Migration and dermatology: an
issue of planetary importance
Relatively little attention has been paid by the International Com-
munity to the most vulnerable population groups in the context of
migration. Yet the magnitude of migration, both forced and volun-
tary, regular and irregular, suggests that unless attention is paid to
these groups, there is a risk that in many settings, individuals and
groups will remain socially excluded and unable to beneﬁt from the
health care that is due to them as human beings and is required to
maintain public health and social cohesion in an increasingly
According to the World Health Organization
(WHO), more people are on the move now than ever before. There
are an estimated 1 billion migrants in the world today of whom
250 million are international migrants and 763 million internal
migrants – one in seven of the world’s population. About 65 mil-
lion of the world’s internal and international migrants are asylum
seekers and refugees today. Recent events in North Africa and the
Middle East triggered a dramatic increase in migration, in Europe,
which highlights the need to engage in a cross-national political dia-
logue on migration. Overall, migration has led to an increase in the
Region’s population by 5 million since 2005 and accounts for nearly
70% of the population growth between 2005 and 2010. Today,
73 million migrants are estimated to be living in the European
Region, accounting for nearly 8% of the total population. Women
represent 52% of migrants. This rapid increase in population move-
ment has important public health implications, and therefore
requires an adequate response from the health sector,
dermatological care, as recently reported in this journal.
of everyone to enjoy the highest attainable standard of physical and
mental health is established in the WHO Constitution of 1948.
The experience of San Gallicano Dermatological Institute in
Rome, founded by the Pope Benedictus XIII in the Holy Year
1725, with migrants coming from Africa to Lampedusa is very
interesting. Since 1985, San Gallicano Dermatological Institute
has been the only Italian public referral point not only for assis-
tance and treatment but also for medical–epidemiological, social
and anthropologic research concerning the immigrant, nomadic
and homeless population. The collated experience has led to
much valued documentation regarding how best skin care can be
delivered. Italy has a huge inﬂux of migrants from EU states and
from developing countries.
These mobile populations obtain free
access to services and essential drugs by registering their name,
date of birth and nationality, and receiving a number and ﬁscal
code. They are then given medical advice and examination from
several specialties, and in the case of dermatology, the necessary
microbiological, mycological, histopathological, X-ray and elec-
tron microscopy investigations are provided for free.
The ability of healthcare system to deal with linguistic and cul-
tural diversity in equitable and effective ways is no longer a mar-
ginal issue. When dealing with immigrant patients’ health, it
reveals crucial to bear in mind their attitude towards illness, pain,
suffering and fear of death, which is different from our own. All
populations have a culturally speciﬁc perception of symptoms. It
is fundamental to take into account the fact that often immigrants
use somatic metaphors as a shortcut for expressing emotions and
feelings, which they would not otherwise be able to communicate.
Very often, they complain of cenestopathic symptoms (headaches,
digestive troubles, vague and generalized pain, itching, a burning
sensation when urinating, worries about their physical health), in
the absence of objective evidence on examination. Illness, too, like
culture, is perceived differently by the different individuals experi-
encing it. As reminded by the WHO, failure to deal with the
whole person in their speciﬁc familial and community contexts
misses out important aspects of health. Transcultural mediators’
tasks include facilitating relations between local and foreign citi-
zens to promote reciprocal knowledge and comprehension
between subjects of different cultural backgrounds. The main
skills of transcultural mediators are communicative competence,
empathy, active listening and good knowledge of both the hosting
country and country of origin (culture, laws, traditions, etc).
Paradoxically, the phenomenon of immigration can con-
tribute to creating a new model of health and to prioritizing
persons’ well-being over proﬁt.
Conﬂict of interest
San Gallicano Dermatological Institute (IRCCS), Rome, Italy
*Correspondence: A Morrone. E-mail: firstname.lastname@example.org
1 Fuller LC, Hay R, Morrone A et al. Guidelines on the role of skin care in
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2 WHO. Seventieth World Health assembly. Provisional agenda item 13.7,
A70/24, 17 May 2017, Geneva.
3 Ring J. Dermatology at the forefront – also with regard to actual politics.
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4 Morrone A. Lampedusa, Gateway to Europe. A Dream to Survive. Edizioni
MAGI, Roma, 2009.
© 2018 European Academy of Dermatology and Venereology
2018, 32, 337