Prevalence and Characteristics of North American Indigenous Inflammatory Skin Disease: A Systematic Scoping Review

Chronic inflammatory skin diseases (CISD) including atopic dermatitis (AD), psoriasis, and hidradenitis suppurativa (HS) are chronic conditions contributing to health inequities. Their burden among North American Indigenous peoples remains poorly characterized. This scoping review assessed Indigenous representation in clinical research, Phase III/IV trials, and practice guidelines on CISD in Canada and the United States, identifying evidence gaps and proposing strategies to enhance inclusion. Following PRISMA-ScR methodology, MEDLINE, Embase, CINAHL, Cochrane Library, Indigenous-focused databases, and gray literature were searched from inception to May 2022. Phase III/IV therapeutic trials for AD and psoriasis (2011-2021) were reviewed separately to evaluate reporting of Indigenous participants and North American guidelines were screened for Indigenous considerations. Of 49 studies included, 39% specifically focused on Indigenous populations of primarily pediatric, rural, and remote Canadian cohorts. Prevalence estimates for AD among Indigenous children ranged from 10% to 25%, with frequent comorbid asthma. Data on psoriasis suggested potentially higher morbidity among First Nations populations, while HS evidence was extremely limited. Indigenous representation was minimal in clinical trials (1.3% of total participants reported under Indigenous categories across included Phase III/IV therapeutic trial reports for AD and psoriasis), and only one recent guideline explicitly incorporated Indigenous perspectives. Overall certainty in burden estimates was low, especially for psoriasis and HS. To address these gaps, key recommendations include consistent reporting of Indigenous identity, setting recruitment targets in trials, supporting Indigenous-led cohorts and registries, and integrating Indigenous and remote care expertise into guidelines. Advancing CISD research and clinical equity requires alignment with Indigenous data sovereignty and governance principles.