Skin diseases in war

Abstract

Dermatologic disease has been a major source of morbidity for military personnel whether at war or in peace, so dermatologists have a major role in maintaining the health and readiness of the forces. Data from World War I show that 5.1% of all admissions to field hospitals were the result of skin diseases, with only gastrointestinal disease and wounds having been seen more frequently.1 In the southern Pacific during World War II, 20% of soldiers seeking medical attention suffered from a dermatologic process,2,3 whereas 12.2% of all outpatients had a cutaneous disease in the Vietnam War.4 An American study from Operation Desert Storm in the Persian Gulf showed a skin disease frequency of 13.9%.5 Many of the most notable figures in dermatology have written of their experiences after the armed conflict of their generation.6 Pillsbury and Livingood7 described how an army bereft of a single qualified dermatologist at the start of World War II found itself faced with rates of hospital admissions for dermatologic disease as high as one man for every 10 soldiers in the Middle East and southwestern Pacific theaters of operation. They found that the “rare” skin diseases that were emphasized during training were virtually nonexistent in the young, healthy population that went to war. Rather, it was the common infections, inflammatory diseases, and environmental skin disease that caused the bulk of the morbidity. The spectrum of skin diseases is similar to that seen in general civilian practice: dermatophyte infections, superficial bacterial skin infections, and eczematous dermatitis were among the most frequent skin complaints.2,3 Dermatologic conditions among military personnel vary with the environment, and the diseases will differ between situations of conflict and deployment setting (Table 1). In addition to endemic pathologies, the bare essentials of personal hygiene are often difficult or impossible to obtain when stationed abroad. In view of past problems with wartime hygiene, it has been suggested that soldiers in the field should bathe “as often as possible” to help prevent skin diseases such as miliaria rubra, intertrigo, and other fungal and bacterial infections. 8 Frostbite and related cold injuries have hindered combat operations and sometimes changed the course of history for such notable generals as Alexander the Great, Hannibal, Washington, and Napoleon. In more recent times, the military effectiveness of the German Army in Russia during the winter of 1941–1942 was reduced by the soldiers’ being ill-equipped to face the bitter eastern Russian winter, a scenario repeated by the American Army in Korea during the winter of 1950 – 1951, when setbacks during the worst part of the winter left the troops exposed to the harsh cold. Even during peacetime, troops who conduct training exercises in preparation for winter combat have been plagued by cold injuries, with many sustaining permanent disabilities.9,10 “Trench foot” as another form of cold injury is often found in discussions on frostbite: the appellation is derived from the static warfare conditions of World War I in which the soldiers stood for long periods of time in cold, wet, but unfrozen puddles of water in their trenches. “Shelter foot” was described in World War II among people who spent long hours in cold and wet air-raid shelters. “Sea-boot foot” occurs when sailors