Abstract
There is a paucity of information surrounding dermatologic care for persons experiencing homelessness (PEH). This scoping review aims to map existing literature and provide a summary of the most common cutaneous manifestations among PEH, risk factors for dermatologic disease, describe any reported interventions, as well as identify research gaps for future studies. Search strategies developed for MEDLINE and hand searching yielded 486 articles. Out of the 486 articles screened, 93 articles met the inclusion criteria. The majority were cohort studies, cross-sectional studies, and case-control studies concentrated in North America and Europe. Excluding the pediatric population, the prevalence of dermatologic conditions ranged from 16.6% to 53.5%. Common skin conditions described in PEH were: acne, psoriasis, seborrheic dermatitis, atopic dermatitis, and lichen simplex chronicus. There were no studies comparing the extent or severity of these cutaneous diseases in PEH and the general population. PEH have a higher prevalence of skin infections and non-melanoma skin cancers. This scoping review has direct implications on public health interventions for PEH and highlights the need for evidence-based interventions to provide optimum and safe dermatologic healthcare for PEH. We propose several recommendations for improved care delivery, including addressing upstream factors and comorbidities impacting skin health, providing trauma informed care, reducing barriers to care, preventing and managing skin conditions, as well as including PEH in the planning and implementation of any proposed intervention.
Highlights
The Canadian Observatory on Homelessness (2012) describes homelessness as “the situation of an individual, family, or community without stable, permanent, appropriate housing or the immediate prospect, means and ability of acquiring it.”[1]
Indigenous individuals, refugees and other newly arrived immigrants in Canada, individuals living with disability, members of lesbian, gay, bisexual, trans, queer, intersex, asexual, and 2-spirit(LGBTQIA2S) communities, people with mental health and substance use problems, and people exiting institutions such as correctional facilities or foster care are overrepresented among those experiencing homelessness.[3]
We utilized the general six step approach described by Arskey and O’Malley for conducting scoping reviews,[5,6,7] surrounding our research questions of “What is the prevalence of dermatologic conditions amongst persons experiencing homelessness (PEH)?”, “What are the common dermatologic conditions amongst PEH?”, “What are risk factors for dermatologic conditions amongst PEH?”, and “What are described interventions for dermatologic care provision?”
Summary
The Canadian Observatory on Homelessness (2012) describes homelessness as “the situation of an individual, family, or community without stable, permanent, appropriate housing or the immediate prospect, means and ability of acquiring it.”[1] Homelessness encompasses a range of housing and shelter circumstances, including unsheltered, emergency sheltered, provisionally accommodated, and those at risk of homelessness.[1] At risk individuals are not experiencing homelessness, but their current economic and/or housing situation is precarious or does not meet public health and safety standards.[1] According to the most recent reports, 35 000 Canadians are homeless on a given night and at least 2 35 000 Canadians experience homelessness in a year.[2] Of these individuals, 27.3% were women, 18.7% were youth, and 6% were recent immigrants or migrants.[2] Indigenous individuals, refugees and other newly arrived immigrants in Canada, individuals living with disability, members of lesbian, gay, bisexual, trans, queer, intersex, asexual, and 2-spirit(LGBTQIA2S) communities, people with mental health and substance use problems, and people exiting institutions such as correctional facilities or foster care are overrepresented among those experiencing homelessness.[3] Persons experiencing homelessness face significantly higher rates of morbidity, mortality, and hospitalization rates due to extreme poverty, congested living conditions in shelters, Journal of Cutaneous Medicine and Surgery 00(0)
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