Native American and Indigenous communities experience a disproportionate burden of dermatologic disease, yet remain underrepresented in dermatology research and underserved in clinical care. This narrative review synthesizes current evidence on common skin conditions and barriers to achieving positive dermatologic outcomes.
A total of 173 articles were screened from PubMed, Google Scholar, Embase, Consensus AI, Cochrane, and CINAHL using predefined inclusion and exclusion criteria focused on Native American and Indigenous populations, dermatologic conditions, and access to care. Twenty-two articles met full inclusion criteria. Dermatologic disease burden was consistently high. Reported conditions included acne with a 79 percent lifetime prevalence and 55 percent scarring, atopic dermatitis and eczema with rates as high as 91 percent in northern Canadian Indigenous communities, psoriasis at 72 percent, actinic prurigo, and acanthosis nigricans in children. Several studies also identified elevated melanoma incidence, regional variation in risk, and later-stage diagnoses among American Indian and Alaska Native individuals. Chronic wounds and skin and soft-tissue infections were frequently described, including those related to diabetes, vascular disease, and inadequate wound-care resources.
Barriers to care were substantial. Rural Indian Health Service facilities required median travel distances of 68 miles to reach dermatology services, and few homelands had even one dermatologist. Additional obstacles include long wait times, limited Medicaid acceptance, formulary restrictions, underrepresentation in clinical trials, and inconsistent teledermatology availability. Cultural and historical factors such as mistrust, insufficient patient education, and limited culturally grounded care further shaped outcomes.
Evidence gaps included small or region-specific samples, limited tribal-level stratification, reliance on retrospective or self-reported data, and minimal Native representation in dermatology clinical trials. Improving outcomes will require expanding dermatology workforce capacity, strengthening culturally informed teledermatology, and addressing structural inequities in access and treatment.
A total of 173 articles were screened from PubMed, Google Scholar, Embase, Consensus AI, Cochrane, and CINAHL using predefined inclusion and exclusion criteria focused on Native American and Indigenous populations, dermatologic conditions, and access to care. Twenty-two articles met full inclusion criteria. Dermatologic disease burden was consistently high. Reported conditions included acne with a 79 percent lifetime prevalence and 55 percent scarring, atopic dermatitis and eczema with rates as high as 91 percent in northern Canadian Indigenous communities, psoriasis at 72 percent, actinic prurigo, and acanthosis nigricans in children. Several studies also identified elevated melanoma incidence, regional variation in risk, and later-stage diagnoses among American Indian and Alaska Native individuals. Chronic wounds and skin and soft-tissue infections were frequently described, including those related to diabetes, vascular disease, and inadequate wound-care resources.
Barriers to care were substantial. Rural Indian Health Service facilities required median travel distances of 68 miles to reach dermatology services, and few homelands had even one dermatologist. Additional obstacles include long wait times, limited Medicaid acceptance, formulary restrictions, underrepresentation in clinical trials, and inconsistent teledermatology availability. Cultural and historical factors such as mistrust, insufficient patient education, and limited culturally grounded care further shaped outcomes.
Evidence gaps included small or region-specific samples, limited tribal-level stratification, reliance on retrospective or self-reported data, and minimal Native representation in dermatology clinical trials. Improving outcomes will require expanding dermatology workforce capacity, strengthening culturally informed teledermatology, and addressing structural inequities in access and treatment.