Jul 18, 2019

Are you prepared to treat a U.S. military service member with acne or psoriasis? Civilian specialists are playing a larger role in the care of our military population. Josephine Nguyen, MD, president of the Association of Military Dermatologists, talks with Dr. Kristina Burke to help civilian dermatologists understand the concept of medical readiness. They also discuss skin conditions and treatments that are incompatible with military service and cannot be maintained in a deployed environment. "It’s not [meant] to be discriminatory; but it’s recognizing that, in this unique population, [service members] are going to be put into situations that are totally different than what they would be at home, and they have to be medically ready,” Dr. Burke explains. When treating a service member, you must consider patient satisfaction as well as his/her career and our nation’s security.

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

1. Racial and ethnic minorities often don’t practice sun protective behaviors 

Cultural beliefs, stigma, and personal preferences may affect behaviors.

2. Patients with atopic dermatitis should routinely be asked about conjunctivitis

New onset conjunctivitis always should be referred to an ophthalmologist, especially in more severe cases when patients do not respond to antihistamine or artificial tears.

3. Measles cases have slowed but not stopped

The CDC removes California from the list of active measles outbreaks.

Things you will learn in this episode: 

• Military medicine is focused on medical readiness for U.S. military service members to deploy to locations across the globe and perform their duties. Dr. Burke explains medical readiness as "maintaining a person and a unit that is medically able to perform their military functions, both at home and in a deployed environment."
• Accession guidelines can disqualify a person from military service if symptomatic.
• A diagnosis of psoriasis or eczema is potentially disqualifying. Dr. Burke details why these conditions would be incompatible with military service. The key consideration is what’s going to happen when this patient is deployed and not able to access care. While service members are deployed, there is a lack of appropriate medication, a lack of refrigeration, and intense stress that can exacerbate an underlying condition such as psoriasis. She explains, “Mild cases can explode into severe flares when [service members] are under stress; when they’re in a different environment, an austere environment; and they’re not able to routinely access the care and the normal treatment that they would at home.”
• Acne treatment guidelines are the same in active-duty service members, but the therapies are worked around schedules for deployment and field training. For example, isotretinoin is a nondeployable medication — secondary to its side-effect profile, laboratory monitoring, and maintenance of the iPLEDGE system — and may be used when a service member comes home from deployment or is in between deployments.
• Unique populations such as aircrew members, special operations, and submariners have more restrictions on medications. For example, a flight crew member on doxycycline for acne will be grounded for a short period of time to monitor for side effects. Spironolactone and minocycline use also grounds aircrew members. “When a pilot takes medication, it can affect his or her spatial orientation,” Dr. Nguyen adds. “You can’t just give them a medication and assume that there will be no side effects.”
• Civilian dermatologists with questions about how to treat a service member can consult the Association of Military Dermatologists and Military Dermatology columns published in Cutis. 

Hosts: Elizabeth Mechcatie; Terry Rudd; Josephine Nguyen, MD (Captain James A. Lovell Federal Health Care Center, North Chicago, Ill.)

Guest: Kristina R. Burke, MD (Tripler Army Medical Center, Honolulu)

Show notes by Melissa Sears, Alicia Sonners, and Elizabeth Mechcatie. 

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