Dermatologic Conditions in Veterans of the Persian Gulf War
Karen Klickmann
(847) 240-1735
kklickmann@aad.org
Jennifer Gale
(847) 240-1730
jgale@aad.org
Julie Bremer
(847) 240-1743
jbremer@aad.org
EMBARGOED UNTIL JULY 31, 2001
TEN YEARS AFTER THE GULF: DERMATOLOGIC CONDITIONS IN VETERANS OF THE PERSIAN GULF WAR
How to Protect Yourself When Going Abroad
ANAHEIM, CALIF. (July 31, 2001) -- In 1990, the United States deployed over 500,000 troops to the Persian Gulf region. As with all Veterans of military campaigns and wars abroad, returning stateside often has physical and psychological effects on the men and women returning home. Often these physical effects and battle wounds appear immediately, however, there are some dermatological conditions that can remain dormant for years.
Speaking today at Academy 2001, the American Academy of Dermatology's (AAD's) summer scientific meeting in Anaheim, dermatologist John H. Bocachica, MD, Clinical Director of the Department of Dermatology of Loma Linda University, Loma Linda, Calif., reported on the skin conditions in Veterans of the Persian Gulf, as well as dermatologic tips for safe travel abroad.
"While it has been over a decade since the end of the conflict in the Gulf, dermatologists are continuing to treat Veterans suffering from a variety of dermatologic conditions which may be related to their time spent in the Gulf region," said Dr. Bocachica. "Most of these skin conditions are treatable, however, early detection and treatment is the key to an early recovery."
One such dermatological condition, Leishmaniasis, an infectious disease caused by a protozoan transmitted by the bite of a sandfly, is one of the most interesting and perplexing problems found in Gulf Veterans. Sandflies are mosquito-like insects whose small size allows them to pass through mosquito netting.
Sandflies are found in deserts such as the Persian Gulf area as well as rainforests and highlands. Only the female sandfly sucks blood and transmits the disease.
Rodents and other animals in endemic areas may serve as reservoirs for the infective parasites and in India, it is believed that humans with a form of Leishmaniasis actually store the organism and may pass it on to others.
When introduced into the body, the parasite may migrate to the bone marrow, spleen and lymph nodes and may damage the immune system by decreasing the number of disease-fighting cells. Death may result from complications, such as other infections, rather than from Leishmaniasis itself.
The disease tends to begin as a small dark purplish or reddish bump that may appear immediately after a bite or several weeks later. With time the legion eventually becomes crusty in the center. Skin lesions may become locally invasive and attack deeper tissue, even muscle. Once the bump has been present for about two months, it stops spreading and eventually heals into a chronic skin sore. These lesions bare a strong resemblance to other ulcers affiliated with tuberculosis, syphilis, leprosy and basal cell carcinoma, a skin cancer.
Sodium stilbogluconate has been an effective treatment for Leishmaniasis disease and is available to military and civilian physicians through the Centers for Disease Control. Cosmetic surgery may be required to correct disfigurement by destructive facial lesions.
Worldwide, over 12 million people are affected by Leishmaniasis. Deployment of military troops, movement of new immigrants into high risk areas, increased tourism to exotic locations, and a decrease in the use of insecticides have all contributed to an increase in the number of cases seen annually; now estimated to be over 400,000. The more severe systemic form of the disease causes over 75,000 deaths worldwide annually.
In addition to Leishmaniasis, there are a variety of skin conditions which appear to occur more frequently in Gulf War Veterans. These include tropical acne, certain fungal infections, and scaling of the skin and inflammation of the hair follicles. These dermatologic conditions can be treated with medications prescribed by the dermatologist.
Tropical acne has been noted in Veterans who have been posted in Southeast Asia in World War II, the Vietnam War and the conflict in the Gulf. The cause of tropical acne is not known. In its most severe form, tropical acne presents as large, inflammatory nodules, mainly on the body and buttocks; the nodules may become secondarily infected with staphylococci bacteria.
Tropical acne isn't the only skin condition that soldiers and travelers need to negotiate with when visiting the arid regions of the world. Overexposure to the sun is the most frequent environmental hazard experienced by travelers abroad. Since many travelers are not accustomed to the intensity of the sun in many arid regions of the world, they falsely rely solely on the effectiveness of sunscreens; resulting in severe sunburns that can ruin a trip and lead to skin cancer. In addition, research has found that exposure to ultraviolet radiation also temporarily suppresses the immune system and can leave the body susceptible to other illnesses.
Travelers abroad may also develop a variety of infectious skin conditions. One such condition, cutaneous myiasis is often found in the countryside and is identified as an infection that is transmitted when a mosquito carrying botfly eggs bites a traveler. As these eggs are released into the skin, the affected skin becomes prickly and swollen and a small hole appears in the skin for the larvae to breathe.
For those who enjoy the surf and sand during the warm weather, a bad sunburn isn't the only skin condition that can limit outdoor activity. Creeping eruption, a frequent summer infection, is caused by larvae from dog and cat feces after it is deposited on beaches. Once the larvae penetrate the skin, red fluid-filled bumps form in a continuous pattern as the worm advances a few millimeters a day. Creeping eruption is treated by an oral medication prescribed by a dermatologist.
Lastly, while spiders such as the brown recluse are usually not aggressive and are known to have nocturnal habits, travelers are encouraged to check the inside of their shoes and clothing in the morning for any unexpected "night visitors."
Spider bites are most likely to affect travelers on ecological adventures who participate in outdoor activities, such as hiking or camping. After a spider bite, the tissue around the effected area may be destroyed and an ulcer may develop. While anti-venom is necessary for poisonous spiders, most bites can be treated symptomatically.
"While the type and severity of illness depends on a number of factors, such as age, country visited, lifestyle and duration of stay, it is estimated that 3 percent to 10 percent of travelers experience problems related to the hair, skin and nails," said Dr. Bocachica. "Packing preventive measures, such as sunscreen, bug repellant and appropriate clothing are just as important to your travels as your passport and guidebook."
Travelers should consider the following precautions when traveling abroad to avoid returning with any unintended souvenirs:
-- Avoid perfumes and scented lotions which may serve as an attraction to insects.
-- Apply sunscreen 20 minutes before going outdoors and always reapply every two hours.
-- Wear long-sleeved shirts and long pants, a wide brimmed hat and sunglasses. Socks and hard-soled shoes should also be worn, especially if you are going to be traveling into dense forest regions.
-- Wear insect repellant.
-- Ensure that all cuts and scrapes are cleaned and bandaged as soon as possible.
The American Academy of Dermatology, founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of over 13,000 dermatologists worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical, and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; supporting and enhancing patient care for a lifetime of healthier skin. For more information, contact the AAD at 1-888-462-DERM or www.aad.org.
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