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MILITARY DERMATOLOGY

(1994, 625 pages)

 

Office of The Surgeon General

U.S. Department of the Army

Falls Church, Virginia

Walter Reed Army Medical Center

Washington, D.C.

Uniformed Services University of the Health Sciences

Bethesda, Maryland

Armed Forces Institute of Pathology

Washington, D.C.

1994

 

 

 

 

Foreword

 

Skin diseases such as infections, infestations, and immersion foot may

devastate the fighting strength of a unit by incapacitating its soldiers. In

addition, whereas environmental insults such as severe cold will affect an

entire force, the sheer numbers of troops who fall victim to frostbite or

nonfreezing injuries can easily cripple an entire force. It is important to keep

in mind that incapacity due to skin disease is usually preventable. When

preventive measures fail, the soldier may be back on the front line relatively

quickly with proper treatment, as opposed to the more dramatic missile

wounds, where evacuation and replacement are often necessary. The role

that military dermatologists play in educating, implementing preventive measures,

and treating these common disorders is indispensable.

Owing to the historical perspective of the Textbook of Military Medicine

series, this volume contains several lessons to be learned. First, dermatologists

who can function as consultants, educators, preventive medicine

officers, and healers need to be available for deployments of a division or

greater. Organization that will provide them mobility so they can provide

on-the-spot advice to unit commanders in the field regarding preventive

strategies will help avoid many days of soldiers’ incapacitation. Second,

training of nonsurgical medical officers in the diagnosis and treatment of

skin disorders should be firmly established as a portion of the core curriculum.

This volume will provide a useful tool from which such training can

be modeled. And third, research efforts directed at protective and preventive

strategies needs to continue to be supported.

This volume will be useful to active-duty and reservist dermatologists,

family practitioners, general medical officers, internists, nurses, physician

assistants, and medics. It provides an up-to-date, in-depth, highly visual

resource both for teaching and for providing medical care to our soldiers in

the field.

August 1994

Washington, D.C.

Lieutenant General Alcide M. LaNoue

The Surgeon General

U.S. Army

 

 

 

Table of Contents

 

Foreword by The Surgeon General xi

Preface xiii

Patient Flow in a Theater of Operations xv

1. Historical Overview and Principles of Diagnosis 1

2. Cold-Induced Injury 21

3. Skin Diseases Associated with Excessive Heat, Humidity, and Sunlight 39

4. Immersion Foot Syndromes 55

5. Cutaneous Reactions to Nuclear, Biological, and Chemical Warfare 69

6. Allergic and Irritant Contact Dermatitis 111

7. Cutaneous Trauma and its Treatment 143

8. Arthropod and Other Animal Bites 157

9. Arthropod Infestations and Vectors of Disease 183

10. Viral Hemorrhagic Fevers 197

11. Rickettsial Diseases 213

12. Tropical Parasitic Infections 255

13. Bacterial Skin Diseases 291

14. Leprosy 319

15. Cutaneous Tuberculosis 355

16. Atypical Mycobacterial Diseases 391

17. Superficial Fungal Skin Diseases 423

18. Deep Fungal Skin Diseases 453

19. Sexually Transmitted Diseases 493

20. Common Skin Diseases 549

Acronyms and Abbreviations 597

Index 599

 

 

 

INDEX

A

Abdomen

and contact dermatitis, 136

Achiya, Michihiko, 70, 71

Acids

See Alkalis and acids

Acquired immunodeficiency syndrome (AIDS)

and atypical mycobacterial infections, 404, 417

and cryptococcosis, 481

and genital herpes infection, 531

and leprosy, 352

and molluscum contagiosum, 580-581

and secondary syphilis, 503

and tuberculosis, 376, 377, 379

See also Immunocompromised patients

Acrocyanosis, 33

clinical manifestations, 33

etiology, 33

treatment, 33

Acrodermatitis chronica atrophicans, 311

Actinomycosis, 483-485

Africa

and dracunculiasis, 279

and filariasis, 274

and histoplasmosis, 457

and loiasis, 276

and lymphogranuloma venereum, 522

and mycetoma, 476

and onchocerciasis, 277, 278

and schistosomiasis, 281

and streptocerciasis, 279

African trypanosomiasis, 266-268

clinical manifestations, 267

diagnosis, 267

treatment, 267-268

Afzelius, A., 309

Age differences

and plague, 298

and Rocky Mountain spotted fever, 220

AIDS

See Acquired immunodeficiency syndrome (AIDS)

