Prevalence of skin disease in a cohort of shelter-based homeless men.
BACKGROUND
Cutaneous disease is a frequent cause of morbidity in homeless people. A variety of infectious and noninfectious conditions have been described in this population that are exacerbated by malnutrition, exposure to hazardous environment, psychiatric disease, physical injuries, and limited access to health care.


OBJECTIVE
Our purpose was to study the prevalence of skin disease in a selected group of the homeless population.


METHODS
We evaluated skin diseases in a cohort of 142 homeless men who were staying overnight in a major Boston homeless shelter for men over a period of 3 months (March-June 1992). The subjects participated in the study by volunteering for a free skin examination. Completion of a detailed questionnaire on age, race, duration of homelessness, and general medical status was followed by a thorough skin examination performed by dermatologists.


RESULTS
The most prevalent skin diseases in the examined population were tinea pedis (38%), pitted keratolysis of the feet (20.4%), traumatic injuries (19.7%), toenail onychomycosis (15.4%), acne vulgaris (18.3%), and seborrheic dermatitis (13.3%).


CONCLUSIONS
To our surprise the majority of patients had relatively normal findings from skin examinations with only a few pathologic findings, most often related to poor foot hygiene and long-term exposure to moisture. We attribute the relatively good condition of our cohort to the excellent care provided by the shelter with regard to clothing, cleaning facilities, and medical care. Our findings may represent the prevalence of skin diseases in shelter-based homeless but not in street homeless persons who are likely to have much poorer hygiene and perhaps more skin disease.
Stratigos
A J
AJ
Department of Dermatology, Beth Israel Deaconess Medical Center, Boston, MA USA.
Stern
R
R
González
E
E
Johnson
R A
RA
O'Connell
J
J
Dover
J S
JS
D000328:Adult; D001900:Boston / Q000453:epidemiology; D015331:Cohort Studies; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D015995:Prevalence; D012111:Residence Characteristics; D012871:Skin Diseases / Q000453:epidemiology*