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Eades LE, Sines J, Hoi AY, Liddle R, Kandane-Rathnayake R, Morand EF, Brady S, Rischmueller M, Vincent FB. Autoimmune rheumatic disease in Australian Aboriginal and Torres Strait Islander Peoples: What do we know? Semin Arthritis Rheum 2024; 65:152354. [PMID: 38237231 DOI: 10.1016/j.semarthrit.2023.152354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/11/2023] [Accepted: 12/18/2023] [Indexed: 03/22/2024]
Abstract
Autoimmune rheumatic disease (AIRD) is a collective term, which comprises a group of multisystem inflammatory autoimmune diseases, including connective tissue disease, chronic inflammatory arthritis, sarcoidosis and systemic vasculitis. Some AIRD are prevalent in the general population, and all can cause significant morbidity and reduced quality of life, with some increasing the risk of premature mortality, such as systemic lupus erythematosus (SLE), a connective tissue disease that is more prevalent and severe in Australian Aboriginal and Torres Strait Islander Peoples with high mortality rates. To ensure that management of AIRD can be optimised for all Australians, it is important that we understand the prevalence and potential phenotypic variations of AIRD across the Australian population. However, to date there have been few described cases of AIRD other than SLE in Aboriginal and Torres Strait Islander Peoples. In this review, we summarise what is known about AIRD other than SLE in Aboriginal and Torres Strait Islander Peoples, particularly with regards to prevalence, phenotype and disease outcomes, and highlight the current gaps in knowledge.
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Affiliation(s)
- Laura E Eades
- Centre for Inflammatory Diseases, Monash University, Clayton, Victoria 3168, Australia; Rheumatology Department, Monash Health, Clayton, Victoria 3168, Australia
| | - Jason Sines
- Department of Rheumatology, Royal Prince Alfred Hospital, Sydney NSW 2001, Australia
| | - Alberta Y Hoi
- Centre for Inflammatory Diseases, Monash University, Clayton, Victoria 3168, Australia; Rheumatology Department, Monash Health, Clayton, Victoria 3168, Australia
| | - Ruaidhri Liddle
- Primary and Public Health Care Central Australia, Alice Springs, Northern Territory 0870, Australia
| | | | - Eric F Morand
- Centre for Inflammatory Diseases, Monash University, Clayton, Victoria 3168, Australia; Rheumatology Department, Monash Health, Clayton, Victoria 3168, Australia
| | - Stephen Brady
- Rheumatology Department, Alice Springs Hospital, The Gap, Northern Territory 0870, Australia
| | - Maureen Rischmueller
- Rheumatology Department, Alice Springs Hospital, The Gap, Northern Territory 0870, Australia; Rheumatology Department, Royal Darwin Hospital, Tiwi, Northern Territory 0810, Australia; Discipline of Medicine, University of Adelaide, South Australia 5011, Australia; Rheumatology Department, The Queen Elizabeth Hospital, Woodville, South Australia 5011, Australia
| | - Fabien B Vincent
- Centre for Inflammatory Diseases, Monash University, Clayton, Victoria 3168, Australia.
