Page 126 - Journal of Special Operations Medicine - Spring 2015

Figure 4 Mirror image or “kissing” lesions. forward­deployed elements can often have similar chal­
lenges of maintaining hygiene and wound care, the au­
thors recommended considering using antibiotics early
if a large surface area is affected or if the area affected is
difficult to keep clean.

Prevention
The old saying that an ounce of prevention is worth a
pound of cure is certainly applicable in this case. The
primary method to prevent Paederus dermatitis is to
prevent human contact with beetles. Methods to avoid
this contact include clearing excess or decaying vegeta­
tion, keeping doors closed, using screens on windows
and doors, sleeping under a bed net, and wearing uni­
forms and clothes properly to cover skin. However, it is
unclear if permetherin or N,N­diethyl­meta­toluamide
can result in sleep and activities of daily living being af­ (DEET) use repels Paederus. The beetles are drawn to
4
fected. In addition, wearing of body armor or equipment incandescent lights, so working or resting directly under
can be problematic due to discomfort. Furthermore, bright lights during periods when beetles are most active
secondary infection of these lesions is a concern in an (just after rain or high humidity) should be avoided. In
austere environment where hygiene can be a challenge. addition, personnel should be instructed to not brush or
crush beetles when they land on the skin, and to wash
In this case, the patient was instructed to wash the area areas that come into contact with the beetles, dead or
thoroughly and keep the area clean and dry. He was pre­ alive. 13,14
scribed an oral antihistamine, an oral analgesic, and a
topical steroid. While some may suggest a high­potency Importance of Preventive Medicine and Flora and
steroid and others recommend potassium permanganate Fauna Familiarity in the Deployed Environment
with calamine for treatment of contact irritant dermati­
tis, in this case, only a low­potency topical steroid was SOIDCs, SFMSs, and IDMTs receive specific blocks of
available for use, due to limited medication choices in instruction on preventive medicine, including informa­
an austere environment. After 4 days of treatment, tion on field sanitation, water treatment, waste disposal,
10
the patient’s symptoms markedly improved, the patient and pest control. However, not all medical personnel de­
stopped taking medications, and his symptoms contin­ ployed in support of SOF have received similar training.
ued to resolve. On follow­up a week later, the patient When deployed to augment intrinsic SFMSs or SOIDCs,
had healed completely with no noticeable sequelae. preventive medicine issues can be addressed by the or­
ganic medic. However, if deployed as the sole medical
Historically, treating Paederus dermatitis as a simple provider, a lack of familiarity with preventive medicine
irritant contact dermatitis has been the standard. Ir­ in an austere environment can be problematic, espe­
ritant removal, area cleansing, application of cold wet cially if there are potentially dangerous flora and fauna
compresses, use of antihistamines, and application of in the region.
steroids is typical, with an addition of antibiotics only
if the area becomes secondarily infected. However, a Resources
5
study from a hospital in Sierra Leone that examined the
effectiveness of using an antibiotic (ciprofloxacin) in ad­ An excellent resource for practical preventive medicine
dition to standard treatment in management of known issues is the Special Operations Forces Medical Hand-
Paederus dermatitis cases revealed shorter healing times book. 1,15 The chapter on preventive medicine includes
in the group that received antibiotics. The authors of discussions on immunizations, medical surveillance,
11
this study commented that the shorter healing times sug­ field sanitation, waste disposal, water purification, and
gest a concurrent bacterial infection and theorized the pest control. In­depth information organized by re­
15
known gram­negative bacteria (Pseudomonas species) gion/country, command, and subject can be found at the
the Paederus beetle harbors secondarily contaminate the Defense Intelligence Agency’s National Center for Medi­
area affected. While not discussed by the authors of cal Intelligence website. For those that have a common
12
16
this study, considering that Sierra Leone is a developing access card, a vast amount of useful information can
country, contamination of the lesions could alternatively be found in the “Country Handbooks” section of the
have been a result of poor hygiene and wound care. As Marine Corps Intelligence Agency website. Further
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116 Journal of Special Operations Medicine Volume 15, Edition 1/Spring 2015