Gaps in Knowledge Identified Regarding Skin Health Outcomes in Migrant Populations

Exposures before, during, and post-migration among migrant populations in the US are associated with dermatologic health outcomes, new findings suggest, as well as structural factors.1

These data resulted from a review assessing the skin health data of migrants within the US, led in part by Herbert B. Castillo Valladares, MD, MHS, of the University of California, San Francisco School of Medicine’s department of dermatology. Valladares and colleagues noted in migrant health research, social drivers of health have been linked with access to health care as well as other factors.2

“Despite this knowledge, a critical gap remains in our understanding of dermatologic care and skin health of migrants in the US,” Valladares and colleagues wrote.1 “This scoping review aimed to understand the spectrum of dermatologic conditions seen in migrant populations, identify considerations for dermatologic care delivery, and synthesize the current literature on skin health in US migrant populations.”

The investigative team's review was conducted with the aim of addressing 5 key inquiries related to dermatologic health among migrant populations located in the US. First, which skin conditions were shown to be most commonly reported? Second, which countries of origin were represented most within the available literature? Third, in what type of setting is dermatologic care provided? Fourth, who are the key stakeholders involved in care? Lastly, what roadblocks persist that could prevent access to dermatologic care among migrant populations?

In their examination of such questions, the team carried out a comprehensive literature review via the PubMed, ClasePeriodica, and EMBASE databases. They focused specifically on publications released in the timeframe between January 2000 - December 2022. The investigators utilized a structured set of keywords, screening research and selecting studies through the use of Covidence software.

The definition the investigative team used for migrants was drawn from that of the United Nations Migration Agency's criteria: any individual who has moved or is moving across an international border away from their habitual residence, regardless of their legal status, rationale for movement, voluntariness, or duration of their stay. Articles the team assessed would have to explicitly refer to patients or populations as refugees, migrants, asylum seekers, or immigrants.

The investigators did not look at any prior analyses in their review which had been shown to be solely regarding returning travelers. The investigators retained the terminology from the original articles when discussing the associated findings.

There were 2 investigators assigned to make independent screenings of abstracts and their titles. This process was then followed by a full-text review for determining research eligibility. Articles that met the team's criteria for inclusion had their data independently extracted by 2 team members through the use of a REDCap-based form built upon the pre-established data framework.

Overall, 87 articles were included in the investigators' review, of which 42.5% were listed as cross-sectional studies, 41.4% as case reports or case series, 3.4% as qualitative analyses, and 1.1% implementing a mixed-methods approach. Among the list of reported dermatologic conditions, the research team noted a wide variance.

Infections of patients' skin were the most commonly reported, with 51.7% of articles describing such conditions. These were then followed by inflammatory skin conditions among 37.9% of analyses, traumatic injuries among 18.4%, neoplastic conditions among 11.5%, disorders related to pigment among 11.5%, signs of violence or torture among 4.6%, cosmetic issues among 3.4%, disorders related to hair or nails among 1.1%, and genetic skin conditions among 1.1%.

The investigators found that 74.6% of studies in their final review involved data on migrants’ countries of origin. They highlighted that the most frequently cited was Mexico in 43.0% of these articles, followed by Guatemala for 21.5%, Vietnam for 12.3%, and then 38 additional countries.

From the investigators' analysis of available research, 4 notable themes were shown to have emerged:

• Pre-migration and migration-related exposures contributed to dermatologic conditions that had been identified at the destination.
• Environmental and occupational exposures at the destination also played a notable role in development of different skin diseases.
• Structural barriers limited adequate dermatologic care access among the migrants analyzed.
• Targeted educational initiatives for different groups of learners presented opportunities to enhance skin health outcomes for migrant communities.

“We identified critical literature gaps that represent opportunities,” they concluded.1 “These opportunities include research focused on a broad spectrum of dermatologic diseases, countries of birth, occupations, and vulnerable populations, such as women and children, as well as implementing and evaluating policy that addresses structural barriers migrants face in accessing quality health care.”

References

1. Castillo Valladares HB, Kim-Lim P, Chang AY. Dermatologic Care and Skin Health of Migrant Populations in the US: A Scoping Review. JAMA Dermatol. Published online April 09, 2025. doi:10.1001/jamadermatol.2025.0404.

2. Alarcon FJ. The migrant crisis and access to health care. Dela J Public Health. 2022;8(4):20-25. doi:10.32481/djph.2022.10.006.