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Open Access 19-10-2022 | Atopic Dermatitis | Review

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

Authors: Sami Jelousi, Divya Sharma, Andrew Alexis, Jenny E. Murase

Published in: Dermatology and Therapy | Issue 12/2022

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.

Wilson BN, Alexis A, Murase JE. Art of prevention: Atopic dermatitis in women and families of color-prevalence, recognition, and prevention. Int J Womens Dermatol. 2022;8(1):e014. Published 2022 Mar 29. https://doi.org/10.1097/JW9.0000000000000014

Janumpally SR, Feldman SR, Gupta AK, Fleischer AB Jr. In the United States, blacks and Asian/Pacific Islanders are more likely than whites to seek medical care for atopic dermatitis. Arch Dermatol. 2002;138(5):634–7. https://doi.org/10.1001/archderm.138.5.634 (PMID: 12020225).CrossRefPubMed

Shaw TE, Currie GP, Koudelka CW, Simpson EL. Eczema prevalence in the United States: data from the 2003 National Survey of Children’s Health. J Invest Dermatol. 2011;131(1):67–73. https://doi.org/10.1038/jid.2010.251.CrossRefPubMed

Ben-Gashir MA, Hay RJ. Reliance on erythema scores may mask severe atopic dermatitis in black children compared with their white counterparts. Br J Dermatol. 2002;147:920–9256.CrossRefPubMed

Martinez A, de la Rosa R, Mujahid M, Thakur N. Structural racism and its pathways to asthma and atopic dermatitis. J Allergy Clin Immunol. 2021;148(5):1112–20. https://doi.org/10.1016/j.jaci.2021.09.020.CrossRefPubMedPubMedCentral

UNHCR: Figures at a Glance. https://www.unhcr.org/en-us/figures-at-a-glance.html. Accessed June 25

UNHCR Refugee data finder. https://www.unhcr.org/refugee-statistics/download/?url=iTKd65. Accessed June 25

The UN Refugee Agency USA. Refugee facts, what is a refugee. UNHCR website. https://www.unrefugees.org/refugee-facts/what-is-a-refugee/. Accessed June 2, 2022.

Refugees and Migrants Definitions. https://refugeesmigrants.un.org/definitions. Accessed June 2, 2022.

10.

UNHCR ’Refugees’ and ‘Migrants-Frequently Asked Questions (FAQs). 2016. https://www.unhcr.org/en-us/news/latest/2016/3/56e95c676/refugees-migrants-frequently-asked-questions-faqs.html. Accessed June 2, 2022.

11.

UNHCR: Asylum-Seekers. https://www.unhcr.org/asylum-seekers.html Accessed June 2, 2022.

12.

Internally Displaced People. https://www.unhcr.org/en-us/internally-displaced-people.html. Accessed June 2, 2022.

13.

El-Khatib Z, Scales D, Vearey J, et al. Syrian refugees, between rocky crisis in Syria and hard inaccessibility to healthcare services in Lebanon and Jordan. Confl Health. 2013;7:18. https://doi.org/10.1186/1752-1505-7-18.CrossRefPubMedPubMedCentral

14.

Knapp A, Rehmus W, Chang A. Skin diseases in displaced populations: a review of contributing factors, challenges, and approaches to care. Int J Dermatol. 2020;59:1299–311.CrossRefPubMed

15.

Saikal SL, Ge L, Mir A, Pace J, Abdulla H, Leong KF, Benelkahla M, Olabi B, Medialdea-Carrera R, Padovese V. Skin disease profile of Syrian refugees in Jordan: a field-mission assessment. J Eur Acad Dermatol Venereol. 2020;34(2):419–25.CrossRefPubMed

16.

Wollina U, Gaber B, Mansour R, et al. Dermatological challenges of health care for displaced people: lessons from a German emergency refugee camp. Our Dermatol Online. 2016;7:136–8.CrossRef

17.

Eugenia DM, Anteo DN, Loredana MA, Antonio F, Gianfranco C, Alessandra R, Concetta M, Alessio P, The INMP Team. Infectious and dermatological diseases among arriving migrants on the Italian coasts. Eur J Pub Health. 2018;28(5):910–916

18.

