrupted medication access in communities affected by extreme weather events not only destabilizes preexisting disease but may also prevent early and effective management of new cases 66 . Sudden therapy interruption, particularly of systemic agents, and delayed treatment are risk factors for complications such as superinfected and/or erythrodermic AD 72,73 .…”

“…35 At community level, interrupted medication access in communities affected by extreme weather events not only destabilizes preexisting disease but may also prevent early and effective management of new cases. 66 Sudden therapy interruption, particularly of systemic agents, and delayed treatment are risk factors for complications such as superinfected and/or erythrodermic AD. 72,73 The cumulative impact of the above considerations should be reflected in the planning and provision of dermatology services.…”

“…Climate change both increases the number of displaced people and can exacerbate health issues for this population who have more limited resources and are less prepared to handle extreme weather events 66. Studies suggest that the prevalence of dermatitis/eczema ranges from 10.5% in a study conducted in rural Sudan67 to as high as 33% of Syrian refugees in Jordan 68.…”

The Burden of Air Pollution on Skin Health: a Brief Report and Call to Action

“…The current levels of harmful particulates in the air leading to exacerbations of diseases like AD and asthma mirror the essence of that theory [ 26 , 34 ]. Additionally, miasmas were particularly associated with the spread of disease among the poor [ 35 ], and the socioeconomic factors and environmental inequities that made those groups in the eighteenth century more prone to cholera make some in the twenty-first century more vulnerable to the effects of air pollution, including poor living conditions, greater exposure to natural disaster events, psychological stress, and a lack of access to medical care [ 36 ]. Recent research has shown that households near roadways and with frequently open windows, both more common in low-income households lacking air conditioning units, are exposed to significantly higher levels of indoor air pollution [ 37 ].…”