Albrecht, 305

Alexander the Great, 321

Alexander, W., 584

Algorithms

for diagnosing blisters, 14

for diagnosing changing growths, 15

for diagnosing deep fungal diseases, 455

for diagnosing genital ulcer disease, 496

for diagnosing and isolating atypical mycobacteria, 402

for diagnosing macular erythema, 17

for diagnosing new growths, 15

for diagnosing pruritic, inflamed papules, 18

for diagnosing pustular lesions, 13

for diagnosing scaling papules, plaques, and patches, 16

for diagnosing and treating Rocky Mountain spotted fever,

225

for diagnosing vesicles and bullae, 14

for treating dermatophyte infections, 436

for treating reactional states in leprosy, 349

Alimentary toxic aleukia, 87

Alkalis and acids

and irritant contact dermatitis, 132

Allen, Alfred M., 5, 112, 396, 425

Allergic contact dermatitis, 113-131

and cashew, 118-119

and clothing, 129-130

and fragrances, 131

and ginkgo, 119-120

and Gluta, 120

and India marking nut tree, 117

and Japanese lacquer tree, 117-118

and mango, 118

and metals, 125-128

and miscellaneous sensitizers, 131

and plants, 113-114

geographical distribution, 120-123

and poison ivy and poison oak, 114-117

and poison sumac, 117

and preservatives, 130-131

and rubber compounds, 129

and shoes, 128-129

and sunscreens, 125

and topical drugs, 123-125

See also Atopic dermatitis; Contact dermatitis; Irritant

contact dermatitis

Almeida, Louis, 323

Altman, J., 562

Amebiasis, 268-269

clinical manifestations, 269-269

diagnosis, 269

treatment, 269

Amenhotep II, 321

American Dermatologic Association, 464

American Revolution

and cold injuries, 22

and shoes, 56

Americas

and allergenic, indigenous plants, 120-122

and filariasis, 274

and onchocerciasis, 277

and schistosomiasis, 281

and tularemia, 300

Amherst, 71

Anacardiaceae, 113-114, 117

Anesthesia

for surgery on cutaneous trauma, 150

Angioedema, hereditary, 570

Animal bites

arachnids, 170-178

arthropods, 159

and bacterial contamination, 149

cats and dogs, 180

centipedes and millipedes, 160

insects, 160-170

reptiles, 179-180

Animal hookworm, 272

Annelids, 269

See also Helminthic infections

Annular lesion, 12

Ansamycins

and leprosy, 346

Military Dermatology

600

See also Drugs

Anthralin

in treatment of psoriasis, 559

Anthrax in biological warfare, 82-84

clinical findings, 83

cutaneous findings, 83

diagnosis, 83-84

military significance, 84

prophylaxis, 84

treatment, 84

Antibiotics

and contact dermatitis, 138

Antigen detection

of genital herpes, 529-530

Arabian peninsula

and schistosomiasis, 281

See also Middle East

Arachnids, 170-178

mites and ticks, 185-190

nonscabietic mites, 173-174

scabietic mites, 172-173

scorpions, 174-175

spiders, 175-178

ticks, 170-171

Arenaviridae-caused hemorrhagic fevers, 205-207

Aretaeus, 322, 357

Argentine hemorrhagic fever, 206-207

laboratory findings and treatment, 207

signs and symptoms, 206-207

Aristotle, 22, 322, 357

Aronson, 394

Arsenic

and contact dermatitis, 128

Arsenical vesicants in chemical warfare, 101

Arthritis, psoriatic, 555, 558

Arthritis-dermatitis syndrome, 307

Arthropods, 184

and bites, 159

as vectors of disease, 184

See also Arachnids; Centipedes and millipedes; Insects;

