Itching for Change: Addressing the Burden of Eczema in Indigenous Canadian Communities

Written by: Sarah Kashkari

Reviewed by: Jessica Muha, Katie Kugler, and Ethan Bendayan

Introduction

Atopic dermatitis, otherwise known as eczema, is a chronic inflammatory skin condition that usually begins in early childhood. It can show up as intensely itchy, dry, red, or bumpy skin that can disrupt sleep and make everyday activities harder to manage. Eczema is the most common inflammatory skin disease worldwide, with roughly 9 in 10 cases starting before the age of 5 years old. 

For Indigenous families, context is everything. “Indigenous” refers to thousands of distinct First Nations, Inuit, and Métis communities, each with their own histories, languages, and needs. Across Canada, community surveys and health providers have found eczema to be one of the most common childhood conditions, often present alongside asthma and allergies. In some northern communities, estimates suggest that as many as 1 in 4 children may be affected, with many experiencing moderate to severe symptoms.

The Importance of Social Determinants of Health

Social determinants of health (SDOHs) are non-medical factors that influence health and medical outcomes (e.g., income and race/ethnicity). SDOHs are particularly relevant in eczema because it isn’t only about what’s happening inside the body; it’s also shaped by the world around us. Where people live, whether they have safe water, access to accurate and reliable health information, and whether they face systemic barriers such as racism, all make a difference. Together, these factors influence not only who develops eczema, but also how severe it becomes  and how easy or hard it is to treat. This is especially true in rural and remote Indigenous communities, where access to care and resources are often more limited.

In everyday life, this means that in many communities, when potable water isn’t guaranteed and homes are crowded, the basics of eczema care (e.g., gentle bathing, regular moisturizing) become harder to maintain. Work led by and focused on Indigenous peoples have flagged these barriers, along with the gaps in prevention and inconsistent treatment. In many northern and remote regions, getting access to a dermatologist can mean long waits and travel time. Although family doctors can handle the bulk of management, access to a specialist is incredibly important in more severe cases, particularly to prevent ER visits.  

And then there’s the bigger picture. For Indigenous people, structural racism shows up in everyday life, in underfunded neighborhoods, in homes that aren’t always safe or well-maintained, in wealth gaps that limit choices, and in healthcare resources that are harder to access. These barriers mean eczema can often be difficult to manage and flares can be harder to control.

While, genetics have an important part to play, social and environmental barriers are factors that can be addressed. This area is where anyone can make a difference. When we improve the basics, like access to a generic products and clean water, eczema becomes easier to control. Where people live and the systems around them affect more than the skin, they also shape sleep, mood, and mental health. These factors have been known to contribute to the cycle of quality-of-life impairment experienced by patients with eczema. Moreover, barriers to healthcare are prominent in northern and primarily Indigenous communities. For example, in 2020, there were only 25 physicians (of any kind) in the whole territory of Nunavut. Accessing a dermatologist in these communities is nearly impossible. That’s why advocacy is important: it can help equip patients with the information they need.

The Part We Don’t Always See

Eczema is more than “a rash.” Day after day, the itch, the lost sleep, the infections, and the treatments can pile up, leaving families exhausted. It can cause anxiety, low mood, irritability, trouble concentrating at school or work, and constant worry about the next flare. Due to the visibility of the condition, affected individuals may feel self-conscious or stigmatized, pushing people to step back from sports, friendships, or cultural events.

Families feel it too. Parents and caregivers have reported losing sleep, juggling appointments and school notes, and trying to make room in already tight budgets for moisturizers and medications, often while navigating systems that don’t feel welcoming or easy to understand. Over time, that stress piles up and can make flares worse, creating a loop that’s hard to break. Caring for eczema also means caring for mental health, with clear guidance, practical support, and culturally safe care for the whole family.

For Indigenous families, the pressures are even greater when care doesn’t feel culturally safe. Culturally safe care means care that feels respectful, welcoming and empowering to patients, while adopting community values. This includes plain-language materials that use everyday words like “eczema,” interpreters when needed, staff who understand Indigenous health, and space for traditional practices and family involvement. When care reflects culture and community, families feel seen and supported. Trust grows, stress eases, and people are more likely to reach out early and stick with treatment, making flares easier to prevent and manage.

What We Can Do Now

Here are the small, doable fixes that families and clinicians say help most.

1. Keep treatment simple. Eczema care works best when routines are easy to follow. Clear, picture-based instructions and prescriptions that last (e.g., large tubs of moisturizer) help families stay ahead of flares instead of falling behind. It is important to consider availability issues and ensure long-term access to the products that help.

2. Know what’s covered. For eligible First Nations and Inuit patients, the Non-Insured Health Benefits program may cover basic moisturizers when prescribed. This lowers costs and makes it easier for families to keep up with daily care.

3. Bring care closer. Virtual visits and teledermatology cut down on long trips and long waits. Following up in ways families prefer, like by phone or text, makes it easier to ask questions and get help sooner.

4. Make care culturally safe. Avoid medical jargon and offer translation. Invite Elders or family members into visits and train staff in Indigenous health. When care feels welcoming and respectful, people come sooner and stick with treatment.

5. Use your voice. Use your platform to show how the environment shapes flares such as housing, water, and transport. This helps funders and policymakers see where changes can be made and where investment is most needed.

A Hopeful Future

Indigenous clinicians, researchers, and communities are already leading the way through culturally safe education, tele-outreach clinics, and policy advocacy for housing and water. What families need now is support that’s practical, respectful, and fair. That kind of support doesn’t just mean calmer skin, it means protecting mental health and focusing on prevention so that patients can live burden-free.

References

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