Skin Woes Take Toll on U.S. Combat Troops
TUESDAY Feb. 17, 2009 -- Rashes, eczema and other skin troubles can be exacerbated by combat conditions in Iraq and Afghanistan and are a major cause of American soldiers being evacuated for treatment, a new report finds.
In the history of warfare, skin diseases have been responsible for poor morale and combat ineffectiveness, the researchers noted in the February issue of the Archives of Dermatology. In fact, in tropical and subtropical areas, more than half of the days lost by front line units are due to skin diseases.
"Although skin diseases are rarely fatal, they have significant morbidity; thus they have an appreciable effect on combat medicine and operational primary care," said study author Dr. Timothy A. McGraw, from the U.S. government's Uniformed Services University of the Health Sciences and the Pentagon Air Force Flight Medicine Clinic.
"This study evaluated a set of patients, all servicemen and women, who were evacuated from the war zones for ill-defined, non-traumatic skin conditions. The main outcome of the study was that dermatitis, benign melanocytic nevus [noncancerous moles], malignant neoplasms [skin cancers], urticaria [hives], and a group of nonspecific diagnoses were the most common post-evacuation diagnoses in our study population," McGraw said. "These diagnoses are similar to the most common dermatologic diagnoses from 20th-century wars."
"This is an important paper," added Dr. R. Rox Anderson, a dermatology professor at the Harvard Medical School Wellman Center for Photomedicine at Massachusetts General Hospital, in Boston. "There are a wide variety of skin problems, created or made worse by the conditions faced by soldiers. Prevention, proper diagnosis and treatment benefit the individual soldier and those who depend upon them."
The study shows the high frequency and wide range of skin conditions involved, from life-threatening lesions to conditions that wear soldiers down, increase their risk of infection or their ability to function well, leave permanent scarring, or are simply a nuisance, Anderson added.
"The study suggests that thorough skin evaluation prior to deployments, early diagnosis, prevention and prompt care on site, and the availability of expertise by telemedicine technologies would make a difference," Anderson said.
"With a few exceptions, such as infectious diseases endemic to the countries of conflict, military skin problems have not changed much since 20th century warfare. What has changed is our ability to potentially deal with them," he added.
For the study, McGraw's team collected data on 170 military personnel who left combat zones in Iraq and Afghanistan for ill-defined dermatologic reasons between 2003 and 2006. These were classified as non-specific skin eruptions or skin disorders not otherwise specified.
In total, 154 soldiers were seen by dermatologists and the others were seen by other doctors. Thirty-four individuals were diagnosed with dermatitis or general skin inflammation, 16 with non-cancerous moles, 13 with skin cancer and 11 with no conclusive diagnosis. Chronic itchy rash, eczema, hives and psoriasis were the other common conditions, the researchers found.
Skin troubles can worsen with sun exposure and extremes in temperature and humidity, the researchers said. Diseases common to the combat area, as well as insects and crowded living conditions, can also exacerbate dermatologic woes. Other factors include difficulty maintaining personal hygiene and the chafing and sweating caused by body armor, helmets and other protective gear, McGraw noted.
Several measures will reduce the likelihood of evacuation from the war zone for skin problems, McGraw said. These include identifying individuals with chronic skin diseases during medical screening before they are deployed and emphasizing preventive measures to clinicians in the field.
Doctors also need to develop specific treatment plans for soldiers with skin problems so that they can participate in lengthy deployments without requiring frequent visits to a dermatologist. In addition, diagnosing skin problems in combat zones needs to be more accurate, McGraw said.
Dr. Steve Feldman, a professor of dermatology, pathology and public health sciences at Wake Forest University School of Medicine in Winston-Salem, N.C., believes that better training could cut the need to evacuate patients with skin problems.
"The people evacuated were evacuated for common skin conditions that were largely benign," Feldman noted. "Had there been greater dermatological expertise on site, maybe they wouldn't have had to evacuate those folks."
Perhaps tele-dermatology, where patients are evaluated by doctors who are not on-scene, or better training in dermatological issues could reduce the need to evacuate these troops, he said.
For more on various skin conditions, visit the U.S. National Library of Medicine.
Posted: February 2009