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Acne is themost common
dermatologic diagnosis in a
homeless shelter clinic
Though unexpected, the most common dermatologic
diagnosis at a homeless shelter clinic was acne, with
approximately one in five patients presenting with the
condition, finds a retrospective chart review.
M
ichael J. Murphy, MD, of the
University of Connecticut,
Farmington, explained that
among the homeless, dermato-
logic conditions are very common
due to the exposure of skin to
environmental elements and often
inadequate clothing and hygiene.
The University of Connecticut
South Park Dermatology Clinic
was founded in 2008 to reduce
barriers to care and increase con-
venience in these patients. The
clinic is part of a general med-
ical clinic founded in 1987 by a
group of University of Connecti-
cut medical students. Their goal
was to provide critical health-
care services to this underserved
population.
Dr Murphy and colleagues set
out to identify the most common
dermatologic diagnoses among
all patients seen at the clinic from
2008 to 2016. Particular attention
was paid to age, gender, season
of the year, and the rate of malig-
nancy. The data will be used to
generate a robust supply of treat-
ment options to best care for
homeless patients.
Patient charts from 45 derma-
tology clinics held at the shelter
clinic were reviewed and demo-
graphics, diagnosis, and treatment
data were recorded.
Overall, 273 patients, 1–67 (mean
37, median 39 years of age were
seen for dermatologic concerns.
Demographically, 54% were male
and 46% were female, with 30%
identifying as African-American/
black, 29% Hispanic, and 25%
Caucasian. Sixteen percent did
not disclose their race. A total of
363 diagnoses were recorded,
encompassing 90 separate der-
matologic conditions, with 26%
of patients presenting with more
than one complaint.
The top 10 diagnoses per total
number of patients over 8 years
were:
•
Acne, 19.78%
•
Atopic dermatitis, 9.89%
•
Tinea pedis, 9.16%
•
Xerosis, 8.06%
•
Folliculitis, 5.13%
•
Post-inflammatory hyperpig-
mentation, <5%
•
Seborrheic dermatitis, <5%
•
Tinea infection of the body and
head, <5%
•
Psoriasis, <5%
•
Verruca vulgaris, <5%
Surprisingly, only acute cold injury
and two foot lacerations were
treated. Additionally, the rate of
suspected malignancy per total
patients seen was 2.6%, with
seven patients presenting with
lesions concerning for melanoma
(n=5) and basal cell carcinoma
(n=2). Diagnostic trends were also
analysed based on gender, eth-
nicity, age, and season of the year.
Dr Murphy concluded that though
unexpected, the most common
diagnosis at the clinic was acne,
with approximately one in five
patients in the homeless shel-
ter clinic presenting with the
condition.
The most common diagnoses will
advise decisions about diagnostic
and treatment supplies ordered
for future clinics in order to best
care for these homeless individ-
uals. Results of the study will be
published in an upcoming issue
of
Connecticut Medicine
.
The studywas limited by the lack of
clinics during the summer months
and diagnosis variability between
attending dermatologists.
PracticeUpdate Editorial Team
•
The use of a J-Tip, CO
2
-powered, lidocaine-loaded
syringe is reported to greatly reduce injection pain
and provide a 2-cm radius of numbing.
•
Other pearls for pain reduction include use of a Buzzy
Bee vibration device and an ice pack.
•
Reducing fear in a child during a procedure can be
done by thorough preparation (tell the child what is
being done before it is done), reducing chaos (having
only one person in the room talk), and preparing trays
outside of the room.
The use of iPads or other tablets
during the actual procedure are very helpful as well.
Lastly, restraining the child leads to fear and anxiety;
being held in a comfortable position by a parent proves
to be more helpful.
Managing hidradenitis suppurativa in the
pediatric population –
Chris Sayed
Dr Sayed reviewed the management of hidradenitis sup-
purativa (HS) in pediatric patients, and, like in adults, it
is very challenging. Pediatric patients are more likely to
have a family history of HS, and disease comorbidities
include metabolic syndrome and other inflammatory dis-
eases, which are on par with adult disease.
•
Of note, young children with HS should be evaluated
for androgen excess
, specifically precocious puberty.
Evaluation for metabolic syndrome or other systemic
disease is dictated by physical exam and findings.
•
A treatment algorithm with clindamycin and rifampin,
hormonal therapy for women (drospirenone-containing
oral contraceptives), laser for follicular destruction, and
deroofing vs local excision can be considered.
•
Immunomodulators such as etanercept, adalimumab,
infliximab, and ustekinumab are considered in adults
with HS
but have limited use in children.
•
The use of retinoids to treat HS signs and symptoms
is not promising in children
or adults with HS.
References
1. Simpson EL, Chalmers JR, Hanifin JM, T, et al.
J Allergy Clin
Immunol
2014;134(4):818-823.
2. Craiglow BG, Liu LY, King BA.
J Am Acad Dermatol
2017;76(1):29-32.
© 2017 American Academy of Dermatology Association.
2017 AAD ANNUAL MEETING
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VOL. 1 • NO. 1 • 2017