Dermatologic care of persons experiencing homelessness

A recent article in JAMA Dermatology reviewed key aspects of dermatologic healthcare delivery for persons experiencing homelessness (PEH). For a variety of reasons , rates of homelessness are increasing among both rural and urban populations in the US. According to the article, PEH “experience high rates of ectoparasitic, fungal, and sexually transmitted infections; chronic wounds; skin cancer; malnutrition; and cutaneous consequences of injection drug use”. Additionally, PEH have higher rates of hepatitis C, tuberculosis as well as group A streptococcal skin abscesses compared with housed patients.

The review article urges dermatology providers to utilize screening questions such as those devised by Centers for Medicare & Medicaid Services , Veterans Health Administration or the American Academy of Family Physicians’ EveryONE Project to determine housing status of all patients. Further considerations for treatment of PEH include the barriers of managing chronic dermatologic conditions such as atopic dermatitis, psoriasis, prurigo nodularis, and hidradenitis suppurativa while experiencing a lack of privacy and poor access to clean water and bathing/shower facilities. In order to meet the needs of PEH, it is essential to develop a person-centered care plan through a multidisciplinary approach which takes into consideration housing status, healthcare coverage and access to resources. The article concludes:

“It is our duty as dermatologists to use a standardized approach for identifying homelessness and develop a person-centered care plan for PEH”.