Atopic dermatitis (AD) is a highly challenging dermatologic condition for U.S. military members, especially for those deployed overseas with less-than-ideal access to care. Dr. Josephine Nguyen, president of the Association of Military Dermatologists, talks with Dr. Emily Wong about the military’s medical standards for evaluating individuals with AD who want to join the service. They also discuss how deployment can exacerbate symptoms of AD. “What is most important to understand regarding the military and any medical issue, including atopic dermatitis, is that we do not want a person’s medical condition to worsen because of their military service, or for them not to be able to receive the medical care they need,” advises Dr. Wong. “On the other hand, medical standards are in place to also ensure that the overall mission of the military can be done safely.”

We also bring you the latest in dermatology news and research.

1. Apple cider vinegar soaks fall short in atopic dermatitis

Acetic acid, particularly apple cider vinegar, has become prominent among emerging natural remedies for atopic dermatitis.

2. Long-term opioid use more common in hidradenitis suppurativa

The results suggest that periodic assessment of pain and screening for long-term opioid use may be warranted.

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Mark your calendars for our upcoming MDedge Dermatology Twitter Chat on skin cancer, this Tuesday, Oct. 8, beginning at 8 p.m. EDT. You can join the discussion with Dr. Julie Amthor Croley, Dr. Candrice Heath and Dr. Anthony Rossi as they review what’s new in sunscreen, skin of color, melanoma, and more.

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Things you will learn in this episode:

• Individuals with AD that persists after 12 years of age may be disqualifying to enter the military. Additionally, any history of recurrent or chronic dermatitis within the last 2 years that requires frequent treatments also is disqualifying. “I will say, in some cases, waivers are possible,” Dr. Wong adds. “Usually those waivers occur when the diagnosis wasn’t quite accurate to begin with. Maybe they had one case of contact dermatitis from poison ivy, but it’s not actually a chronic condition.”
• Atopic dermatitis is one of the main conditions that affect military service members overseas, not battle injuries.
• Military members with AD may be hard pressed to find relief from environmental factors that provoke or exacerbate symptoms.
• When military members are deployed, there are few choices for maintaining hygiene. “They certainly don’t often have choice of soap,” Dr. Wong says. “They don’t have the ability to necessarily carry around moisturizers. So a lot of the things we typically would use to treat our atopic dermatitis patients are just simply not available.”
• Access to systemic medications for AD also can be difficult.
• Stress while being deployed is a concern in military members with AD. “Military deployments create an environment – a stress – that many people have not experienced before,” explains Dr. Wong. “Even if they really understand their skin and what flares their skin, they may not know what to expect in some of these environments that military members are expected to work in.”
• Military uniforms and gear can exacerbate AD.
• In a deployed setting, if a service member experiences a severe exacerbation of AD that prevents him/her from performing the job, then he/she may need to leave the unit, leaving the rest of the unit unexpectedly without those skills. “That is really the impact that we try to avoid,” explains Dr. Wong, “in setting some of the medical standards that we have, in making sure we appropriately evaluate and screen people before they go on deployment.”
• Smallpox is considered a potential biologic weapon that could be used by adversaries. Military members receive the smallpox vaccine before being deployed overseas. However, members with a history of or current AD or any skin condition that compromises the epidermis are exempt from receiving the smallpox vaccine. If the service member has a family member at home who has AD or is pregnant, then that military member will receive the smallpox vaccine after reaching the deployed location. “Certainly, patients who are receiving the smallpox vaccination need to be very careful when around other patients with atopic dermatitis,” advises Dr. Nguyen.

 

Host: Josephine Nguyen, MD

Guest: Emily B. Wong, MD (Uniformed Services Health Education Consortium, Joint Base San Antonio–Lackland, Tex.)

Show notes by: Jason Orszt, Melissa Sears, Elizabeth Mechcatie

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