Vectors of disease

Atopic dermatitis, 564-568

clinical features, 564, 565

complications, 566

course, 565-566

diagnosis, 566

military considerations, 567-568

precipitants, 566

treatment, 566-567

Ashworth, 480

Asia

and allergenic, indigenous plants, 122-123

and filariasis, 274

and lymphogranuloma venereum, 522

and tularemia, 300

Asklepiades, 322

Asteatotic eczema, 27

clinical manifestations, 27

etiology, 27

treatment, 27

Atrophy, 10

Aufrecht, 358

Aurelianus, Caelius, 322

Australia

and allergenic, indigenous plants, 123

and atypical mycobacterial infections, 412

and histoplasmosis, 457

and murine typhus, 234

and tick paralysis, 189

Avicenna, 324

Azithromycin

for chancroid, 518

B

Bacille bilié de Calmette-Guérin (BCG), 351, 363

Bacillus anthracis, 82

Bacterial index

and leprosy, 332

Bacterial skin infections

and heat and humidity, 46

Baillie, 357

Baldwin, E.R., 356

“Balkan grippe,” 238

Balsam of Peru

and allergic contact dermatitis, 131

Bamboo Book, 322

Bancroft, J., 189, 198

Bancroftian filariasis, 274-275

clinical manifestations, 274-275

diagnosis, 275

treatment, 275

Barrett, O., Jr., 356

Baumgarten, 358, 359

Bayle, Gaspard Laurent, 357

Bazemore, J.M., 564

Beaman, J.H., 114

Bedbugs, 193-194

Bees, wasps, and hornets, 168

Beetles, 167

Belly

See Abdomen

Benzocaine

and allergic contact dermatitis, 123-124

Bernhard, J.D., 554

Bible

and leprosy, 321

and swarm of flies, 184-185

Bikini BRAVO shot, 76

Biological and Toxin Weapons Convention, 73

Biological warfare, 82-90

anthrax, 82-84

botulism, 87

hemorrhagic fevers, 84-87

history, 71-73

mycotoxins, 87-90

plague, 84

tularemia, 84

Biting flies, 194

See also Mosquitoes and flies

Black Death, 295

See also Plague

Black piedra, 448

Black widow spider, 177-178

Blackhead, 11

Blastomycosis, 464-467

clinical manifestations, 465-466

diagnosis, 466

distribution, 464-465

epidemiology, 464

history, 464

military implications, 467

primary cutaneous inoculation, 466

primary pulmonary, 465

Index

601

systemic, 465-466

treatment, 466-467

Bloch, Iwan, 321

Blood agents, 105

Body lice, 164

Bojalil, 394

Bolivian hemorrhagic fever, 207

Borovsky, 257

Borrelia burgdorferi, 187, 309

Bosch, Hieronymus, 71, 72

Botulism in biological warfare, 87

cutaneous and other clinical findings, 87

diagnosis, 87

military significance, 87

prophylaxis, 87

treatment, 87

Boutonneuse fever, 215, 225-228

clinical findings, 226-227

diagnosis, 228

differential diagnosis, 227

epidemiology, vectors, and hosts, 226

laboratory findings, 227

microbiology, 225-226

prevention, 228

treatment, 228

Bowenoid papulosis, 534

Boxer Rebellion

and leprosy, 325

Bradt, J.G., 515

Brazil

and lobomycosis, 479

and sporotrichosis, 470

Bretonneau, 301-302

Brill-Zinsser disease, 215, 233

See also Recrudescent typhus (Brill-Zinsser disease)

