Cutaneous infection and atopic dermatitis: the importance of early intervention in Indigenous children in Australia

Abstract

There are dramatic disparities in the life expectancy, health and healthcare access between Indigenous and non-Indigenous Australians. The burden of chronic disease is significantly elevated and contributed to by multiple socioeconomic determinants of health. Cutaneous disease, both infectious and inflammatory, have major contributions to the risk of developing chronic disease in later life and contributing to barriers to education, employment and healthcare. Atopic dermatitis (AD) is a common, burdensome inflammatory skin disease worldwide; however, a paucity of literature exists reviewing the prevalence in Indigenous Australians. Typical therapies of AD are time-consuming and burdensome and can be an additional barrier to treatment compliance. However, multiple novel targeted therapeutics now exist for the effective and safe management of AD which are demonstrated to reduce the risk of cutaneous infections. Effective early and prioritised access to such therapies in the setting of moderate to severe AD may represent a potential intervention, with downstream benefits in the development of chronic disease. Nevertheless, there are multiple outstanding questions regarding the safety of such therapies in the setting of endemic infections such as scabies and strongyloidiasis which require attention, as well as the practicalities for such therapies to be administered in rural and remote communities. Overall, the appreciation of the role of cutaneous inflammatory and infectious disease as a contributor to health disparities in Indigenous populations is sorely needed. Discussion regarding the risk-benefit and cost-efficacy of targeted therapeutics in moderate to severe AD and consideration of prioritised access to Indigenous patients in need should be undertaken as part of a wider health prevention strategy with community input.