Page 123 - Journal of Special Operations Medicine - Spring 2015
P. 123
An Ongoing Series
A Painful Rash in an Austere Environment
John S. (Josh) Hellums, MD, MPH; Kyle Klapperich
ABSTRACT
Dermatologic complaints are common in the deployed Case Presentation
environment. Preventive medicine and knowledge of in
digenous flora and fauna are cornerstones for forward A 28yearold man who arrived in the East Africa AO
deployed medical personnel. This article describes a 2 days prior to presentation stated that while working
case of Paederus dermatitis in an austere environment, on a vehicle, he felt a bug crawling on the back of his
reviews dermatologic terminology, and provides a re left leg, followed by a pinprick sensation just below the
minder of the importance of exercising good preventive leg of his shorts. He swiped the back of his leg, think
medicine procedures. ing he was bitten by the bug, but was unable to identify
the insect. He further examined the area and noted no
bleeding, no foreign body, nor other clear source for his
Keywords: Africa, dermatology, Special Operations medic, pain. A few minutes later, the patient noted a sharp stab
Paederus dermatitis
bing pain in the area. Approximately 12 hours later, the
patient reported the area became “red, itchy, and pain
ful.” That evening, the patient sought medical attention.
Introduction At that time, the patient reported having several small,
fluidfilled sacs on the back of his knee that popped,
As the face of conflict is undergoing a radical change
from the past decade, Special Operations Forces (SOF) leaving multiple sores (Figure 1) in the middle of the
are increasingly engaging in and returning to operations red areas. The patient reported having no past medical
that are outside declared theaters of active armed conflict. or surgical history with the exception of chicken pox
These areas of operation (AOs) are often in regions that as a child. He denied allergies to medications or foods,
have little to no medical support available outside of the and reported taking only malaria prophylaxis and occa
team medic. In addition, with drawdowns and a chronic sional acetaminophen. He denied any other symptoms
shortage of Special Forces medical sergeants (SFMSs)
and Special Operations independent duty corpsmen Figure 1 Posterior aspect of the left knee, popliteal fossa.
(SOIDCs), some Special Operations units look to use
Air Force pararescuemen (PJs), Army Special Operations
Combat medics (SOCMs), and Air Force independent
duty medical technicians (IDMTs) to meet the medical
requirement for forward deploying elements. While PJs
and SOCMs have extensive training in trauma manage
ment, many do not have specific training in dealing with
preventive health issues such as sanitation and pest con
trol. In addition, there is little to no common knowledge
regarding flora and fauna of these “new” AOs. This ar
ticle discusses a dermatologic case in an austere environ
ment, provides a review of dermatologic evaluation, and
provides a reminder for all medical personnel of the im
portance of becoming familiar with preventive medicine
and indigenous flora and fauna prior to deployment.
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