B’rit milah, 365

Brown recluse spider, 176-177

Brugia malayi, 275

See also Malayan filariasis

Brugia timori, 275

See also Timorian filariasis

Brugsch, 321

Bubo, 295

Bubonic plague, 297-298

Buhl, 358

Bulla, 8

Bunney, M.H., 584

Bunyaviridae-caused hemorrhagic fevers, 202-205

Burgdorfer, W., 309

Burkina Faso

and yellow fever, 201

Burrow, 11

Byogenkorosenkin-ho, 323

C

Calomys callosus, 207

Candidosis, 437-443

clinical features, 438-441

diagnosis, 441-442

intertrigo, 438-439

onychomycosis, 439-441

paronychia, 439-441

treatment, 442-443

Caribbean region

and allergenic, indigenous plants, 120-122

and filariasis, 274

and lymphogranuloma venereum, 522

and schistosomiasis, 281

Carter, Vandyke, 476

Case histories

of tuberculous gumma, 374

Cashew

and contact dermatitis, 118-119

Cat and dog bites, 180

Caterpillars and moths, 160-161

Catherine the Great, 295

Ceftriaxone

for chancroid, 518

Cell wall

and leprosy, 328, 329

Cellulitis, 293

Celsus, 357

Celsus, Aulus Cornelius, 322

Centers for Disease Control and Prevention

diagnostic criteria for Rocky Mountain spotted fever, 221

Plague Branch, 298

Centipedes and millipedes, 160

Cercariae, 281

Chagas’ disease, 193

Chagoma, 264-265

Champion, R.H., 569

Chancroid, 515-519

clinical manifestations, 516

laboratory diagnosis, 516-518

treatment, 518-519

Chang Chung-ching, 323

Chemical warfare, 90-105

and arsenical vesicants, 101

and cyanides, 105

doctrine and weaponry, 90

history, 73-76

and nerve agents, 105

and oximes, halogenated, 104-105

and sulfur mustard and nitrogen mustard, 90-101, 101-104

Chemoprophylaxis

of meningococcal infections, 308

Chernobyl (U.S.S.R.), 82

Chien Chen, 323

Chilblain, 31

Children

and condyloma acuminata, 535

and gonorrhea, 511

and leprosy, 346

and tetracycline, 301

and tick paralysis, 189

and treating Lyme disease, 313

China, ancient

and leprosy, 322-323

and plague, 295

and schistosomiasis, 281

and syphilis, 498

Chiracanthium, 178

Chloracne

and irritant contact dermatitis, 132-133

Chlorovinyldichloroarsine, 101

Cholinergic urticaria

and heat and humidity, 45

Christ, Jesus, 321, 322

Chromates

and contact dermatitis, 127

Chromoblastomycosis, 473-475

clinical manifestations, 473

diagnosis, 473-475

Military Dermatology

602

epidemiology and distribution, 473

history, 473

treatment, 475

Chrysops deerflies

vectors for loiasis, 276

Civil War

and chancroid, 515

and shoes, 56

Cleland, 198

Clinics of Dermatology, 120

Clofazimine

and leprosy, 345

See also Drugs

Clostridium botulinum, 87

Clothing

and contact dermatitis, 129-130

and heat loss, 26

and mite control, 237

and preventing Rocky Mountain spotted fever, 224

See also Shoes

Clovis, 357

Coal tar

in treatment of psoriasis, 559

Coccidioidomycosis, 459-464

clinical manifestations, 461

diagnosis, 461-463

distribution, 460-461

epidemiology, 460

history, 459-460

prevention, 463-464

treatment, 463

Cold-induced injury, 21-37

direct, 27-30

history, 22-24

indirect, 31-36

influential factors, 25-26

mechanisms, 24-25

pathogenesis, 27

prevention, 24

Cold panniculitis, 34

clinical manifestations, 34

etiology, 34

treatment, 34

Coleman, W.R., 560

Colophony

and allergic contact dermatitis, 131

Columbus, Christopher, 192, 498

Combat type

and heat loss, 26

Comedo, 11

Commentary of Taiho-rei, 323

Conder, 321

Conduction, 24

Confucius, 322

Contact dermatitis, 112

allergic, 113-131

by anatomical site, 135-137

irritant, 131-133

and mechanical injury, 133

patch and use testing, 137-138

and pharmacological reactions, 133-134

treatment, 138-139

urticaria, 134

See also Allergic contact dermatitis; Atopic dermatitis;