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Ricciardo BM, Kessaris HL, Nannup N, Tilbrook D, Farrant B, Michie C, Hansen L, Douglas R, Walton J, Poore A, Whelan A, Barnett TC, Kumarasinghe PS, Carapetis JR, Bowen AC. Describing skin health and disease in urban-living Aboriginal children: co-design, development and feasibility testing of the Koolungar Moorditj Healthy Skin pilot project. Pilot Feasibility Stud 2024; 10:6. [PMID: 38200545 PMCID: PMC10782716 DOI: 10.1186/s40814-023-01428-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Indigenous children in colonised nations experience high rates of health disparities linked to historical trauma resulting from displacement and dispossession, as well as ongoing systemic racism. Skin infections and their complications are one such health inequity, with the highest global burden described in remote-living Australian Aboriginal and/or Torres Strait Islander (hereafter respectfully referred to as Aboriginal) children. Yet despite increasing urbanisation, little is known about the skin infection burden for urban-living Aboriginal children. More knowledge is needed to inform service provision, treatment guidelines and community-wide healthy skin strategies. In this pilot study, we aimed to test the feasibility and design of larger multi-site observational studies, provide initial descriptions of skin disease frequency and generate preliminary hypotheses of association. METHODS This project has been co-designed with local (Noongar) Elders to provide an Australian-first description of skin health and disease in urban-living Aboriginal children. In collaboration with an urban Aboriginal Community Controlled Health Organisation (Derbarl Yerrigan Health Service), we conducted a week-long cross-sectional observational cohort study of Aboriginal children (0-18 years) recruited from the waiting room. Participants completed a questionnaire, skin examination, clinical photos, and swabs and received appropriate treatment. We assessed the feasibility and impact of the pilot study. RESULTS From 4 to 8 October 2021, we recruited 84 Aboriginal children of whom 80 (95%) were urban-living. With a trusted Aboriginal Health Practitioner leading recruitment, most parents (or caregivers) who were approached consented to participate. Among urban-living children, over half (45/80, 56%) of parents described a current concern with their child's skin, hair and/or nails; and one-third (26/80, 33%) reported current itchy skin. Using a research-service model, 27% (21/79) of examined urban-living participants received opportunistic same-day treatment and 18% (14/79) were referred for later review. CONCLUSIONS This co-designed pilot study to understand skin health in urban-living Aboriginal children was feasible and acceptable, with high study participation and subsequent engagement in clinical care observed. Co-design and the strong involvement of Aboriginal people to lead and deliver the project was crucial. The successful pilot has informed larger, multi-site observational studies to more accurately answer questions of disease burden and inform the development of healthy skin messages for urban-living Aboriginal children.
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Affiliation(s)
- Bernadette M Ricciardo
- University of Western Australia, Crawley, WA, Australia.
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia.
- Fiona Stanley Hospital, Murdoch, WA, Australia.
- Perth Children's Hospital, Nedlands, WA, Australia.
| | - Heather-Lynn Kessaris
- Fiona Stanley Hospital, Murdoch, WA, Australia
- Perth Children's Hospital, Nedlands, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Noel Nannup
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Dale Tilbrook
- Telethon Kids Institute, Nedlands, WA, Australia
- Maalingup Aboriginal Gallery, Caversham, WA, Australia
| | - Brad Farrant
- University of Western Australia, Crawley, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Carol Michie
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Lorraine Hansen
- Derbarl Yerrigan Health Services Aboriginal Corporation, East Perth, WA, Australia
| | - Richelle Douglas
- Derbarl Yerrigan Health Services Aboriginal Corporation, East Perth, WA, Australia
| | - Jacinta Walton
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Ainslie Poore
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Alexandra Whelan
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Timothy C Barnett
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, University of Western Australia, Nedlands, WA, Australia
| | | | - Jonathan R Carapetis
- University of Western Australia, Crawley, WA, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Perth Children's Hospital, Nedlands, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Asha C Bowen
- University of Western Australia, Crawley, WA, Australia
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Nedlands, WA, Australia
- Perth Children's Hospital, Nedlands, WA, Australia
- Telethon Kids Institute, Nedlands, WA, Australia
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Willems A, Tapley A, Fielding A, Tng ETV, Holliday EG, van Driel ML, Ball JI, Davey AR, Patsan I, FitzGerald K, Spike NA, Magin PJ. Prevalence and Associations of General Practice Registrars' Management of Atopic Dermatitis: A Cross-Sectional Analysis from the Registrar Clinical Encounters in Training Study. Dermatol Pract Concept 2021; 11:e2021128. [PMID: 34631271 DOI: 10.5826/dpc.1104a128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2021] [Indexed: 10/31/2022] Open
Abstract
Introduction Atopic dermatitis (AD) is a chronic inflammatory condition which imposes substantial burden upon patients and their families. As a frequent primary care presentation, general practice (GP) trainees must develop adequate skills in AD diagnosis and management. Objectives We aimed to explore the prevalence and associations of GP registrars' management of patients with AD. Methods This study used data from the Registrar Clinical Encounters in Training (ReCEnT) project, an ongoing cohort study of the clinical and educational experience of Australian GP registrars. Registrar, patient, and consultation factors were independent variables in multivariable logistic regression with outcome factor 'diagnosis/problem being AD'. Results From 2010-2019, 2,783 registrars (96% response rate) provided data from 381,180 consultations. AD was encountered in 0.6% of consults. AD was more likely to be seen in patients aged 0-1 years and patients from a non-English speaking background. AD was less likely to be seen in Aboriginal or Torres Strait Islander patients. Learning goals were more likely to be generated for AD and these consultations were associated with registrars seeking information or assistance. AD was strongly associated with a medication being prescribed, of which the most prescribed medications were mild or moderate potency topical corticosteroids. Conclusions Our findings suggest that, similar to other dermatological presentations, registrars find AD challenging to manage. There may be some gaps in AD management knowledge and application.
