A report in the February issue of Archives of Dermatology investigates common ill-defined dermatologic diseases among military personnel who were evacuated from combat zones, finding benign moles, dermatitis, hives and cancerous skin lesions among the most common diagnoses.
“Throughout the history of warfare, dermatologic diseases have been responsible for troop morbidity, poor morale, and combat ineffectiveness,” write the authors.

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, MD, and Scott A. Norton, MD, MPH, of the Uniformed Services University of the Health Sciences, Bethesda, Md, 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%) 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 20% were diagnosed with dermatitis or general skin inflammation; 9% with benign melanocytic nevus (non-cancerous moles); 8% with a malignant neoplasm (cancerous skin lesions); and 7% 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,” write the authors. “[This] series illustrates the dermatologic diagnoses that are troublesome for both patients and clinicians in US 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.”