Skin Complaints in the Returning Traveler

11 Apr

Typically caused by:

-exacerbations of pre-existing disease (atopic dermatitis, psoriasis, etc.)

-environmental conditions (photosensitivity, contact allergies, etc.)

-infective organisms

 

Most rashes are minor problems such as sunburn and insect bites, and are self-limiting requiring only symptomatic care.

 

Top 10 tropical travel dermatoses requiring specific therapy:

-cutaneous larva migrans

-pyodermas (due to staph or strep)

-arthropod-reactive dermatoses

-myiasis (infection with a fly larva)

-tungiasis (infestation by burrowing flea)

-urticaria

-febrile syndromes with rash

-cutaneous leishmaniasis

-scabies

-fungal infections

 

rash1Elevated, serpiginous, reddish-brown lesion of cutaneous larva migrans.
 
leishOld world cutaneous leishmaniasis ulcer.

 

Syndromes to be on the lookout for…

Fever and rash (petechial or hemorrhagic): dengue fever, arboviruses, rickettsial infections (e.g., scrub typhus), meningococcemia, leptospirosis, malaria, and erythema multiforme caused by drug reaction or common infection
Papules: insect bites, persistent lesions (chiggers), scabies, allergic drug reactions, cercarial dermatitis (swimmers), Pseudomonas folliculitis (hot-tubbing), onchocerciasis (long-term travel)
Nodules: furunculosis, myiasis (movement within the lesion), chancroid, syphilis, systemic parasites/fungi
Migratory: cutaneous larva migrans, strongyloidiasis (fast-moving and often on the buttocks), urticaria from various causes, and Loa loa (rarely)
Ulcerative: pyodermas, spider bites, chancroid and syphilis, cutaneous leishmaniasis

 

Management

-rarely is it necessary to recommend anything more than symptomatic care in the ED

-referral to your local infectious disease or tropical medicine clinic for suspicious or chronic lesions

 

Submitted by K. Estes.

References: Tintinalli’s Emergency Medicine:  7th Edition; uptodate.com (pictures)

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