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Affiliation(s)
- Anneliese Willems
- Eastern Victoria General Practice Training, Regional Training Organisation, Hawthorn, Victoria, Australia.,University of Melbourne, Department of General Practice and Primary Health Care, Berkeley Street, Carlton, Victoria, Australia
| | - Amanda Tapley
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 Mclntosh Drive, Mayfield West, NSW, Australia
| | - Alison Fielding
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 Mclntosh Drive, Mayfield West, NSW, Australia
| | - Er Tsing Vivian Tng
- Department of Dermatology, John Hunter Hospital, Newcastle, New Lambton Heights, NSW, Australia
| | - Elizabeth G Holliday
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, Australia
| | - Mieke L van Driel
- The University of Queensland Faculty of Medicine, Primary Care Clinical Unit, Faculty of Medicine, Level 8 Health Sciences Building, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Jean I Ball
- Hunter Medical Research Institute, Clinical Research Design, IT and Statistical Support Unit (CReDITSS), New Lambton, NSW, Australia
| | - Andrew R Davey
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 Mclntosh Drive, Mayfield West, NSW, Australia
| | - Irena Patsan
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 Mclntosh Drive, Mayfield West, NSW, Australia
| | - Kristen FitzGerald
- University of Tasmania Tasmanian School of Medicine, Hobart, TAS, Australia.,General Practice Training Tasmania, Regional Training Organisation, Hobart, TAS, Australia
| | - Neil A Spike
- Eastern Victoria General Practice Training, Regional Training Organisation, Hawthorn, Victoria, Australia.,University of Melbourne, Department of General Practice and Primary Health Care, Berkeley Street, Carlton, Victoria, Australia
| | - Parker J Magin
- University of Newcastle, School of Medicine and Public Health, University Drive, Callaghan, Newcastle, NSW, Australia.,GP Synergy, Regional Training Organisation, NSW & ACT Research and Evaluation Unit, 20 Mclntosh Drive, Mayfield West, NSW, Australia
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Williams C, Hunt J, Kern JS, Dunn R. A casemix study of patients seen within an urban Aboriginal Health Service dermatology clinic over a five-year period. Australas J Dermatol 2021; 62:331-335. [PMID: 34004028 DOI: 10.1111/ajd.13630] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 03/29/2021] [Indexed: 11/27/2022]
Abstract
This is the largest study of Aboriginal and Torres Strait Islander dermatologic presentations to an urban specialist clinic within a community-controlled health organisation. It adds to our understanding of Aboriginal and Torres Strait Islander dermatoepidemiology. Patient files were reviewed over the five-year audit period, with age, gender, Indigenous status, diagnosis, disease category, 'new' or 'review consultation' and 'did not attend' (DNA) data recorded. Our study shows that eczema and benign, pre-malignant or malignant neoplasms are the most common presentations for urban Aboriginal and Torres Strait Islander patients. Lupus erythematosus and cutaneous infections were less prominent in comparison to data from rural and remote populations. Overall, a broad casemix of dermatologic presentations was observed. Similar to other studies, adult male patients were under-represented. Most skin malignancies were diagnosed in this cohort; this, therefore, identifies a possible target for public health intervention. A high ratio of new to review patients is consistent with the clinic offering a consultation model of care facilitated by primary health-care providers' support within Aboriginal Community-Controlled Health Service. DNA rates in this study were lower than hospital outpatient rates in a comparative study and may be attributed to specialist dermatology care being offered in a more culturally sensitive environment. The dermatology clinic at the Victorian Aboriginal Health Services (VAHS) provides a good breadth of specialist dermatology care. The community health-care model could be replicated in centres elsewhere, including interstate, to help overcome barriers to specialist dermatology care experienced by Aboriginal and Torres Strait Islander populations. Additionally, this model improves trainee exposure and understanding of Aboriginal and Torres Strait Islander health.
