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

Figures & data

Table 1. Prevalence of skin disease in different military deployments.

Army	Name of Operation	Deployment location	Climate	Type of mission	Length of time	Number of dermatology diagnoses	Dermatological diagnoses % of total medical diagnoses	Bacterial infection (% of skin diagnoses)	Fungal Infection (% of skin diagnoses)	Viral infection (% of skin diagnoses)	Dermatitis and eczematous conditions (% of skin diagnoses)	Acne (% of skin diagnoses)	Diseases of hair and hair follicles (% of skin diagnoses)	Skin Cancer	Insect Bites (% of skin diagnoses)
US [19] (Army field Hospital in Saudi Arabia)	Persian Gulf War	Saudi Arabia	Hot and Dry	Warfare	2/1991–3/1991	81	N/A	7.2%	13%	11.5%^a (includes Viral infection, other and Wart)	16.5% (includes: AD, CD, eczema, seborrheic dermatitis)	4.3%	4.3%	0%	N/A
US [21]	Vietnam War	Vietnam	Hot and Humid	Warfare	1965–1970	4166	12.2%	21.2%^a	3%^a	N/A	8.5%^a	N/A	N/A	N/A	N/A
Australian [5]	N/A	East Timor	Hot and humid	Peacekeeping	93 d (1999)	193^b	25.2%	15.5%	23.3%	17%	16%	1%	0.5%	N/A	N/A
US [7]	OIF	Iraq	Hot and Dry	N/A	1/2005–1/2009	2197	N/A	7%	7%	N/A	13%	N/A	N/A	N/A	N/A
US [28]	OIF	Iraq	Hot and Dry	N/A	1/15/2008–7/15/2008	2696	N/A	6%	6%	5%^a (Includes viral disease and warts)	18%^a (includes eczema and seborrheic dermatitis)	9%	3%^a (includes alopecia and pseudo folliculitis barbae)	8%	1%^a
United Nations (different countries) [18]	United Nations and African Mission in Darfur (UNAMID)	Darfur, Sudan	Hot and dry climate	peacekeeping	3/2014–2/2015	542	N/A	N/A	22.5%	N/A	38.7%	10.7%	N/A	N/A	N/A
United Nations [17]	United Nations Interim Forces in Lebanon (UNIFIL)	Lebanon	Hot and dry	peacekeeping	1/2018–5/2019	549 (experienced by 399 military personnel and 150 civilians)	N/A	9.3%	13.3%	7.5%	27.1%	6.6%	5.1%	N/A	2.2%
US [10]	Many	Afghanistan, Iraq, other regions of Middle East, Africa, Asia, Americas (all deployments during timeframe)	Multiple	Multiple	2008–2015	429,837	10%	7.5%	11.6%	N/A	8.5%^a (Contact Dermatitis = 7.7% Eczematous dermatitis 0.8%)	5.5%	8.1%	0.02%	N/A
Britain [20]	HERRICK	Afghanistan	Hot and dry	N/A	7/2010	365	20%	12%	25%	8%	N/A	N/A	N/A	N/A	N/A

AD: Atopic dermatitis (AD); CS: Contact dermatitis; OIF: Operation Iraqi Freedom (OIF).

^a Percentages were calculated from information provided in publication for comparison with other publications.

^bSkin diagnoses of different conditions were added up to find total number of skin disease diagnoses.

Table 1 shows the prevalence of different skin diseases that affected military soldiers in different deployments. Articles used in this table were first identified conducting a PubMed search of Major MeSH terms “Military Personnel” OR “Military Hygiene” OR “Military Medicine” AND “Skin Diseases” From 1/1/2002–8/30/2022. Articles that included prevalence of skin disease in military soldiers in deployed settings were added to this table. In addition, references of relevant articles were queried to expand search and some, but not all, of relevant articles were included. [5,7,10,17–21,28].

Table 2. Prevalence of skin disease in non-deployed settings.

