Healthy Skin Workshop

A/Prof Asha BowenHead, Skin Health, Telethon Kids Institute

asha.bowen@telethonkids.org.au

International Meeting on Indigenous Child Health, 22 – 24 March 2019

Acknowledgements

Faculty/Presenter Disclosure

• In the past 12 months, Dr Asha Bowen has no relevant financial relationships with the manufacturer(s) of commercial services discussed in this CME activity

• I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

• All of the photos used are consented for use in presentations and online. Where possible, the communities represented want to present images of Healthy Skin. We have attempted throughout to frame all images in a positive light to reflect this important strengths based approach to achieving healthy skin.

Learning Objectives

1. Identify different types of skin infections including scabies, skin sores and crusted scabies

2. Understand the importance of community consultation and strategies to partner in research that is important for improving Indigenous health outcomes

3. Understand the integration of health promotion and environmental health into programs for skin infection control

Adapted from Engelman et al PLoS NTD 2013

Australian Aboriginal Children are:

• World Leaders for impetigo prevalence (median 45%)1,3

• Top 5 for scabies prevalence (median 10 – 25%)1,2,3

1Bowen et al PLOS One 2015; 2Romani et al Lancet Inf Dis 2014; 3May et al MJA 2016

Systematic Review Reference

SR commissioned by Kimberley Aboriginal Health Planning Forum to inform skin treatment in the context of a region-wide APSGN outbreak affecting >130 children (~2% of Aboriginal childhood population)

May et al TMIH 2019

May et al TMIH 2019

National Healthy Skin Guideline

Mr Glenn Pearson, Head Aboriginal Programs, Telethon Kids Institute, Dr Asha Bowen and National Indigenous Health Minister, Mr Ken Wyatt launching the Guideline 2 May 2018

www.telethonkids.org.au/skin-guidelines

• Free to download, print, share, use & train health care workers

• Endorsed by 18 Aus organisations• >2500 views • >850 downloads• >200 quiz completions

See, Treat, Prevent Skin Sores &

Scabies

What is SToP about?

Treat: Clinic

Prevent: Community

See:School

SeeSores

ScabiesCrusted Scabies

Measure height

See: At School

Treat: Skin sores

Penicillin needle Medicine to drink

Old way

75.00

80.00

85.00

90.00

95.00

100.00

105.00

Treatment success Clinical success Sore resolution

Day 7 results

BPG SXT3 SXT5 SXT

Day 0

(pre-Rx)

Day 2

(2 doses SXT)

Day 7

(5 doses SXT)

Treat: Scabies and Crusted Scabies

Lyclear cream Ivermectin tablet medicine

Old way

0

5

10

15

20

25

30

35

40

45

Baseline 12 months Baseline 12 months

Scabies Impetigo

Pre

vale

nce

(%

)

Standard Permethrin Ivermectin

94% reduction

67% reduction

Prevent: at homeEnvironmental health is the Key!

Prevent: in the community Environmental health is the key!

• Moisturise dry, cracked skin

• Cover skin sores from dirt or

being scratched

• Apply Bush Medicines

• Bathe/wash children every day

• Clean hands with soap & water

• Wash towels, clothes & bedding &

dry in the sun

• If skin is not improving after

a day or two, speak to your

health clinic

CareClean

CheckHome

• Make an Environmental

Health referral to help

check house

10. Maintaining Healthy Skin

Acknowledgements

Jonathan Carapetis, Vicky O’Donnell, Bec Smith, Ray Christophers, Roz Walker, Juli Coffin, Julie Marsh, Andrew Steer, Steven Tong, David Atkinson, Glenn Pearson, Kristen White, Tom Snelling, David Hendrickx, Clancy Read, Frieda McLoughlin, Marianne Mullane, Rachael Donovan, Tim Barnett, Bec Pavlos, Jeff Cannon, Hannah Mann, Monica Frain, Rahaney Poelina, Tracy McRae, John Jacky, Janine McNamara, Dylan Barth,

+ all teams throughout Kimberley

“Gotta keep it strong”https://www.youtube.com/watch?v=bhLU5Qnf0n8

Changes in Practice Slide (1)

• Skin infections are under-recognised and under-appreciated.

• Commit to training health care workers about the importance of skin infection recognition and treatment.

Changes in Practice Slide (2)

• Skin infections are common, are a visual diagnosis and may present in combination with other illnesses.

• Commit to recognition using visual handbooks to guide health care workers.

Changes in Practice Slide (3)

• Skin infections should be recognised and treated early to reduce transmission to other children and family members

Changes in Practice Slide (4)

• Consider opportunities to prevent further skin infections e.g. education on hand and body washing, clothes washing, checking children regularly for skin infections, maintenance to achieve functional health hygiene in homes

www.telethonkids.org.au/skin-guidelinesasha.bowen@telethonkids.org.au @ashabowen