Dermatitis, benign moles, hives and cancerous skin lesions are among the most common diagnoses among military personnel who were evacuated from combat zones for ill-defined dermatologic diseases, according to a report in the February issue of Archives of Dermatology, one of the JAMA/Archives journals.
"Throughout the history of warfare, dermatologic diseases have been responsible for troop morbidity, poor morale and combat ineffectiveness," the authors write as background information in the article. In tropical and subtropical climates, skin diseases have accounted for more than half of the days lost by frontline units. Skin diseases during wartime are exacerbated by sun exposure, temperature and humidity extremes, native diseases, insects, crowded living conditions, difficulty maintaining personal hygiene and chafing and sweating caused by body armor, helmets and other protective gear.
Timothy A. McGraw, M.D., of the Uniformed Services University of the Health Sciences, Bethesda, Md., and Pentagon Air Force Flight Medicine Clinic, Washington, D.C., and Scott A. Norton, M.D., M.P.H., also of the Uniformed Services University of the Health Sciences, studied 170 military personnel who left combat zones in central and southwest Asia for ill-defined dermatologic reasons between 2003 and 2006 (for example, non-specific skin eruption or skin disorder, not otherwise specified).
Of these, 154 (91 percent) were evaluated by a dermatologist after evacuation, and the rest were evaluated by other types of physicians, including family physicians and internal medicine specialists. A total of 34, or 20 percent, were diagnosed with dermatitis or general skin inflammation; 16, or 9 percent, with benign melanocytic nevus (non-cancerous moles); 13, or 8 percent, with a malignant neoplasm (cancerous skin lesions); and 11, or 7 percent, received an uncertain final diagnosis. Other common diagnoses included atopic dermatitis (chronic itchy rash), eczema, urticaria (hives) and psoriasis.
"Although skin diseases cause few fatalities, they have an appreciable role in combat and operational primary care," the authors write. "[This] series illustrates the dermatologic diagnoses that are troublesome for both patients and clinicians in U.S. Central Command. The results of this study largely agree with observations from the first Persian Gulf War and in other 20th-century American and British conflicts: eczemateous and atopic dermatitis and other chronic skin conditions continue to be among the most common reasons that deployed military personnel seek dermatologic care."
Identifying individuals with these conditions before deployment, emphasizing preventive measures and developing treatment plans may reduce the number of evacuations and their resulting impact on combat units, the authors recommend. Efforts should also be made to improve the accuracy of dermatologic diagnoses in the combat zone, perhaps by creating virtual dermatology clinics so that off-site specialists can provide consultation and support.