Kibar ÖM. Skin diseases in rural Nyala, Sudan (in a rural hospital, in 12 orphanages, and in two refugee camps). Int J Dermatol. 2019;58(11):1341–9. https://doi.org/10.1111/ijd.14619 (Epub 2019 Sep 9 PMID: 31498882).CrossRef

19.

Valeska P, Ada ME, Tanya MF, Marika PC, Daniele D, Gianfranco C, Concetta M. Migration and determinants of health: clinical epidemiological characteristics of migrants in Malta (2010–11). J Public Health. 2014;36(3): 368–374

20.

Kaufman BP, Guttman-Yassky E, Alexis AF. Atopic dermatitis in diverse racial and ethnic groups-variations in epidemiology, genetics, clinical presentation and treatment. Exp Dermatol. 2018;27(4):340–57. https://doi.org/10.1111/exd.13514 (PMID: 29457272).CrossRefPubMed

21.

Richter JC, Jakobsson K, Taj T, et al. High burden of atopy in immigrant families in substandard apartments in Sweden—on the contribution of bad housing to poor health in vulnerable populations. World Allergy Organ J. 2018;11:9.CrossRefPubMedPubMedCentral

22.

Alnsour J, Meaton J. Housing conditions in Palestinian refugee camps, Jordan. Cities. 2014;36:65–73.CrossRef

23.

Al-Khatib IA, et al. Impact of housing conditions on the health of the people at al-Ama'ri refugee camp in the West Bank of Palestine. Int J Environ Health Res. 2003;13.4: 315–326.

24.

Habib RR, Basma SH, Yeretzian JS. Harboring illnesses: on the association between disease and living conditions in a Palestinian refugee camp in Lebanon. Int J Environ Health Res. 2006;16(2):99–111.CrossRefPubMedPubMedCentral

25.

Tamagawa-Mineoka R, Norito K. Atopic dermatitis: identification and management of complicating factors. Int J Mol Sci. 2020;21(8):2671. https://doi.org/10.3390/ijms21082671

26.

Mumcuoglu KY, et al. Asthma in Gaza refugee camp children and its relationship with house dust mites. Ann Allergy. 1994;722:163–6.

27.

Al Khatib IA, Hasan T. Housing conditions and health in jalazone refugee camp in palestine. EMHJ-Eastern Mediterran Health J. 2006;12(1–2), 144–152

28.

Murota H, Takahashi A, Nishioka M, Matsui S, Terao M, Kitaba S, Katayama I. Showering reduces atopic dermatitis in elementary school students. Eur J Dermatol. 2010;20:4104–11. https://doi.org/10.1684/ejd.2010.0928.CrossRef

29.

Mochizuki H, Muramatsu R, Tadaki H, Mizuno T, Arakawa H, Morikawa A. Effects of skin care with shower therapy on children with atopic dermatitis in elementary schools. Pediatr Dermatol. 2009;26:223–5. https://doi.org/10.1111/j.1525-1470.2009.00887.CrossRefPubMed

30.

Morrone A, Roderick H, Bernard N (eds). Skin Disorders in Migrants. Springer International Publishing. 2020.

31.

Wang V, Boguniewicz J, Boguniewicz M, Ong PY. The infectious complications of atopic dermatitis. Ann Allergy Asthma Immunol. 2021;126(1):3–12. https://doi.org/10.1016/j.anai.2020.08.002.CrossRefPubMed

32.

Romani L, Steer AC, Whitfeld MJ, et al. Prevalence of scabies and impetigo worldwide: a systematic review. Lancet Infect Dis. 2015;15:960–7. https://doi.org/10.1016/S1473-3099(15)00132-2.CrossRefPubMed

33.

Mason DS, Marks M, Sokana O, et al. The prevalence of scabies and impetigo in the Solomon Islands: a population-based survey. PLoS Negl Trop Dis. 2016;10:e0004803. https://doi.org/10.1371/journal.pntd.0004803

34.

Ibrahim F, Khan T, Pujalte GG. Bacterial skin infections. Prim Care. 2015;42:485–99. https://doi.org/10.1016/j.pop.2015.08.001.CrossRefPubMed

35.

Lapeere H, Naeyaert JM, De Weert J, et al. Incidence of scabies in Belgium. Epidemiol Infect. 2008;136:395–8.CrossRefPubMed

36.

Bottoni U, Dianzani C, Rossi ME, et al. Skin diseases in immigrants seen as outpatients in the Institute of Dermatology of the University of Rome “La Sapienza” from 1989 to 1994. Eur J Epidemiol. 1998;14:201–4.CrossRefPubMed

37.

