Addressing the challenges to skin health of refugees and migrants in the WHO European region

Dermatologic Care and Skin Health of Migrant Populations in the US: A Scoping Review

Importance

Despite literature on migrant skin health globally, there remains a critical gap in understanding the dermatologic care and skin health of migrants in the US, where immigrants represent 13.9% of the population.

Objective

To understand the spectrum of dermatologic conditions reported among US migrant populations, identify considerations for dermatologic care delivery, and synthesize the current literature on skin health.

Evidence Review

PubMed, Embase, and ClasePeriodica were searched for articles published from January 2000 to December 2022 using search terms related to dermatologic conditions and migrants. Original research articles, review articles, case reports, and case series that reported on dermatologic conditions affecting migrant populations within the US and US territories were included.

Findings

Of 87 articles included, cross-sectional studies accounted for 37 (42.5%), followed by case reports and case series (36 [41.4%]), qualitative studies (3 [3.4%]), and a mixed-methods study (1 [1.1%]). Articles discussed a range of dermatologic conditions: infections (45 [51.7%]), inflammatory conditions (33 [37.9%]), traumatic wounds (16 [18.4%]), neoplasms (10 [11.5%]), pigmentary disorders (10 [11.5%]), signs of torture/violence (4 [4.6%]), cosmetic (3 [3.4%]), hair/nail disorders (1 [1.1%]), and genodermatoses (1 [1.1%]). Of 65 articles (74.6%) reporting migrants' country of origin, Mexico was most frequently reported (28 [43.0%]), followed by Guatemala (14 [21.5%]), Vietnam (8 [12.3%]), and 38 other countries. Four themes were developed: (1) exposures before and during migration were risk factors for dermatologic conditions that presented at destination; (2) occupational and environmental exposures were risk factors for dermatologic conditions that developed at destination; (3) structural factors limited migrants' access to quality health care; and (4) educational interventions targeting different learner groups were opportunities to improve skin health of migrants.

Conclusions and Relevance

This scoping review found that exposures before, during, and after migration and health care access are associated with the skin health of US migrant populations. Research opportunities include focusing on a broad spectrum of dermatologic diseases, countries of birth, occupations, and vulnerable populations, such as women and children, as well as implementing and evaluating policy that addresses structural barriers migrants face in accessing quality health care.

Cutaneous Leishmaniasis in the Context of Global Travel, Migration, Refugee Populations, and Humanitarian Crises

Cutaneous leishmaniasis (CL) is a vector-borne infection caused by protozoan parasites belonging to the genus Leishmania. CL is an emerging global health concern due to increasing migration, travel, and climate change. Traditionally, it was confined to endemic regions such as the Americas, the Middle East, and Central Asia; however, it is now spreading to non-endemic areas. Climate change has further contributed to the expansion of sandfly habitats, increasing CL transmission risk in previously unaffected areas. Healthcare providers in non-endemic regions often misdiagnose CL, delaying treatment and morbidity. Diagnosis remains challenging due to the need for species-specific identification, while treatment is limited by cost, availability, and personnel expertise. This review explores the epidemiology, clinical presentation, diagnostic challenges, and management of CL in the context of global mobility. It highlights rising CL cases in refugee settlements, particularly in Lebanon and Jordan, due to poor living conditions, inadequate vector control, and healthcare barriers. While there have been advances in systemic and topical therapies, access in refugee and resource-poor settings remains a barrier. Addressing the global burden of CL requires improved surveillance, healthcare provider training, and increased awareness. By enhancing global collaboration and policy changes, public health efforts can mitigate the expanding impact of CL.

The Impact of Global Health Disparities on Atopic Dermatitis in Displaced Populations: Narrowing the Health Equity Gap for Patients with Skin of Color

Atopic dermatitis (AD) is a relatively common inflammatory skin disease marked by eczematous lesions and pruritus often leading to significant morbidity and quality of life impairment for those affected. Recent studies have shown that patients with skin of color (SOC) carry a larger disease burden than patients of European descent. In the USA, these disparities are partly due to structural, environmental, and interpersonal racism. From a global perspective, there is a paucity of research on the burden of atopic dermatitis and other inflammatory skin diseases experienced by the record numbers of refugees, migrants, and asylum seekers around the world. Although it is still unclear whether the true prevalence of AD in displaced communities is higher compared with the general population, those who are displaced suffer from unique risk factors that render them especially vulnerable. In this review, we outline a number of factors contributing to AD susceptibility and/or aggravation in displaced communities. These include poor living conditions, climate change events, psychological stress, and lack of access to medical care and health-related behaviors.

Teledermatology in the Control of Skin Neglected Tropical Diseases: A Systematic Review

Introduction

Neglected tropical diseases (NTDs) include a group of about 20 illnesses that have garnered relatively little attention, despite their ability to inflict significant suffering and disability. Skin neglected tropical diseases (sNTDs) are a subset of NTDs that present with cutaneous manifestations and are well known for their ability to generate stigma and promote poverty. Teledermatology (TD) represents a potential method to control sNTDs.

Objective

We sought to analyze the potential for TD to ease the burden of sNTDs.

Methods

We performed a systematic literature search using the Texas Medical Center Library One Search, which scans 167 databases, including Embase, PubMed, and Scopus. We included all original investigations published after 2011 that assessed the impact of TD intervention in the control of one or more sNTDs. We excluded studies not written in English and studies that did not perform any outcome analyses.

Results

Twenty studies met our search criteria, and 18 expressed positive attitudes towards TD. Overall, we found that TD may be a sustainable, cost-effective strategy for expanding access to care for individuals afflicted with sNTDs. However, poor image quality, lack of access to further diagnostic tests, and ethical, legal, and cultural issues pose as barriers to TD utilization.

Conclusion

TD may be helpful in achieving control of sNTDs but has its limitations. An integrated approach, which employs TD in conjunction with other strategies, represents a realistic path for alleviating sNTDs.