Tropical skin diseases in British military personnel

A review of skin disease in military soldiers: challenges and potential solutions

Introduction: Military soldiers comprised 1,195 million United States active-duty members and 778,000 reserve members in 9/2021. Soldiers are often exposed to drastic climates, environments, and living conditions which may make them more susceptible to cutaneous diseases.Methods: A PubMed search of studies published between 1/1/2002 - 8/30/2022, using MeSH terms: ((("Military Personnel"[Majr]) OR "Military Hygiene"[Majr])) OR "Military Medicine"[Majr]) AND "Skin Diseases"[Majr]), the reference lists of select articles, and other applicable sources were reviewed to identify articles on skin conditions affecting military soldiers and treatment options.Discussion: In this article, we review skin conditions that affect military soldiers in both the deployed and non-deployed settings including infectious diseases, arthropod associated diseases, sexually transmitted infections, ultraviolet radiation related skin disease, acne, diseases of hair and hair follicles, dermatitis, onychocryptosis, and conditions caused by extreme weather conditions and occupational exposures. We also discuss treatment options and prevention methods as they relate to military settings.Conclusion: Dermatological conditions can considerably impact soldiers' wellbeing and military performance, often lead to evacuation of military personnel, and are associated with high financial costs. Cutaneous disease is one of most common reasons for soldiers to seek medical care and may cause significant morbidity. Serving in the military often impacts and limits treatment options.

Morphological and Molecular Characterizations of Cochliomyia hominivorax (Diptera: Calliphoridae) Larvae Responsible for Wound Myiasis in French Guiana

Myiasis is an ectoparasitic infection caused by the larvae of true flies (Diptera). We came across a rather rare case of myiasis in an immunocompetent 34-year-old man from French Guiana with advanced wound myiasis masquerading as cavitary myiasis and a history of cholesteatoma surgery in the left ear. The Diptera larvae responsible for the disease were isolated and identified using morphological and molecular approaches as Cochliomyia hominivorax. We underline the importance of this parasitosis as the second case of myiasis caused by C. hominivorax and the first case of wound myiasis in this overseas department of France and its incidence in pre-urban areas of the capital, Cayenne, in South America.

Infectious diseases in German military personnel after predominantly tropical deployments: a retrospective assessment over 13 years

OBJECTIVES

Military deployments to the tropics are associated with specific infection risks. To add to the available epidemiological information, infectious disease risks in German military personnel returning from predominantly tropical deployments were assessed.

METHODS

Since 2006, German soldiers returning from predominantly tropical deployments have been offered the opportunity of returnee screenings at the Department of Tropical Medicine and Infectious Diseases of the Bundeswehr Hospital Hamburg. Case files and diagnostic results recorded between 2006 and 2018 were retrospectively assessed to identify deployment-associated infectious disease risks.

RESULTS

Along with high enteric colonisation rates with apathogenic protozoa and resistant Enterobacteriaceae, direct or indirect proof of infections among the 764 assessed cases comprised Plasmodium spp (n=37), Giardia duodenalis (n=21), Schistosoma spp (n=14), Yersinia enterocolitica (n=5), Strongyloides stercoralis (n=3), Campylobacter jejuni (n=1), Leishmania spp (n=1) and Salmonella enterica (n=1), as well as latent infections with Mycobacterium tuberculosis complex (n=8). The infections were mainly imported from the African region and Eastern Mediterranean region and high proportions of cases lacked typical symptoms. Reported side effect rates of antimalarial chemoprophylaxis for mefloquine (n=121), atovaquone/proguanil (n=49) and doxycycline (n=6) were 36.3%, 19.3% and 11.8%, respectively, while non-compliance rates were 12.9%, 13.0% and 5.9%, respectively.

CONCLUSIONS

Considerable rates of infections with sometimes atypical or absent symptoms confirm a need for returnee screenings after tropical deployments. High reported side effect rates for mefloquine support its replacement by atovaquone/proguanil or doxycycline for antimalarial chemoprophylaxis.

Recognition and development of customized cosmetics for military trainees in 20s and 30s in Republic of Korea

BACKGROUND

For the health of the skin, social standards have been changed to increase the public's interest in achieving perfect skin. With the diversification of consumer needs, the reorganized core market for demand pursues the attributes of customization that bring the individual ego and product image to match through aggressive consumer needs.

OBJECTIVES

Therefore, in this study, we conducted a questionnaire to 450 men in their 20s and 30s, Chuncheon City, Gangwon-do, Republic of Korea, focused on the fact that customized cosmetics drive individuals and optimization.

METHODS

Statistical processing of materials collected by the data analysis method is analyzed using the SPSS (Statistical Package for Social Science) WIN25.0 statistical package program through the process of data coding and data cleaning.

RESULTS

As a result, "I think I need customized cosmetics for me." 3.91 (SD = 1.19), and it seems that the number of custom cosmetics used will increase in the future. "3.99 (SD = 1.06) It was the highest in terms of points. Also, I would like to use PX's men's custom cosmetics when they are released." The average was 4.34 (SD = 0.91), which was the highest. Comprehensive research results of P <0 .001 and above suggested the possibility of developing customized cosmetics for men.

CONCLUSION

Therefore, this requires continuous research on personalized bespoke cosmetics according to work and usage characteristics, and PX custom products for future soldiers should be developed. In the future, the researcher plans to continue to study the recognition and development potential of customized cosmetics for female military personnel in South Korea in subsequent research.