Cheng, HM, Sujith PK. Dermatological problems of asylum seekers arriving on boats: a case report from A ustralia and a brief review. Aust J Dermatol. 2014;55.4: 270–274.

38.

Padovese V, Knapp A. Challenges of managing skin diseases in refugees and migrants. Dermatol Clin. 2021;39(1):101–15.CrossRefPubMed

39.

Knapp AP, Rehmus W, Chang AY. Skin diseases in displaced populations: a review of contributing factors, challenges, and approaches to care. Int J Dermatol. 2020;59(11):1299–311.CrossRefPubMed

40.

Tempark T, Lueangarun S, Chatproedprai S, et al. Flood-related skin diseases: a literature review. Int J Dermatol. 2013;52:1168–76.CrossRefPubMed

41.

UNHCR: Climate change and disaster displacement. Accessed 10 June 2022. Available from: https://www.unhcr.org/en-us/climate-change-and-disasters.html

42.

Eberlein-König B, Przybilla B, Kühnl P, et al. Influence of airborne nitrogen dioxide or formaldehyde on parameters of skin function and cellular activation in patients with atopic eczema and control subjects. J Allergy Clin Immunol. 1998;101(1 Pt 1):141–3.CrossRefPubMed

43.

Song S, Lee K, Lee YM, et al. Acute health effects of urban fine and ultrafine particles on children with atopic dermatitis. Environ Res. 2011;111:394–9.CrossRefPubMed

44.

Kim EH, Kim S, Lee JH, et al. Indoor air pollution aggravates symptoms of atopic dermatitis in children. PLoS One. 2015;10: e0119501.CrossRefPubMedPubMedCentral

45.

Kathuria P, Silverberg JI. Association of pollution and climate with atopic eczema in US children. Pediatr Allergy Immunol. 2016;27(5):478–85. https://doi.org/10.1111/pai.12543 (Epub 2016 May 13 PMID: 26842875).CrossRefPubMed

46.

Yanagisawa R, Koike E, Takano H. Benzo[a]pyrene aggravates atopic dermatitis-like skin lesions in mice. Hum Exp Toxicol. 2021;40(12_suppl):S269–S277. (Epub 2021 Aug 23. PMID: 34424081). https://doi.org/10.1177/09603271211036123.

47.

Takenaka H, Zhang K, Diaz-Sanchez D, Tsien A, Saxon A. Enhanced human IgE production results from exposure to the aromatic hydrocarbons from diesel exhaust: direct effects on B-cell IgE production. J Allergy Clin Immunol. 1995;95(1 Pt 1):103–15. https://doi.org/10.1016/s0091-6749(95)70158-3 (PMID: 7529782).CrossRefPubMed

48.

Liu H, Xu C, Jiang ZY, Gu A. Association of polycyclic aromatic hydrocarbons and asthma among children 6–19 years: NHANES 2001–2008 and NHANES 2011–2012. Respir Med. 2016;110:20–7. https://doi.org/10.1016/j.rmed.2015.11.003 (Epub 2015 Nov 10 PMID: 26626452).CrossRefPubMed

49.

Fadadu RP, Grimes B, Jewell NP, Vargo J, Young AT, Abuabara K, Balmes JR, Wei ML. Association of wildfire air pollution and health care use for atopic dermatitis and itch. JAMA Dermatol. 2021;157(6):658–66. https://doi.org/10.1001/jamadermatol.2021.0179.PMID:33881450;PMCID:PMC8060890.CrossRefPubMed

50.

Manisalidis I, Stavropoulou E, Stavropoulos A, Bezirtzoglou E. Environmental and health impacts of air pollution: a review. Front Public Health. 2020;20(8):14. https://doi.org/10.3389/fpubh.2020.00014.PMID:32154200;PMCID:PMC7044178.CrossRef

51.

Park H. The Power of Cities. United Nations High Commissioner for Refugees Innovation [Internet]. 2016 Nov 25. Available from: https://www.unhcr.org/innovation/the-power-of-cities/#:~:text=Displaced%20populations%20are%20also%20part,employment%20and%20access%20to%20services.

52.

