Cutaneous Manifestations and Clinical Disparities in Patients Without Housing
Dermatologic disease in patients without housing (NWH) has not been well characterized. We present a retrospective cohort study delineating dermatologic disease in NWH patients and patients with housing (WH) during presentation to the emergency department. A total of 842 medical records were reviewed, with evenly matched NWH and WH patients based on sex, self-identified race and ethnicity, and age. To improve outcomes in this vulnerable population, our study sought to elucidate more information on the morphology of cutaneous disease and highlight disparities in clinical workup.
Practice Points
- Dermatologic disease in patients without housing (NWH) is characterized by more infectious concerns and fewer follicular and urticarial noninfectious inflammatory eruptions compared with matched controls of those with housing.
- Patients with housing more frequently presented with cutaneous chief concerns and received more consultations while in the hospital.
- This study uncovered notable pathological and clinical differences in treating dermatologic conditions in NWH patients.
• Involve outreach teams, such as the Assertive Community Treatment teams, that assist individuals by delivering medicine for psychiatric disorders, conducting total-body skin examinations, assisting with wound care, providing basic skin barrier creams or medicaments, and carrying information regarding outpatient follow-up.
• Educate ED providers on the most common skin concerns, especially those that fall within the noninfectious inflammatory category, such as hidradenitis suppurativa, which could easily be misdiagnosed as an abscess.
Future Directions—Owing to limitations of a retrospective cohort study, we present several opportunities for further research on this vulnerable population. The severity of disease, especially infectious etiologies, should be graded to determine if NWH patients truly present later in the disease course. The duration and quality of housing for NWH patients could be categorized based on living conditions (eg, on the street vs in a shelter). Although the findings of our NWH cohort presenting to the ED at UMC provide helpful insight into dermatologic disease, these findings may be disparate from those conducted at other locations in the United States. University Medical Center provides care to mostly subsidized insurance plans in a racially diverse community. Improved outcomes for the NWH individuals living in New Orleans start with obtaining a greater understanding of their diseases and where disparities exist that can be bridged with better care.
Acknowledgment—The dataset generated during this study and used for analysis is not publicly available to protect public health information but is available from the corresponding author on reasonable request.
