Assessment of the ability of the topical skin protectant (TSP) to protect against contact dermatitis to urushiol (Rhus) antigen.

BACKGROUND: Military personnel have a need for effective protection against cutaneous exposure to chemical warfare agents (CWA). Topical Skin Protectant (TSP) is being developed to supplement chemical warfare protective garments. TSP protects against CWA exposure in animals, but does it work for humans? Because humans should not be tested with live CWA, urushiol (poison ivy) extract was used as a surrogate substance in place of CWA for human efficacy testing of TSP. OBJECTIVE: Determine whether TSP protects human skin against experimentally-induced urushiol dermatitis. METHODS: Open urushiol patch testing of 50 rhus-sensitive subjects comparing the 96-hour dermatitis severity scores between TSP protected and TSP unprotected sites. There were 4 paired sites (i.e., protected versus unprotected) per subject. Test sites were scored using a 9-point dermatitis scale of 0.0 to 4.0 (using 0.5 increments). RESULTS: Analysis of variance of the dermatitis scores from 192 paired sites on 48 evaluable subjects showed that TSP protected sites had mean dermatitis scores about 2 points lower than TSP unprotected sites (P <.001). CONCLUSION: Although this study does not provide direct scientific evidence that TSP protects humans against the percutaneous absorption of CWA, it does provide circumstantial evidence that this is the case. The fact that TSP is so highly effective against a lipophilic substance like urushiol and that most common vesicant CWAs are lipophilic and are weaponized in oleaginous vehicles, makes the effectiveness of TSP in preventing absorption and dermatitis from CWA seem likely.

The history of teledermatology in the Department of Defense.

The Department of Defense (DoD) healthcare system supports the medical needs of service members while engaged in a variety of missions frequently in isolated, remote, and austere locations. As a result, the DoD has been a leader in the development of telemedicine, including teledermatology as a way to provide "good medicine in bad places." A brief technical history of teledermatology, representative DoD experiences including military unique concerns, and a novel approach to increase the access of DoD teledermatology consultation are presented in this article.

The effect of decreasing digital image resolution on teledermatology diagnosis.

OBJECTIVE: To determine the effect of degraded digital image resolution (as viewed on a monitor) on the accuracy and confidence of dermatologic interpretation. MATERIALS AND METHODS: Eight dermatologists interpreted 180 clinical cases divided into three Logical Competitor Sets (LCS) (pigmented lesions, non-pigmented lesions, and inflammatory dermatoses). Each case was digitized at three different resolutions. The images were randomized and divided into (9) 60-image sessions. The physicians were completely blinded concerning the image resolution. After 60 seconds per image, the viewer recorded a diagnosis and level of confidence. The resultant ROC curves compared the effect of LCS, level of clinical difficulty, and resolution of the digital image. One-way analysis of variance (ANOVA) compared the curves. RESULTS: The areas beneath the ROC curves did not demonstrate any consistently significant difference between the digital image resolutions for all LCS and levels of difficulty. The only significant effect observed was amongst pigmented lesions (LCS-A) where the ROC curve area was significantly smaller in the easy images at high resolution compared to low and medium resolutions. For all other ROC curve comparisons within LCS-A, at all other levels of difficulty, as well as within the other LCS at all levels of difficulty, none of the differences was significant. CONCLUSION: A 720 x 500 pixel image can be considered equivalent to a 1490 x 1000 pixel image for most store-and-forward teledermatology consultations.

Plea for standardization in teledermatology: a worm's eye view.

Like any clinical interaction, teledermatology requires accurate, timely, and relevant information. The need to provide reliable, representative, diagnostic-quality images to the consultant is obvious. Predetermined patient views for a given clinical presentation and optimal hands on techniques to acquire them are not standardized. As a result, the training provided to those who take the images is inconsistent. Anecdotal evidence from the author's telemedicine practice is employed to support this contention. A formal collaboration between the telemedicine and medical photography communities is proposed to generate such standards and a relevant curriculum.

The epidemiology of dermatologic and venereologic disease in a deployed operational setting.

We studied the epidemiology, morbidity, and etiology of dermatologic and non-human immunodeficiency virus venereologic disease (Derm/STD) aboard a deployed aircraft carrier to revise Derm/STD training objectives for shipboard primary care providers. Onboard supplies for treatment of Derm/STD were also evaluated. Over 3 months, 929 Derm/STD patients were treated for 1,320 diagnoses generating 2,011 visits. Derm/STD caused 22% of the total morbidity. Pyoderma alone accounted for nearly one-half of that morbidity and involved many work-center groups. Air wing, aircraft maintenance, and engineering work-center groups had lower burdens of pyoderma. Bacterial cultures were performed on 248 exudative dermatoses. Staphylococcus aureus was the dominant pathogen and was overwhelmingly sensitive in vitro to common, inexpensive antibiotics. Strategies to encourage prevention, earlier diagnosis, and rapid treatment of Derm/STD by deployed primary care providers are discussed.

An atypical piloleiomyoma presenting as a nonhealing ulcerated nodule.

Piloleiomyomas are benign smooth muscle tumors arising from the arrectores pilorum muscles in the skin. They vary in size and number, and are often spontaneously painful or sensitive to touch and cold. An unusual case of an ulcerated and painless piloleiomyoma is presented.

Postoperative alopecia: a case report and literature review.

Postoperative alopecia is the temporary or permanent loss of hair that occurs following prolonged immobilization during general anesthesia and intubation. The clinical and histopathologic aspects of a typical case are described and the literature reviewed. Localized pressure-induced ischemia is the likely cause. Patients at highest risk for permanent hair loss include those subject to cardiac or gynecologic surgical procedures where the combined intraoperative and postoperative intubation time exceeds twenty-four hours. Frequent intraoperative and postoperative head repositioning provides excellent prophylaxis.

Tuberculoid leprosy: a case report.

A case of tuberculoid leprosy, undiagnosed and consequently untreated for four years, is presented. This case report is presented in an attempt to alert the clinician to the occurrence of leprosy in American population and to raise the index of suspicion in the proper clinical setting.

Porokeratotic eccrine ostial and dermal duct nevus: a case of systematized involvement.

We describe a case of porokeratotic eccrine ostial and dermal duct nevus presenting as widespread, symmetrical lesions. To our knowledge, this represents the most extensive case of this entity reported to date. Both the localized and systematized variants of this nevoid condition are discussed.

Buerger's disease in a middle-aged woman. A unique presentation.

We have presented the 11th probable case of Buerger's disease in a female patient. She had the oldest age of onset of any female patient with this disease yet described. In addition, she was the first female patient who was not actively smoking at the onset of ischemic symptoms. Hence, Buerger's disease should be included in differential diagnosis in any female patient, young or middle-aged, who is an active or former cigarette smoker, has a history of Raynaud's phenomenon, and presents with ischemic disease of the distal extremities. Poor results from attempted revascularization surgery can be anticipated.