Limited English Proficiency and Social Determinants in Diagnosing Stevens-Johnson Syndrome

Conclusions

• Limited English proficiency can substantially hinder dermatologic care by reducing patient comprehension, satisfaction, and perceived support while increasing delays, costs, and missed information.
• Language-concordant care appears to improve clinical outcomes, as shown by better glycemic control in patients who receive care in their preferred language.
• Dermatology disparities for LEP patients are real and measurable, including lower access to effective acne therapies and delays in starting isotretinoin.
• Interpreter services are necessary but not sufficient, because they do not fully eliminate communication barriers and are often not covered by insurers.
• In-person interpretation and culturally humble questioning can uncover critical medication histories that standard interviews miss, especially when patients use non-U.S. or over-the-counter medications.
• A patient with severe SJS/TEN-like disease was ultimately found to have taken medications from her home medicine cabinet, including non-U.S. products, underscoring the need to ask about all remedies patients use when they feel unwell.
• Health systems should expand beyond interpreters alone by using community house calls, multilingual resources, and programs like EthnoMed to better serve diverse patients.
• Medication access and patient behavior are shaped by affordability, immigration background, and family learning, so clinicians should consider cross-border and culturally transmitted medication use in their assessments.
• Cultural humility is essential for diagnosing and treating patients with complex social and language barriers.
• Improving dermatologic equity will require structural investment in language services and broader social-determinants-of-health interventions, not just individual clinician effort.