Operational Dermatology

Watch a Video: Dermatology in a Combat Environment

Believe it or not, rare or exotic dermatoses are not the skin conditions that create the greatest difficulty for deployed military personnel. In fact, only about 20 or so conditions induce the majority of outpatient dermatologic visits and generate the lion's share of morbidity. Under field conditions, common dermatoses may have unusual clinical appearances or become more severe than what is encountered in routine "in garrison" or "in port" care.

This chapter of the GMO Manual is not just for Navy providers. The intended audience is the primary care providers of all U.S. Armed Forces. It is meant to supplement but not replace the commonly available dermatologic textbooks, online atlases, therapeutic manuals, PDR and CD-ROMs. It does however contain diagnostic and therapeutic "pearls" that are most useful to military primary care providers in an operational setting.

The chapter is restricted to conditions that are highly prevalent or produce disproportionate morbidity in a deployed military population.

(2) Prevention and Minimization of Skin Disease

The old adage that “an ounce of prevention is worth a pound of cure” is when applied to dermatologic conditions in the field. The presence of extremes of head and cold along with fewer opportunities for personal hygiene and clothing change have been the traditional enemies of deployed military personnel. Military unique dermatology can be thought of as a battle of the Sailor and Marine versus the hostile environment.

Included below are some prevention tips for hot and cold climates written by the U.S. Army in plain language for field troops. Some phrases are quoted verbatim in the next few paragraphs. This simple wisdom applies to any person in any of the Armed Forces. These words are just as true today as when they were written.

(3) Hot and Humid Areas

These tips were published in 1977 by the US Army in a small field manual entitled: FM 8-40 "Management of Skin Diseases in the Tropics at Unit Level".

a) Keep the skin clean.

"Cleanliness helps preserve the skin's health. Bathing removes dirt, decreases the number of microorganisms and lessens body odor. For all these reasons, keeping clean is preferable to remaining dirty. In addition, showers are great for relaxation, morale and personal comfort."

"If bathing facilities are not handy, they (your personnel) can keep quite clean by washing with cold water from their helmets. Potable water is preferable for showers, but if not available, nonpotable water is adequate."

"Soap and water must be used judiciously and properly. Whatever soap is used must be rinsed off completely. As to the type of soap to use, scientific evidence does not support the notion that germ killing or deodorant soaps or detergents reduce the incidence of bacterial or fungal infections."

"Soldiers (military personnel) must not shower excessively, such as three showers a day with lots of lather. Too much soap and water removes the skin's moisteners and protective oils, causes the skin to become dry and irritated, and thereby reduces the skin's capacity to protect the body."

"Even though cleanliness helps preserve the skin's health, bathing cannot perform miracles in preventing skin disease. This is true regardless of the brand of soap used or the number of showers taken."

(b) Keep the skin dry.

"Tropical skin diseases would be greatly reduced if another rule of skin hygiene, keeping the skin dry, could be adhered to."

"The realities of combat and (other) military operations often make this difficult, but there are a few rules to follow:"

"Remove wet socks and boots as frequently as possible. If dry socks are not available, wring out the wet ones."

"Rinse mud off boots. Mud on boots prevents (the leather) from drying."

"Pay special attention to the skin fold areas; the armpits, groin, buttocks, and the areas between the toes, where several common skin diseases can erupt. Dry these areas frequently. In addition, get in the habit of using talcum (or other nonfragranced) powder. These two practices will promote drying, reduce friction, and prevent infections."

"Do not starch jungle fatigues (BDUs). Starch clogs the openings in the cloth, blocks sweat from escaping, and therefore prevents sweat from evaporating and cooling the skin."

"Air the skin as much as conditions permit."

"If underwear is aggravating an existing skin condition, do not wear it."

"In base camp, encourage the wearing of as little clothing as the commander will allow. Under some conditions, commanders may permit clothing, such as shortened fatigue (BDU) pants, tennis shoes or shower clogs, at base camp and particularly in the company area. It is the commander's responsibility to prescribe the uniform, however. The medic (medical personnel) can only recommend a uniform that is consistent with command policy."

“Unless you are reasonably sure the patient has a fungal or bacterial infection, it is better to soothe the skin than to “kill the germs”. More damage can be done by “over treatment” than by under treatment. As a rule, highly inflamed, blistered, or oozing areas require gentle and calmative treatment. The application of wet soaks (e.g. Burow's solution), removal of restrictive clothing, can encourage the patient to stop scratching by eliminating the itching.”

(4) Cold Weather Operations

These quotes are from the US Army TC 21-3 (1986) "Soldier's Handbook For Individual Operations and Survival In Cold-Weather Areas". This 1986 version is easily understood.

(a) Keep it Loose

"All items of the cold-weather uniform are large enough to allow wearing of the appropriate number of layers (of clothing). Your field jacket may appear too large without all of the layers designed to fit under it. If the uniform items do not fit loosely, the insulation that keeps you warm (a layer of warm air) will be greatly reduced."

(b) Keep it dry

"It is important to keep clothing dry, since wet clothing conducts heat away from the body more quickly than dry clothing. Moisture soaks into clothing from two directions: the inside and the outside. From the outside you must guard against melting snow; from the inside you must guard against sweating. Brush snow and frost from clothing before entering any heated shelter or vehicle, and avoid overheating."

(5) The Cold Weather Uniform

"The feet are hard to keep warm and dry, so protect them."..."When you are active, your feet will sweat and....the moisture will remain in the socks or in the bottom (and leather) of the boots. Drying (the feet), massaging with foot powder, warming and putting on dry socks will correct this."..."Don't wear socks that are too tight."..."Change your socks at least twice a day."

Written and revised by CAPT Dennis A. Vidmar, MC, USN, Department of Military and Emergency Medicine, and Department of Dermatology, Uniformed Services University of the Health Sciences, Bethesda, MD (1999).

*Additional images provided by CAPT Vidmar in June, 2000, subsequent to the initial publication of this manual.

Preface · Administrative Section · Clinical Section

The General Medical Officer Manual , NAVMEDPUB 5134, January 1, 2000
Bureau of Medicine and Surgery, Department of the Navy, 2300 E Street NW, Washington, D.C., 20372-5300

This web version of The General Medical Officer Manual, NAVMEDPUB 5134 is provided by The Brookside Associates Medical Education Division. It contains original contents from the official US Navy version, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense. All material in this version is unclassified. This formatting © 2006 Medical Education Division, Brookside Associates, Ltd. All rights reserved.

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