Eczema and dermatitis in the afloat population: an overview of the assessment and management of the common erythematous skin conditions encountered in adults deployed on afloat platforms

摘要

Skin conditions constitute a large proportion of the workload of deployed medical staff. Dermatology is an area where pattern recognition is key, and making a diagnosis can sometimes be difficult for deployed medical staff, who may have limited experience of dermatology. This article provides a structure to assess patients presenting with skin rashes, as well as a summary of the key features and management of common types of dermatitis that may be encountered when deployed afloat: atopic eczema; irritant contact dermatitis; pompholyx; scabies and plaque psoriasis. Introduction Skin conditions constitute a large proportion of the workload of deployed medical staff, with 20% of clinical presentations (n=83) during the author's (AL) 2012 deployment to the Central Arabian Gulf being classified as dermatological disease (1). Dermatitis is defined as an inflammation of the skin, and although the underlying pathological trigger for the inflammation differs in the different types of dermatitis, all types result in an activation of the skin's immune pathways resulting in inflammatory infiltration of the epidermis and epidermal spongiosis (intracellular oedema) (2,3). These conditions are often referred to as 'eczema', and this can often cause confusion as to whether the term is being used to describe the collective group of inflammatory skin conditions or the specific condition of atopic eczema. Therefore, for the purpose of this article, the term 'dermatitis' will be used to describe the collective group of inflammatory skin conditions. Although the underlying pathological trigger may differ (allergen, irritant or infection), the common histopathological features common to the different types of dermatitis result in very similar clinical features, i.e. variants of an erythematous maculopapular rash. This can make establishing an accurate diagnosis difficult. Management of dermatitis is best approached with an understanding of the natural progression of the disease. Figure 1 illustrates how an initial pathological trigger leads to an inflammatory response within the skin (4).