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  • Presentation

Bridging the Gap: Addressing Social Determinants of Health to Decrease Health Disparities in Dermatology

Description

The case presented discusses a 36-year-old man with lower extremity ulcers, compounded by homelessness and substance use disorders (opioids and meth). Despite repeated visits to the emergency department, he was consistently misdiagnosed, primarily due to the influence of social determinants of health, and assumptions about drug-induced lesions. A closer examination revealed that his ulcers were actually linked to primary triple positive antiphospholipid syndrome, not drug effects. The presentation highlighted the pressing overlap between dermatologic health and socio-economic factors, especially how homelessness contributes to increased rates of skin infections, chronic wounds, and other dermatological conditions. The treatment plan initiated by the dermatology team included the use of DOACs to streamline care and facilitate the patient's transition to medical support. This case emphasized the importance of reevaluating narratives surrounding patient care, acknowledging emerging drug trends, and recognizing how skin disease can prompt subsequent issues such as substance use and homelessness. The success in addressing his dermatological condition led to significant improvements in his overall health, pain levels, and stability in housing, showcasing the impact of integrated medical and social support systems in addressing health disparities in vulnerable populations.

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Conclusions

  • The case illustrates the complexity of diagnosing skin conditions in patients with significant social determinants of health, like homelessness and substance use disorders.
  • Primary triple-positive antiphospholipid syndrome was confirmed as the underlying cause of the patient's chronic lower extremity ulcers, rather than drug-induced or venous stasis ulcers.
  • Dermatology played a crucial role in diagnosing a condition that may have otherwise been overlooked due to prevailing narratives about substance use.
  • The bidirectional relationship between social drivers of health and dermatological conditions highlights the importance of assessing and addressing these factors in clinical settings.
  • Emerging trends in drug use, particularly the combination of meth and fentanyl, demand increased awareness and scrutiny when evaluating skin lesions in affected populations.
  • Patient-centered advocacy, including medication management and post-discharge care, significantly improved the patient's health outcomes and living situation.
  • Effective management of skin disease can influence social stability and substance use, making it a vital component of holistic care for vulnerable populations.
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