PC3052: Exploring Specific Dermatologic Concerns Resulting from the Flint Water Crisis

Background: During the Flint water crisis, residents were exposed to a myriad of contaminants and irritants in the water, including lead, bacteria, excessive chlorine, total trihalomethanes, legionella, and increased corrosivity. Reports of skin conditions following exposure to the water arose, yet few studies have examined these dermatological concerns. The Flint Registry, a Centers for Disease Control and Prevention–supported public health program, was established to understand the impact of the crisis and connect participants to public health-promoting resources. Our previous research found that of children reporting a healthcare provider–diagnosed skin condition, nearly 50% reported symptom onset after the water crisis began (April 2014) and 86.5% reported still having the condition at the time of Flint Registry enrollment. This study aims to further explore the specific types of dermatologic concerns reported in open-ended surveys, as well as how the frequency/percentage of these concerns compares with reports of diagnosed dermatologic conditions.

Methods: From January 2020 through April 2021, 4,388 children were enrolled in the Flint Registry. After consent and eligibility questionnaires, a child’s caregiver completed a comprehensive survey to assess the child’s health and development status, ongoing environmental exposures, and service utilization. Quantitative and qualitative analyses were done using SPSS and NVivo, respectively, for questions pertaining to dermatological concerns. Parent-reported skin conditions were identified and coded using the International Classification of Diseases, 11th Revision. Differences in reported skin conditions by sociodemographic characteristics were examined using inferential analysis.

Results: A majority of children were identified as Black/African American (67.5%) and/or from socioeconomically disadvantaged backgrounds (44.7% reported parent income of <$15,999; 42% had high school graduate, GED, or less). In total, 586 (13.4%) respondents described dermatologic concerns on an open-ended question when asked of any health conditions that were possibly created or worsened by the Flint water crisis. The most common conditions reported include rash (36%), xerosis cutis or asteatosis (29%), dermatitis and eczema (21%), alopecia (8%), and epidermolysis bullosa (5%). Other less common conditions ( ≤1% each) included: acne, psoriasis, Steven-Johnson Syndrome, and vitiligo.

Conclusion: Dermatologic concerns are commonly reported in children enrolled in the Flint Registry and are temporally related to the Flint water crisis. Through examination of open-ended responses, we see a high percentage of a multitude of skin conditions that were created or worsened by the water. With these conditions, treatment resources, including access to pediatric dermatologists who are familiar with caring for children of color, should be prioritized for Flint children.