Army	Climate	Length of time	Number of dermatology diagnoses	Dermatological diagnoses % of total medical diagnoses	Fungal Infection (% of skin diagnoses)	Bacterial infection (% of skin diagnoses)	Dermatitis and eczema (% of skin diagnoses)	Viral infection (% of skin diagnoses)	Acne (% of skin diagnoses)	Diseases of hair and hair follicles (% of skin diagnoses)	Skin Cancer (% of skin diagnoses)	Insect bite reactions
Norwegian [11]		8 months 9/1996–5/1997	222	16%	5%	N/A	18.9%	Total: 9%^a Including (Common warts and HSV)	10.4%	N/A	N/A	N/A
Turkish [22]	Hot and humid (during time of study)	2 d	609^c (experienced by 183 military personnel)	N/A	15.9%^a	10.6%^a	21.8%^a (includes Dyshidrotic eczema, Intertrigo, Pityriasis capitis simplex, CD, and Asteatotic eczema)	1%^a	5.6%^a	3.8%^a	12.6%^a	N/A
Korean [23]		4/–9/2010	1081^b (experienced by 798 military personnel)	N/A	24.5%^a Includes:Tinea pedis, onychomycosis, tinea cruris, P. versicolor, tinea corporis, other)	3.7%^a (Includes: Bacterial folliculities, and Pitted keratolysis)	13.4%^a (Includes: Atopic, Seborrheic, Contact, Hand, and Other dermatitis)	5.7%^a	43.7%^a	3.2%^a	N/A	0.4%^a
Singaporean [12]		2 years (2007–2009)	9176	N/A	28%	6%)	24%^a (Includes: Nonspecific dermatitis, CD, and Endogenous eczema)	1%	5%	3.2%^a (Includes: folliculitis and hair disorder)	N/A	7%

CD: Contact dermatitis (CD); HSV: Herpes simplex virus (HSV).

Table 2 shows the prevalence of different skin diseases affecting military soldiers in studies from non-deployed settings. Articles used in this table were first identified conducting a PubMed search of Major MeSH terms “Military Personnel” OR “Military Hygiene” OR “Military Medicine” AND “Skin Diseases” From 1/1/2002–8/30/2022. Articles that included prevalence of skin disease in military soldiers in non-deployed settings were added to this table. In addition, references of relevant articles were queried to expand search and some, but not all, of relevant articles were included [11,12,22,23].

^a Percentages were calculated from information provided in publication for comparison with other publications.

^b Skin diagnoses of different conditions were added up to find total number of skin disease diagnoses.

c Skin diagnoses of different conditions in this cited study were added to find total number of skin disease diagnoses.

Figure 1. Cutaneous abscess on the lateral thigh. There is erythema, fluctuance, and purulence. Photo by Bruno Coignard, M.D.; Jeff Hageman, M.H.S. Reprinted from public domain Centers for disease Control and Prevention public Health Image Library; Retrieved from https://phil.cdc.gov/details.aspx?pid=7826.

Figure 2. Tinea pedis. Annular scaly plaques involving the dorsal foot and web spaces. Reprinted with permission from: Oumeish and Parish [40], with permission from Elsevier.

Figure 3. Cutaneous leishmaniasis. Central domed, eroded, and crusted erythematous nodules on the right dorsal hand of a soldier returning from Iraq deployment. This case has been previously reported. Reprinted with permission from Pehoushek et al. [51], with permission from Elsevier.

Figure 4. Cutaneous leishmaniasis. Ulcerated plaque on the right fourth toe and third web space. This case has been previously reported. Reprinted with permission from: Pehoushek et al. [51], with permission from Elsevier.

Figure 5. Scabies. Erythematous papules on the abdomen due to hypersensitivity to the scabies mite. Image by Joe Miller. Reprinted from public domain Centers for disease Control and Prevention public Health Image Library; Retrieved from https://phil.cdc.gov/details.aspx?pid=15382.

Figure 6. Cutaneous myiasis. Erythematous nodule with Central pustulation (a) and larva of C. anthropophaga, 7 mm long with an oval body and numerous black spines (b). Reprinted with permission from: Deng et al. [74], with permission from John Wiley and Sons.

Figure 7. Monkeypox. Umbilicated papules on the penile shaft. Reprinted with permission from: Vallée et al. [96], with permission from Elsevier.

Figure 8. Pseudofolliculitis Barbae. Follicular papules and hyperpigmented patches. Reprinted from public domain United States Government document Tshudy and Cho [131].

Figure 9. Contact dermatitis of the leg and dorsal foot secondary to military boots. Erythematous plaques correspond to the outline of the military boots. Reprinted with permission from: Oumeish and Parish [40], with permission from Elsevier.

Figure 10. Frostbite of the lower leg and foot. Reprinted with permission from: Oumeish and Parish [40], with permission from Elsevier.

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Data availability statement

Data sharing is not applicable to this article as no new data were created or analyzed in this study.