People experiencing homelessness (PEH) are at increased risk of experiencing dermatologic conditions and related complications compared to people with stable housing. The causes of the increased prevalence of skin conditions and complications among PEH are multifactorial, stemming largely from the realities of homelessness itself. People experiencing homelessness are often exposed to extreme temperatures and weather, spend increased time on their feet, may not be able to lay down at night, experience increased exposure to ectoparasites such as lice, scabies, and bed bugs, and face difficulties in maintaining skin and wound hygiene. Once a skin condition has developed, it can be very difficult to manage and treat due to the factors discussed above. Additional factors that influence outcomes include limited primary care service access, co-morbid conditions, lack of health insurance, use of the emergency department as a primary source of medical care, delays in seeking and receiving treatment and referrals, and challenges accessing needed follow-up and specialty care.
This adapted clinical guideline will address specific skin conditions facing people experiencing homelessness and present patient-centered strategies to conduct assessments, treatment, and followup care. The guideline covers care across health care for the homeless (HCH) settings and includes specific information for street/outreach, clinic, and medical respite environments.