Defence Medical Services telemedicine now: a successful pilot of video consultations and instant messaging support to firm base training

INTRODUCTION

Telemedicine was pioneered in the Defence Medical Services (DMS) in 1998, since then the capabilities within the DMS have not advanced in step with advances in technology. We present our findings of a pilot of remote video consultation via Skype for MODNET during an arduous course held in the UK.

METHOD

Combat medical technician sick parades were live streamed via Skype to a Defence Primary Healthcare Medical Centre and medical officer (MO) support was delivered remotely. This process was augmented by the use of Pando for still images of wounds and infection sites in order to enhance decision making and situational awareness.

RESULTS

Over a 3-week period, 34 consultations carried out during sick parade required the input from a remote MO, of those 34% required a prescription from an MO. None of the presentations required a face-to-face consultation, and all patients received MO-led care remotely.

CONCLUSION

We have successfully demonstrated that video telemedicine consultations are safe, while simultaneously improving patient care, augmenting the distribution of medical assets and reducing costs.

Unusual presentations of cutaneous larva migrans in British military personnel

Cutaneous larva migrans (CLM) is one of numerous skin diseases that occur in British military personnel on deployments to the tropics and sub-tropics. It is typically managed by military primary healthcare services, but diagnostic uncertainty or unavailability of anti-helminthic medication may prompt referral to UK Role 4 healthcare services. Cases of CLM seen at the UK Role 4 Military Infectious Diseases & Tropical Medicine Service from 2005 to 2020 were identified and their case notes were reviewed to identify learning and discussion points. There were 12 cases identified, of which five came from Brunei and three were from Belize. Causes for referral were due to diagnostic uncertainty (58%) and the unavailability of anti-helminthic medication (42%). Several cases had CLM in an unusual distribution due to specific military activities performed in endemic areas. Telemedicine was very useful in making some of the diagnoses in theatre and avoiding the need for medical evacuation. Military personnel may have unusual presentations of CLM due their unique military activities. In areas that are endemic for CLM, clinicians should maintain high clinical suspicion for CLM, carry appropriate anti-helminthic medications and consider screening cases of CLM and their colleagues for other infections with similar aetiology (eg, human hookworm infection and strongyloidiasis).

[Dermatology in the tropics and in medical missions: Consequences for the training of dermatologists and for continuing medical education]

Dermatologists from Germany are increasingly involved in international missions under tropical conditions. While civilian operations take place primarily in the context of international development cooperation, non-governmental organizations and private initiatives, dermatologists of the German Armed Forces have been engaged in numerous military missions and international disaster relief missions abroad. The specific requirements of these missions require a specialist qualification; however, the specialist training in "Skin and Venereal Diseases" under the conditions for medical care in Germany is frequently not sufficient. For an optimal preparation for dermatological missions in tropical regions, an additional qualification in tropical medicine is to be recommended. Since this additional training is time-consuming and can often not be put into practice, especially in the civilian sector, the acquisition of the certificate "Tropical and Travel Dermatology (DDA)" of the International Society for Dermatology in the Tropics in cooperation with the German Dermatological Academy (DDA) can be recommended. In the future, training in tropical dermatology should be incorporated into the main curriculum of dermatology for those specialists planning to work on dermatological missions in the tropics.

Prevalence of skin diseases in civilian and military population in a Turkish military hospital in the central Black Sea region

OBJECTIVES

There are no epidemiological studies comparing the prevalence of skin diseases between civilian and military populations. We sought to determine and compare the prevalence of skin conditions between civilian and military populations.

METHODS

A total of 3382 male patients (1148 military and 2234 civilian) were retrospectively and consecutively evaluated at Merzifon Military Hospital in the central Black Sea Region of Turkey.

RESULTS

The most frequent dermatological condition was tinea pedis (15.8%) followed by acne vulgaris, allergic contact dermatitis and alopecia areata in the military population (15.7%, 7.7% and 5.4%, respectively). Acne vulgaris, xerosis cutis and allergic contact dermatitis were the most common diagnoses in the civilian group (19.4%, 14.1% and 9.1%, respectively). The prevalence of tinea pedis, alopecia areata, pityriasis versicolor, ingrown nail (unguis incarnatus) and callus were statistically significantly higher in the military group (15.8% vs 4.4%, p<0.001; 5.4% vs 1.7%, p<0.05; 3.5% vs 0.7%, p<0.001; 3.3% vs 0.3%, p<0.001 and 4.6% vs 0.9%, p<0.001; respectively). Xerosis cutis was found to be significantly higher in the civilian group (14.1% vs 5.8%, p<0.001). Superficial fungal disease was the most prevalent disorder as in the previous literature.

CONCLUSIONS

Preventive measures should be taken to improve the health of troops and reduce the prevalence of the common disorders such as tinea pedis, alopecia areata and callus. Troops should wear boots only when necessary in base camps. Clothing which reduces ventilation is not recommended. Depression and anxiety should be recognised and treated in soldiers with alopecia areata, as a solely dermatological approach without psychological support may reduce treatment success.

A unique case of facial burn superinfected with Dermatobia Hominis larvae resulting in a bilateral enucleation of the eyes

We present a case of a female Ecuadorian patient who presented a deep facial burn injury complicated with a severe infestation of Dermatobia Hominis larvae. The burn injury was complicated by severe myiasis attributable to the poor management of the wound received at home, using tropical plants, which caused a secondary infection and severe necrosis of the tissue involving the forehead, cheeks, chin, scalp, nose, mouth and the eyes resulting in a bilateral enucleation and long inpatient hospital care.