Identifying Human Trafficking Victims: A Potential Role for Forensic Dermatology.

Human trafficking is a worldwide problem that predominantly affects women and children. The victims are recruited by coercion, deception, or force and then exploited for commercial sex acts or labor, or both. Human trafficking results in severe suffering of the victims including not only physical injuries but also psychological consequences. Many of the victims of human trafficking encounter the medical system; however, this chance for potential intervention is often not realized by the clinician treating the individual. Many of the manifestations of injuries to human trafficking victims involve the skin, hair, nails, and mucosa. Hence, there is a paramount opportunity for forensic dermatology in the detection and evaluation of suspected victims of human trafficking. Cutaneous manifestations frequently observed in victims of sex trafficking include branding (with tattoos), rashes, bruising, and sequelae of self-injurious behavior; in addition, mucocutaneous stigmata of sexually transmitted diseases may be present. Skin features more commonly associated with victims of labor trafficking include deep and long cuts, skin injuries (such as bruises and tears), and scars from prior burns and knife cuts. The presence of an uncommon infection affecting the skin, such as new world leishmaniasis, that only occurs in a specific and restricted geographic endemic area can also be a subtle clue to human trafficking. Forensic dermatology has the potential to identify victims of human trafficking; when a healthcare worker entertains the possibility of human trafficking, a comprehensive cutaneous examination may provide objective evidence that the individual who is being evaluated and treated may be a human trafficking victim and therefore prompt the clinician to initiate appropriate intervention.