17 Nov Pediatric Dermatology Journal Offers Practical Advice For Caring For Sexual and Gender Minority Children
MedicalResearch.com Interview with:
Markus Boos, MD, PhD
Member of the Society for Pediatric Dermatology.
Attending pediatric dermatologist
Seattle Children’s Hospital
Assistant Professor in the Department of Pediatrics
University of Washington School of Medicine
MedicalResearch.com: What is the background for this study?
Response: Our understanding of the cutaneous health of sexual and gender minority (SGM) individuals (lesbian, gay, bisexual, transgender, queer, asexual, intersex, nonbinary, etc.) remains nascent. This dearth of understanding of the unique needs of SGM children is even more pronounced.
This 2-part review article provides practical advice on how to best engage with young SGM patients and serve the distinct needs of this minority population, with a specific emphasis on dermatologic conditions.
MedicalResearch.com: What are the main findings?
Response: Multiple barriers exist for sexual and gender minority youth seeking comprehensive and compassionate medical care. Identifying available, knowledgeable, and empathetic providers who understand the unique developmental and emotional needs of SGM youth, who are easily accessible, who provide acceptable, culturally aware and confidential care, and whose care is equitable, regardless of patients’ sexual or gender identification, is often a challenge for this population.
Part 1 of this review provides discrete recommendations on how dermatologists can make their practices more welcoming to SGM youth, including proper use of pronouns, ensuring confidentiality, and using open and non-judgemental language when taking a patient history. With respect to dermatologic-specific care, it is important to recognize that sexual and gender minority teens have risks for certain skin conditions or related behaviors that may differ from their cisgender/heterosexual counterparts.
Specifically, men who have sex with men are at higher risk of acquire sexually transmitted infections and engage more frequently in tanning activities than their heterosexual counterparts, with important implications for skin health. Treatment of severe acne in this population also requires awareness of unique obstacles and concerns, including an increased prevalence of mental health problems in SGM youth. This has meaningful implications when therapy includes isotretinoin. Use of isotretinoin can also be problematic for transgender patients, who may be forced to register in the iPLEDGE system as a gender with which they do not identify in order to access this medication. Transgender children who undergo gender affirming procedures also require adequate support and a thoughtful approach to this process, which should also include endocrinology, mental health services and other medical specialties as appropriate.
MedicalResearch.com: What should readers take away from your report?
Response: Our hope is that readers take away some practical tips for caring for SGM children, in turn improving their own comfort and their relationship with their patients. There are a number of recommendations on engaging with SGM youth and approaching their skin concerns that will hopefully take some of the confusion or discomfort out of these interactions for providers who may not feel well-versed in acknowledging gender and sexual identity.
Probably the best piece of advice comes from part 1 of the review: when you make an error (in name, pronouns, etc.) apologize sincerely and move on. My personal experience has been that sexual and gender minority teens appreciate a provider who is making an effort and wants to “do better” for this population.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Our understanding of “what” SGM children need from their dermatologist remains unclear. Being a receptive, compassionate and empathetic provider is the first step in engaging this often overlooked group in medicine, but we still have a long way to go in creating safe, affirming environments for all SGM children. Beyond this, we just don’t know what specific skin concerns sexual and gender minority children have, as we thus far have extrapolated from what is known in adults. Do these findings hold in this younger population? It is not clear that they do, and understanding these differences between age groups, genders and sexualities will be important to help dermatologists tailor effective therapies and messages to patients, in turn optimizing their skin health. We are just scratching the surface.
MedicalResearch.com: Is there anything else you would like to add?
Response: Exploring the skin needs of SGM children has improved my understanding of the psychosocial determinants of health. It has also made me appreciate each of my patients as individuals, not simply as a skin condition or part of a specific group. Our young patients have multiple identities (gender, race, sexuality, socioeconomic status, etc) and my work in this field has made me understand that the way that we best care for our patients is by understanding them in all of these different realms. Hopefully we can create hopeful, inviting environments that will allow our patients to express their needs and help us help them.
I have no disclosures to report.
Pediatr Dermatol. 2019 Sep;36(5):581-586. doi: 10.1111/pde.13896. Epub 2019 Jul 1.
Dermatologic care of sexual and gender minority/LGBTQIA youth, Part I: An update for the dermatologist on providing inclusive care.
Boos MD1, Yeung H2, Inwards-Breland D3.
ABOUT PEDIATRIC DERMATOLOGY:
The official publication for the Society for Pediatric Dermatology, Pediatric Dermatology is a peer-reviewed bimonthly journal that captures leading research in the field of children’s skin, hair and nail disorders to promote skin health across the United States and aid the development of new treatments for pediatric patients.
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