Skin lesions, differential diagnosis and practical approach to potential survivors of torture.

As the international refugee crisis has reached new proportions (BMJ, 355, 2016 and i5412), survivors of torture increasingly present in treating physicians with an array of acute or chronic skin lesions. Physicians should be aware of common presentations and likely differential diagnoses in order to avoid mislabelling or under-recognizing torture. Survivors of torture also frequently suffer from psychological sequelae, such as post-traumatic stress disorder, and appropriate referrals are essential in order to improve recovery trajectory. Skin sequelae are the most common physical findings of torture. Not all skin lesions seen in tortured survivors are due to perpetrator inflicted injuries, and many dermatological conditions can mimic lesions typical of torture, as can scars as a result of folk remedies or cultural practices specific to geographical regions. Medical documentation of torture includes injury and lesion description. While forensic dermatology and other forensic specialties use an injury description taxonomy, and the standard dermatologic taxonomy uses an anatomic description, they are complementary sciences for lesions inflicted by torture. This results in an opportunity for learning across disciplines in order to improve evidence documentation for survivors of torture. This article describes features of common skin lesions consistent with torture, including their clinical appearances, differential diagnoses, patterns of injury and appropriate clinical descriptions.

A medical project in an African village.

The authors led a group of 15 students on a medical project to a remote traditional village in Sierra Leone, West Africa. The team lived in the village for one month. They staffed an outpatient clinic, performed a community health survey, and organized an immunization project and a health education program. This project offered a unique opportunity to teach many aspects of primary care, including clinical skills, use of health education, practice of preventive medicine, methods of community epidemiology, and the relationship of health to sociocultural factors. By living in the community, seeing the overwhelming health problems in the clinic, and working in the community to improve health, the students had a provocative and educational primary health care experience. Family medicine teachers are well suited for leading international medical projects.