GD03 Geopolitics and the skin: the importance of historical awareness in improving early recognition and management of cutaneous conditions in the newly arrived migrant

Abstract In the 12 months up to September 2024, the UK experienced increasing numbers of asylum seekers and refugees. Migrants may have complex health needs, often as a result of resettlement, transit or breakdown in health infrastructure in their region of origin due to geopolitical instability. Guidance on ‘Skin lesions in newly arrived migrants’, published by the UK Health Security Agency in January 2025, reiterates the need for prompt recognition, treatment and wider public health intervention for suspected communicable disease in vulnerable populations. Many such diseases first present with dermatological symptoms. Following a local case of presumed diphtheria in a recently settled asylum seeker, we review the more common cutaneous conditions affecting migrant populations and how the historical and geopolitical contexts of the patient journey should be considered as a crucial element of the patient’s history, which may provide key diagnostic clues. When assessing displaced patients we should consider the existing and historical public health infrastructure in their home country. Conflict, or even natural disasters, can also disrupt access to healthcare such as childhood vaccination. For example, the largest number of UK asylum applicants by country of origin in 2023 was from Afghanistan. They were most commonly male and aged 18–39 years. Although nationwide vaccination programmes were reintroduced in Afghanistan in the early 2000s with support from the World Health Organization and UNICEF, a cohort born between 2001 and 2003 remains largely unvaccinated. This population – aged within the most common demographic for asylum seekers entering the UK – is vulnerable to vaccine-preventable diseases such as diphtheria, and is more likely to have spent time with similarly unvaccinated peers during transit and at resettlement. The relative lack of clinical exposure to patients with conditions that are rare in the UK, such as diphtheria and cutaneous leishmaniasis, can cause a particular diagnostic challenge to UK physicians. This could result in late or incorrect diagnoses, inaccurate microbiological or tissue sampling and delayed or ineffective treatment. Given the trend towards multioccupancy accommodation for asylum seekers in the UK there are also significant public health implications for the prevention and containment of outbreaks. As more people are displaced due to conflict, climate change and political and economic instability, it is important for front-line dermatologists to appreciate the region-specific historical context in which the patient has lived and travelled, in order to inform their clinical journey in the present.