Skin Disease After Refugee Resettlement: A Practical 90-Day Approach for Dermatologists and Primary Care Physicians

The first months after refugee resettlement create an opportunity to identify transmissible, disabling, and undertreated skin disease. In the United States, the domestic medical examination generally occurs 30-90 days after arrival, but the clinical principles are relevant across resettlement systems. We conducted a structured narrative review of peer-reviewed publications and organizational or public-health sources. Evidence varied by migration stage, region, age, and referral pathway; camp and specialty-clinic data should not be treated as post-resettlement prevalence estimates. Physicians should first triage fever with generalized rash, vesicular eruptions, rapidly progressive infection, and suspected crusted scabies. A consent-based examination should then prioritize morphology, distribution, scalp and nails, interdigital spaces, sensation, peripheral nerves, chronic ulcers, and scars across skin tones. Testing and infection-control precautions should be guided by clinical findings and exposure history rather than nationality. We propose the Triage-Diagnose-Close the Loop 90-day framework (TDCL-90), which integrates immediate infection-control decisions, morphology- and exposure-directed diagnosis, contact management, referral, and documented reassessment. TDCL-90 is an author-proposed synthesis of published evidence, public-health guidance, and author consensus; it has not been prospectively evaluated.