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Affiliation(s)
- Crystal Williams
- Dermatology Department, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
- Victorian Aboriginal Health Service, Melbourne, Victoria, Australia
- Dermatology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jenny Hunt
- Victorian Aboriginal Health Service, Melbourne, Victoria, Australia
| | - Johannes S Kern
- Dermatology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Rebecca Dunn
- Victorian Aboriginal Health Service, Melbourne, Victoria, Australia
- Dermatology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Skin Health Institute, Carlton, Victoria, Australia
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Prevalence and predictors of vitamin D deficiency in a nationally representative sample of Australian Aboriginal and Torres Strait Islander adults. Br J Nutr 2021; 126:101-109. [PMID: 33028435 DOI: 10.1017/s0007114520003931] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D) concentration <50 nmol/l) is recognised as a public health problem globally. The present study details the prevalence and predictors of vitamin D deficiency in a nationally representative sample (n 3250) of Australian Aboriginal and Torres Strait Islander adults aged ≥18 years. We used data from the 2012-2013 Australian Aboriginal and Torres Strait Islander Health Survey (AATSIHS). Serum 25(OH)D concentrations were measured by liquid chromatography-tandem MS. Survey-weighted logistic regression models were used to determine the independent predictors of vitamin D deficiency. Approximately 27 % of adult AATSIHS participants were vitamin D deficient. Vitamin D deficiency was more prevalent in remote areas (39 %) than in non-remote areas (23 %). Independent predictors of vitamin D deficiency included assessment during winter (men, adjusted OR (aOR) 5·7; 95 % CI 2·2, 14·6; women, aOR 2·2; 95 % CI 1·3, 3·8) and spring (men, aOR 3·3; 95 % CI 1·4, 7·5; women, aOR 2·6; 95 % CI 1·5, 4·5) compared with summer, and obesity (men, aOR 2·6; 95 % CI 1·2, 5·4; women, aOR 4·3; 95 % CI 2·8, 6·8) compared with healthy weight. Statistically significant associations were evident for current smokers (men only, aOR 2·0; 95 % CI 1·2, 3·4), remote-dwelling women (aOR 2·0; 95 % CI 1·4, 2·9) and university-educated women (aOR 2·4; 95 % CI 1·2, 4·8). Given the high prevalence of vitamin D deficiency in this population, strategies to maintain adequate vitamin D status through safe sun exposure and dietary approaches are needed.
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Haggett MG, Tait CP. Five years of dermatological disease requiring specialist care in the Kimberley region of Western Australia. Australas J Dermatol 2020; 62:157-161. [PMID: 33247840 DOI: 10.1111/ajd.13500] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/22/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Epidemiological studies that document the burden of skin diseases in rural and remote regions of Australia are vital in ensuring proper health-care planning and management. The purpose of this study was to establish the burden of skin disease requiring specialist dermatology input for both the Aboriginal and non-Aboriginal communities in the Kimberley. METHODS A retrospective audit of all outpatient encounters with the primary Country Health Service visiting dermatology specialist in the Kimberley region between January 2012 and January 2017. RESULTS A total of 2281 encounters were recorded with 1459 unique patients seen. The most common disease categories seen in the general population were premalignant and malignant skin disease (40%), eczema and dermatitis (17%) and benign skin neoplasms (12%). Among Aboriginal patients, the most common conditions were eczema and dermatitis (19%), autoimmune connective tissue disease/rheumatological and autoinflammatory syndromes (17%), adnexal diseases (10%), pigmentary disorders (7%) and benign skin neoplasms (7%). CONCLUSION These findings can be used to enhance, direct and plan dermatological services for both the Aboriginal and non-Aboriginal populations in the Kimberley region.
