Patients experiencing homelessness (PEH) suffer from a high burden of cutaneous fungal infections. Preventative treatment is important as such infections can lead to harmful complications such as cellulitis and even osteomyelitis. There are sparse data regarding cutaneous fungal infections of homeless populations and management in low-resource settings. A MEDLINE search was conducted using the key terms "cutaneous," "fungal," "infections," "dermatophytes," and "homeless." The search included casecontrol, cohort, and randomized controlled trials published in the English language. This scoping review of studies yielded information with regard to practical treatment advice for providers in low-resource settings, including medical, hygiene, prevention, and treatment options for PEH with cutaneous fungal infections, the most common of which were tinea pedis (3-38%) and onychomycosis (1.6-15.5%). Few studies have been conducted on the differences between sheltered and unsheltered homeless patients, which can have treatment implications. Systemic antifungal therapy should be carefully considered for diffuse, refractory, or nail-based cutaneous fungal infections if there is a history of alcohol use disorder or liver disease. While PEH have a high risk of alcohol use disorder, this can make definitive treatment challenging.

Street Medicine is a volunteer-run initiative for low-resource healthcare settings. Formed to bridge gaps in care for persons experiencing homelessness, these organisations work to provide preventative medicine through maintenance care and follow-up. However, there are limits to what Street Medicine can accomplish given the geographical radius covered, lack of available transportation options and vulnerable sleeping locations night to night for the patients served. The subject of this case report is a middle-aged Spanish-speaking unsheltered man who began his care with a Street Medicine team. He was unable to attend medical appointments due to relocation, complicating his disease course and resulting in hospital intervention for cellulitis. Post-discharge, he stayed within radius and was treated by the street team. Increased emphasis on the effects of housing insecurity and addressing social determinants of health could prevent deterioration of manageable diseases and should be an area of active interest for Street Medicine team expansion.

Introduction: Hypertension (HTN) can lead to adverse cardiovascular sequelae without appropriate management. People experiencing homelessness (PEH) are at increased risk of diseases yet have poor access to HTN monitoring. In particular little is known about prevalence of HTN among unsheltered PEH. Our objective is to assess baseline HTN characteristics in the unsheltered PEH population of Miami-Dade County. Methods: Blood Pressure (BP) measurements were obtained by in-person clinic “street runs” where medical providers meet with unsheltered PEH. Vitals were recorded in RedCap electronic medical record system. Center for Disease Control National Health and Nutrition Examination Survey (NHANES) 2017 – 2020 Pre-pandemic data set represented the general population. Descriptive statistics and independent sample t-test comparisons were performed using SPSS v26. Results: BP was reported in 145 interactions – participant mean age 56.2 years (SD 10.5), 79.8% Male. The total average systolic BP (SBP) 140.14 (SD 22.28), diastolic BP (DBP) 87.99 (SD 12.74). Average visit 1 (N = 94) SBP 141.10 (SD 22.82), DBP 88.46 (SD 13.24). Average visit 2 (N= 22) SBP 145.45 (SD 21.69), DBP 89.82 (SD 12.45). No significant difference was found between visits 1 and 2. Elevated BP at two visits established formal HTN diagnosis, as defined by American College of Cardiology criteria. NHANES average SBP 119.81 (SD 19.38), DBP 71.61 (SD 12.02). NHANES data compared to average Visit 1 BP showed PEH to have significantly higher SBP (p<0.0001), DBP (p<0.0001). Age and gender stratification furthered internal validation. The average BP measurements of unsheltered PEH at clinic was in American Heart Association’s HTN Stage 2 category. Conclusion: BP of the PEH surveyed were higher than in the general population and within pathological staging criteria for HTN. Steady results from multiple visits suggest compounding factors beyond access to care: polysubstance use disorder, smoking, poor and unbalanced nutrition, chronic stress of being unsheltered. Future studies comparing unsheltered vs sheltered PEH could elucidate more information on risks and management of this deadly and preventable disease.

Onychotillomania is a psychodermatosis that involves repetitive, self-induced trauma to the nail and sometimes the periungual skin. It is generally seen as an overlapping psychiatric and dermatologic disorder, although there have not been any statistically significant associations with psychiatric illness. Some studies have noted an association with obsessive-compulsive disorder (OCD). Due to the relative lack of empirical data on this condition, treatments are often not evidence-based. As a result, there is no standardized method of treating onychotillomania, and patients suffering from this disease are susceptible to relapse. This report presents the case of a 32-year-old male experiencing homelessness and suffering from major depressive disorder and methamphetamine use disorder who developed onychotillomania two months after becoming homeless. He regularly used various instruments such as nail cutters, tweezers, and nail files to constantly pick at his nails, a few of which were noted to be bleeding with signs of infection. He was evaluated jointly by dermatology and psychiatry providers who confirmed the diagnosis. By thorough examination of the patient's history, he was provided tactile sensory equipment to reduce his repetitive picking behavior. A direct referral for substance use counseling was also provided. At follow-up, he was noted to have a subjective improvement in his picking symptoms, although there was no significant difference in the size of his nails. This case represents the twofold challenge of managing a difficult condition, onychotillomania, in the setting of the severe socio-personal stressor of homelessness.

Pornography addiction is an area of increasing concern, particularly due to the ubiquitous nature of pornographic material on the Internet. Even so, there is no formal Diagnostic and Statistical Manual of Mental Disorders (DSM-5) inclusion of compulsive pornography use as a behavioral addiction. Although the psychosocial impacts of pornography addiction have been studied, the risk of direct skin injuries and behavioral changes brought about by excessive pornography usage remain to be seen. Adult males constitute the majority of cases of engaging in risky and violent sexual behaviors with an unclear association with pornography consumption. Adult females may be likely to copy pubic hair trimming patterns analogous to those seen in pornographic content, even though attitudes towards labiaplasty are unclear. Finally, adolescents regularly exposed to pornography have been found to replicate sexual activity seen in pornographic material and have earlier sexual activity. In the literature evaluated, an association between pornographic material and direct cutaneous disease remains a major area of further research.