Irritant contact dermatitis

Contact urticaria, 134

See also Urticaria, contact

Convection, 24

Cook, Albert, 392

Corticosteroids, topical

in treatment of psoriasis, 558

Corynebacterium diphtheriae, 301

Creosote

and contact dermatitis, 132

Crimean-Congo hemorrhagic fever, 203

laboratory findings and treatment, 203

signs and symptoms, 203

Crimean War

and frostbite, 224

Crust, 10

Cryptococcosis, 481-482

clinical manifestations, 481-482

diagnosis, 482

epidemiology and distribution, 481

treatment, 482

Culicoides grahami

and streptocerciasis, 279

Culture

for diagnosing gonorrhea, 512-513

Culture, viral

to diagnose genital herpes, 528

Culture and serology

for chancroid, 517-518

Cunningham, D.D., 256-257

Cuprozinc-superoxide dismutase (CSD), 81

Cutaneous manifestations

of amebiasis, 269

of human hookworm disease, 270-271

of strongyloidiasis, 273

Cutaneous nerve biopsy

and leprosy, 333

Cutaneous trauma, 143-156

anatomy, 146-148

evaluation and first aid, 148-149

friction blisters, 144-146

microbiology, 149

pathogenesis, 144-145

prevention and treatment, 145-146

risk factors, 145

surgical intervention, 149-154

Cutaneous viral infections

See Viral infections, cutaneous

Cutis marmorata, 31

Cyanides in chemical warfare, 105

Cytologic diagnosis

of genital herpes, 528-529

D

da Costa Cruz, 393, 415

da Rocha-Lima, Henrique, 456

Dally, Clarence, 70

Damsch, 358

Dante, 324

Dapsone

and leprosy, 343

See also Drugs

Darier, Jean, 380

Darius I, 321

Darling, Samuel Taylor, 456

Daves, J.S., 569

Debridement, 151

Index

603

Dengue hemorrhagic fever, 198-200

laboratory findings and treatment, 200

signs and symptoms, 200

Deoxyfructo-5-hydroxytryptamine (DF5-HT)

and leprosy, 346

See also Drugs

Dermatitis

See Allergic contact dermatitis; Atopic dermatitis; Contact

dermatitis; Irritant contact dermatitis

Dermatology

See Military dermatology

Dermatophytes, 424

Dermatophytosis, 425-437

clinical features, 425-426

diagnosis, 433-434

tinea barbae, 428

tinea capitis, 426-428

tinea corporis, 428-430

Majocchi granuloma, 429

tinea faciei, 429

tinea imbricata, 429-430

tinea cruris, 430

tinea manuum, 431

tinea pedis, 430-431

tinea unguium, 432-433

treatment, 434-437

Deutschmann, 358

Dhobie itch, 117

Dhobie mark dermatitis, 117

Diadochen, 321

Diagnosis, principles, 6-19

anatomy, 6

differential diagnostic considerations, 8, 13-18

patient history, 7

physical examination, 7, 8-12

Diethyltoluamide dermatitis, 132

Diphtheria, 301-305

clinical manifestations, 303-304

diagnosis, 304

epidemiology, 302-303

etiology, 302

immunization, 305

treatment, 304-305

Direct cold injury, 27-30

asteatotic eczema, 27

frostbite, 28-30

Dog bites, 180

Donovan, C., 257, 519

Donovanosis, 519

See also Granuloma inguinale

Dopter, 305

Doughty, John W., 73, 74, 75

Downgrading reaction, in leprosy, 347, 351

Dracunculiasis, 279-280

clinical manifestations, 279

diagnosis, 279-280

treatment, 280

Dracunculus medinensis

and dracunculiasis, 279

Drugs

antimycotic, 435

against leprosy, 343-346

Drugs, topical

and contact dermatitis, 123-125

Duncan, T., 4

Dyshidrosis, 45

Dyshidrotic eczema

and heat and humidity, 45-46

E

Ebola hemorrhagic fever, 208-209

laboratory findings and treatment, 208-209

signs and symptoms, 208

Ebstein, 358

Ecthyma, 293

Ecumenical Council to the Lateran, 73

Edison, Thomas, 70

Edward the Confessor, 357

Egypt, ancient

and leprosy, 321

Ehrlich, 358, 359

Ehrlichiae, 240

See also Ehrlichiosis; Sennetsu fever

Ehrlichiosis, 215, 241-244

clinical findings, 243

diagnosis, 243-244

differential diagnosis, 243

epidemiology, 242

laboratory findings, 243

microbiology, 241

treatment, 244

vectors and reservoirs, 241-242

Emergency War Surgery NATO Handbook, 6

Emperor Gwyo, 323

Empress Komyo, 323

Endemic (murine) typhus, 215, 233-235

clinical manifestations, 234

control, 235

diagnosis, 234

differential diagnosis, 234

epidemiology, vectors, and hosts, 233-234

laboratory findings, 234

microbiology, 233

treatment, 234

Endocervicitis, 509

Entomophthoramycosis, 482-483

Epidemic typhus, 215, 229-233

and Brill-Zinsser disease, 233

clinical findings, 231-232

control, 232-233

diagnosis, 232