Fölster-Holst R, Galecka J, Weißmantel S, et al. Birch pollen influence the severity of atopic eczema—prospective clinical cohort pilot study and ex vivo penetration study. Clin Cosmet Investig Dermatol. 2015;29:539–48.

53.

Luschkova D, Zeiser K, Ludwig A, Traidl-Hoffmann C. Atopic eczema is an environmental disease. Allergol Select. 2021;5:244–250. (Published 2021 Aug 23). https://doi.org/10.5414/ALX02258E

54.

IPCC, 2022. Summary for Policymakers [Pörtner H-O, Roberts DC, Poloczanska ES, Mintenbeck K, Tignor M, Alegría A, Craig M, Langsdorf S, Löschke S, Möller V, Okem A (eds)]. In: Climate Change 2022: Impacts, Adaptation, and Vulnerability. Contribution of Working Group II to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change [Pörtner H-O, Roberts DC, Tignor M, Poloczanska ES, Mintenbeck K, Alegría A, Craig M, Langsdorf S, Löschke S, Möller V, Okem A, Rama B (eds.)]. Cambridge University Press. In Press.

55.

Cruz J, White PCL, Bell A, Coventry PA. Effect of extreme weather events on mental health: a narrative synthesis and meta-analysis for the UK. Int J Environ Res Public Health. 2020;17(22):8581. (Published 2020 Nov 19). https://doi.org/10.3390/ijerph17228581

56.

Chen NT, Chen MJ, Wu CD, Guo YL. Emergency room visits for childhood atopic dermatitis are associated with floods? Sci Total Environ. 2021;773:145435. (Epub 2021 Jan 28. PMID: 33940726). https://doi.org/10.1016/j.scitotenv.2021.145435

57.

Schachtel A, Dyer JA, Boos MD. Climate change and pediatric skin health [published correction appears. Int J Womens Dermatol. 20228;7(5Part B):867]. Int J Womens Dermatol. 2020;7(1):85–90. (Published 2020 Jul 24). https://doi.org/10.1016/j.ijwd.2020.07.006

58.

Lee SH, Choi CP, Eun HC, Kwon OS. Skin problems after a tsunami. J Eur Acad Dermatol Venereol. 2006;20(7):860–3. https://doi.org/10.1111/j.1468-3083.2006.01666.x (PMID: 16898911).CrossRefPubMed

59.

Dayrit JF, Bintanjoyo L, Andersen LK, Davis MDP. Impact of climate change on dermatological conditions related to flooding: update from the International Society of Dermatology Climate Change Committee. Int J Dermatol. 2018;57(8):901–10. https://doi.org/10.1111/ijd.13901 (Epub 2018 Jan 29 PMID: 29377078).CrossRefPubMed

60.

Lee YL, Su HJ, Sheu HM, Yu HS, Guo YL. Traffic-related air pollution, climate, and prevalence of eczema in Taiwanese school children. J Invest Dermatol. 2008;128(10):2412–20. https://doi.org/10.1038/jid.2008.110.CrossRefPubMed

61.

Dayrit JF, Sugiharto A, Coates SJ, Lucero-Prisno DE 3rd, Davis MDD, Andersen LK. Climate change, human migration, and skin disease: is there a link? Int J Dermatol. 2022;61(2):127–38. https://doi.org/10.1111/ijd.15543.CrossRefPubMed

62.

Fazel M, Wheeler J, Danesh J. Prevalence of serious mental disorder in 7000 refugees resettled in western countries: a systematic review. Lancet. 2005;365(9467):1309–14.CrossRefPubMed

63.

Porter M, Haslam N. Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. JAMA. 2005;294(5):602–12.CrossRefPubMed

64.

Tempany M. What research tells us about the mental health and psychosocial wellbeing of Sudanese refugees: a literature review. Transcult Psychiatry. 2009;46(2):300–15.CrossRefPubMed

65.

Silove D, Sinnerbrink I, Field A, Manicavasagar V, Steel Z. Anxiety, depression and PTSD in asylum-seekers: associations with pre-migration trauma and post-migration stressors. Br J Psychiatry. 1997;170:351–7.CrossRefPubMed

66.

Momartin S, Silove D, Manicavasagar V, Steel Z. Comorbidity of PTSD and depression: associations with trauma exposure, symptom severity and functional impairment in Bosnian refugees resettled in Australia. J Affect Disord. 2004;80(2–3):231–8. https://doi.org/10.1016/S0165-0327(03)00131-9.CrossRefPubMed

67.