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Affiliation(s)
| | - Clare P Tait
- Dermatology Specialist Group, Perth, Western Australia, Australia
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Sharma S, Lang C, Khadka J, Inacio MC. Association of Age-Related Cataract With Skin Cancer in an Australian Population. Invest Ophthalmol Vis Sci 2020; 61:48. [PMID: 32460312 PMCID: PMC7405762 DOI: 10.1167/iovs.61.5.48] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Purpose Ultraviolet radiation from sunlight contributes to age-related cataract and skin cancer. The EPHA2 gene is implicated in both these diseases. The purpose of this study was to determine whether age-related cataract and skin cancer are associated in a cohort of older Australians. Methods A cross-sectional study was performed using the Historical Cohort of the Registry of Senior Australians. Individuals aged ≥65 years or aged ≥50 years and of Aboriginal or Torres Strait Islander descent, who had an aged care eligibility assessment between July 2005 and June 2015, and had a history of cataract surgery and/or skin cancer according to the Australian Government Medicare Benefits Schedule dataset, during the 3-year period prior, were evaluated (N = 599,316). A multivariable logistic regression model was used to determine association and multiple hypothesis correction was employed. Results Of the evaluated individuals, 87,097 (14.5%) had a history of cataract and 170,251 (28.4%) a history of skin cancer. Among those with a history of cataract, 20,497 (23.5%), 1127 (1.3%), and 14,730 (16.9%) individuals had a concurrent history of keratinocyte, melanoma, and premalignant/solar keratosis, respectively. Those with a history of cataract were 19% more likely to have a history of skin cancer (odds ratio [OR], 1.19; 95% confidence interval [CI], (1.17–1.21). Co-occurrence of keratinocyte skin cancer was 16% (OR, 1.16; 95% CI, 1.14–1.18), melanoma 21% (OR, 1.21; 95% CI, 1.13–1.29), and premalignant/solar keratosis 19% (OR, 1.19; 95% CI, 1.17–1.22) more in the presence than absence of history of cataract. Conclusions Age-related cataract is positively associated with skin cancer and its subtypes, including premalignant lesions in an older Australian population.
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Slape DR, Saunderson RB, Tatian AHJ, Forstner DF, Estall VJ. Cutaneous malignancies in Indigenous Peoples of urban Sydney. J Med Imaging Radiat Oncol 2018; 63:244-249. [DOI: 10.1111/1754-9485.12832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 10/17/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Dana R‐ML Slape
- Department of Dermatology Liverpool Hospital Sydney New South Wales Australia
| | - Rebecca B Saunderson
- Department of Dermatology Royal North Shore Hospital Sydney New South Wales Australia
| | - Artiene HJ Tatian
- Department of Dermatology Liverpool Hospital Sydney New South Wales Australia
| | - Dion F Forstner
- Department of Radiation Oncology Liverpool Hospital Sydney New South Wales Australia
- Western Sydney University Sydney New South Wales Australia
- University of New South Wales Sydney New South Wales Australia
| | - Vanessa J Estall
- Department of Radiation Oncology Liverpool Hospital Sydney New South Wales Australia
- Western Sydney University Sydney New South Wales Australia
- University of New South Wales Sydney New South Wales Australia
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Velter C, Lenormand C, Kluger N. Dermatite atopique et maladies inflammatoires. Ann Dermatol Venereol 2018; 145S:IS3-IS24. [DOI: 10.1016/s0151-9638(18)30384-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Carr GF, Tait CP. Dermatological learning needs among aboriginal health workers in rural and remote Australia: A cross-sectional survey. Australas J Dermatol 2017; 59:e84-e86. [DOI: 10.1111/ajd.12658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Clare P Tait
- Department of Dermatology; Royal Perth Hospital; Perth Western Australia Australia
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