Department of Dermatology, International Foundation for Dermatology Migrant Health Dermatology Working Group, HealthPartners Institute, Saint Paul, Minnesota, USA.
Departments of Pediatrics and Dermatology, University of British Columbia, Vancouver, BC, Canada.
Int J Dermatol. 2020 Nov;59(11):1299-1311. doi: 10.1111/ijd.15063. Epub 2020 Jul 19.
There are 70.8 million persons displaced worldwide due to war, persecution, and violence. Eighty percent of displaced persons reside in low- and middle-income countries with limited healthcare resources. Cutaneous diseases are commonly reported among displaced persons owing to numerous interrelated factors such as inadequate housing, overcrowding, food insecurity, environmental exposures, violence including torture, and breakdown of healthcare infrastructure. Diagnosis and management of these conditions, as well as an understanding of the context in which they present, is crucial to providing dermatologic care for displaced populations worldwide. Herein, we define displaced populations and, within this context, review the epidemiology of skin diseases, discuss pertinent skin conditions, examine challenges to care provision, and present approaches for improving dermatologic care. Inflammatory and communicable infectious disorders are the most common skin diseases seen in displaced populations. Other relevant conditions include skin manifestations of heat injuries, cold injuries, immersion foot syndromes, macronutrient and micronutrient deficiencies, torture, and sexual and gender-based violence. Provision of dermatologic care to displaced populations is hampered by limited diagnostic and therapeutic resources and specialist expertise. Medical screening for cutaneous disorders, context-relevant dermatology training, and telemedicine are potential tools to improve diagnosis and management of skin diseases in displaced populations.
全球有 7080 万人因战争、迫害和暴力而流离失所。80%的流离失所者居住在医疗资源有限的中低收入国家。由于许多相互关联的因素，如住房不足、过度拥挤、粮食不安全、环境暴露、包括酷刑在内的暴力行为以及医疗保健基础设施的崩溃，流离失所者中常报告发生皮肤病。这些疾病的诊断和治疗，以及了解其发病背景，对于向全球流离失所者提供皮肤科护理至关重要。在此，我们定义了流离失所者，并在这一背景下，综述了皮肤病的流行病学，讨论了相关的皮肤病，检查了护理提供方面的挑战，并提出了改善皮肤科护理的方法。在流离失所者中，最常见的皮肤病是炎症性和传染性传染病。其他相关疾病包括热损伤、冷损伤、浸渍足综合征、宏量和微量营养素缺乏、酷刑和性暴力和基于性别的暴力的皮肤表现。向流离失所者提供皮肤科护理受到诊断和治疗资源以及专家专业知识有限的阻碍。皮肤病的医疗筛查、与背景相关的皮肤科培训和远程医疗是改善流离失所者皮肤病诊断和管理的潜在工具。