Lindert J, Ehrenstein OS, Priebe S, Mielck A, Brähler E. Depression and anxiety in labor migrants and refugees—a systematic review and meta-analysis. Soc Sci Med. 2009;69(2):246–57.CrossRefPubMed

68.

Bogic M, Njoku A, Priebe S. Long-term mental health of war-refugees: a systematic literature review. BMC Int Health Hum Rights. 2015;28(15):29. https://doi.org/10.1186/s12914-015-0064-9.PMID:26510473;PMCID:PMC4624599.CrossRef

69.

Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M. Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA. 2009;302(5):537–49.CrossRefPubMed

70.

Li SSY, Liddell BJ, Nickerson A. The relationship between post-migration stress and psychological disorders in refugees and asylum seekers. Curr Psychiatry Rep. 2016;18:82.CrossRefPubMed

71.

Hashizume H, Horibe T, Ohshima A, Ito T, Yagi H, Takigawa M. Anxiety accelerates T-helper 2-tilted immune responses in patients with atopic dermatitis. Br J Dermatol. 2005;152:1161–4.CrossRefPubMed

72.

Hashiro M, Okumura M. The relationship between the psychological and immunological state in patients with atopic dermatitis. J Dermatol Sci. 1998;16:231–5.CrossRefPubMed

73.

Katoh N, Ohya Y, Ikeda M, Ebihara T, Katayama I, Saeki H, Shimojo N, Tanaka A, Nakahara T, Nagao M, et al. Clinical practice guidelines for the management of atopic dermatitis 2018. J Dermatol. 2019;46:1053–101. https://doi.org/10.1111/1346-8138.15090.CrossRefPubMed

74.

Kang C, Tomkow L, Farrington R. Access to primary health care for asylum seekers and refugees: a qualitative study of service user experiences in the UK. Br J Gen Pract. 2019;69(685):e537–e545. (Epub 2019 Feb 11. PMID: 30745354; PMCID: PMC6617541). https://doi.org/10.3399/bjgp19X701309.

75.

Iqbal MP, Walpola R, Harris-Roxas B, Li J, Mears S, Hall J, Harrison R. Improving primary health care quality for refugees and asylum seekers: a systematic review of interventional approaches. Health Expect. 2021. (Epub ahead of print. PMID: 34651378). https://doi.org/10.1111/hex.13365

76.

Bartovic J, Padovese V, Pahlman K. Addressing the challenges to skin health of refugees and migrants in the WHO European region. Trop Med Int Health. 2021;26(5):602–6. https://doi.org/10.1111/tmi.13552 (Epub 2021 Feb 15 PMID: 33471432).CrossRefPubMed

77.

Lebano A, Hamed S, Bradby H, Gil-Salmerón A, Durá-Ferrandis E, Garcés-Ferrer J, Azzedine F, Riza E, Karnaki P, Zota D, Linos A. Migrants’ and refugees’ health status and healthcare in Europe: a scoping literature review. BMC Public Health. 2020;20(1):1039. https://doi.org/10.1186/s12889-020-08749-8.PMID:32605605;PMCID:PMC7329528.CrossRefPubMedPubMedCentral

78.

European Union Agency for Fundamental Rights. Migrants in an irregular situation: access to healthcare in 10 European Union Member States. Vienna: European Union Agency for Fundamental Rights; 2011.

79.

Legido-Quigley H, Pajin L, Fanjul G, Urdaneta E, McKee M. Spain shows that a humane response to migrant health is possible in Europe. Lancet Public Health. 3(8):e358. (Epub 2018 Jul 3. PMID: 29980489). https://doi.org/10.1016/S2468-2667(18)30133-6

Title: The Impact of Global Health Disparities on Atopic Dermatitis in Displaced Populations: Narrowing the Health Equity Gap for Patients with Skin of Color
Authors: Sami Jelousi
Divya Sharma
Andrew Alexis
Jenny E. Murase
Publication date: 19-10-2022
Publisher: Springer Healthcare
Keywords: Atopic Dermatitis
Climate Change
Published in: Dermatology and Therapy / Issue 12/2022
Print ISSN: 2193-8210
Electronic ISSN: 2190-9172
DOI: https://doi.org/10.1007/s13555-022-00823-w

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