Dermatology in the North: Barriers to Dermatological Care and Opportunity for Virtual Pathways in Northern and Rural Canadian Indigenous Communities

Original Article: Understanding Burdens and Barriers to Dermatological Management, and Potential for Virtual Care in Northern and Rural Canadian Indigenous Communities: A National Healthcare Practitioner Cross-Sectional Survey Analysis

What are the key takeaways of this article?

Northern and Rural Canadian Indigenous communities (NRCIC) face long-standing systemic inequities, mainly rooted in colonial history, geographic isolation, and limited local resources. These factors contribute to major challenges in accessing both primary and specialty care in these communities. The COVID-19 pandemic worsened access by further reducing services and extending wait times. Dermatologic challenges in NRCIC remain underrecognized, costly to both families and the healthcare system. Therefore, these challenges urgently require better characterization. 

In this mixed-methods national survey of 50 healthcare practitioners (HCPs), the authors assessed the burden of skin disease, barriers to dermatology access, impacts of the pandemic, and the role of virtual care in NRCICs. The survey revealed a high burden of moderate-to-severe skin disease in NRCICs, especially atopic dermatitis, bacterial skin infections, and diabetic skin complications, which are frequently inadequately managed due to resource limitation. HCPs identified major barriers such as proximity to care, limited supply and access to therapies, socioeconomic constraints, cultural barriers, and long specialist wait times.

Although the COVID-19 pandemic improved access by expanding virtual care, its impact was limited in NRCICs by poor internet connectivity, inadequate photo quality, and difficulty with follow-up. Some felt that virtual care could not replace in-person care and may even delay proper treatment of high-risk patients. Survey respondents supported solutions such as more in-person dermatology visits to NRCICs, more dermatologic training for HPCs in rural communities, dedicated care coordinators, increased virtual care capacity, and improved cultural awareness of Indigenous therapies. 

In summary, this study highlights significant gaps in dermatologic care in NRCICs. The findings point to a system strained by geographic isolation, limited resources, long wait times, and cultural and socioeconomic barriers—all of which compound disease severity and impede timely, effective care. Virtual care has proven to be helpful, but cannot replace the need for a robust infrastructure with in-person specialist access. These results emphasize the need for a multifaceted, community-centred approach that improves cultural safety, expands both virtual and in-person dermatology services in NRCICs, and meaningfully engages Indigenous leadership.

Publication Date: May 29th, 2025

Reference: Asiniwasis R, Merati N, Lukmanji A, Odeshi O, Eglington T, Phillips Z, Hinther K, Waller B, Van Eaton M, Richels L, Dixon E, Jack C, Chu DK, Campbell T, Pandey M. Understanding burdens and barriers to dermatological management, and potential for virtual care in Northern and Rural Canadian Indigenous communities: A national healthcare practitioner cross-sectional survey analysis. International Journal of Indigenous Health. 2024; 20(1). https://doi.org/10.32799/ijih.v20i1.42156

Summary By: April Foote