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The case for Street Dermatology

It is no secret that people experiencing homelessness (PEH) have a high burden of skin disease [1]. Ranging from skin cancers to infections and chronic wounds, these diseases have a major effect on the overall health and quality of life of unsheltered patients. Skin and soft tissue infections are a leading cause of emergency department admission, particularly in people who inject drugs [2]. Additionally, many PEH are susceptible to methicillin-resistant Staphylococcus aureus (MRSA) infections which can severely complicate their disease course and treatment [3].

Preemptive skin disease management can reduce such complications from developing and can be a cornerstone of preventative patient care.

During the course of our Street Rounds thus far, we have encountered a high level of skin morbidity in a short period of time (Table 1).

Table 1: Skin conditions among 160 patients seen.

A notable level of parasitic skin diseases, inflammatory conditions, and wounds signify disruption of the skin barrier (Figure 1). This can create a portal for ‘superinfections’ which can inevitably land PEH in the emergency department and worsen their already compromised health.

Figure 1: Spectrum of cutaneous diseases encountered during Street Rounds.

Seeing such a dire need for dermatologic services, it is worthwhile to consider a designated ‘Street Dermatology’ branch of our MSM clinic. This team could be specifically tasked to manage skin, hair, and nail complaints that are encountered during Street Rounds. By collaborating with faculty at the University of Miami Department of Dermatology including Dr. Jonette Keri and Dr. Brian Morrison, this Street Dermatology team can tackle the high skin disease burden on Miami’s streets. Teledermatology with HIPAA-compliant databases as well as in-person dermatologist evaluations can manage diseases on two fronts, especially if providers may be unavailable that day.

Thorough skin examinations can be a fundamental aspect of patient care, especially in a street setting where diagnostic tools may be unavailable. Among patients who are unsheltered, the skin barrier is essential for whole-person care, and managing skin diseases preemptively can mean the difference between a hospital admission or staying in good health.

This project is currently being pursued by Taha Rasul, Megan Mathew, and Emily Eachus. We hope to expand our team and by extension, delivery of specialized care to the underserved.

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