Military Dermatology

Atopic Dermatitis in the US Military

In partnership with the Association of Military Dermatologists

Author and Disclosure Information

Nonmilitary providers play a critical role in the diagnosis and management of atopic dermatitis (AD) in children and adolescents who may one day desire to join military service as well as current military members who do not have access to military dermatologists. Failure to diagnose or incorrect diagnosis of AD in a child, adolescent, or current service member may have negative implications on their ability to effectively and safely serve in the US Military.

Practice Points

  • The US Military follows strict medical eligibility requirements for enlistment and retention. Atopic dermatitis (AD) and chronic eczematous conditions after 12 years of age is disqualifying for military service, but waivers may be possible for mild cases.
  • Unpredictable and rigorous environmental and occupational stressors associated with military service as well as limited access to medical care make AD a challenging condition to manage for service members, particularly during military deployment.
  • Accurate diagnosis and documentation of AD in childhood and adolescence by nonmilitary providers are essential, as they will aid in appropriately determining an applicant’s potential to successfully serve in the military.
  • For current service members, nonmilitary providers play a vital role in diagnosis and management where military dermatologists are not readily available.


 

References

Dermatologic conditions historically have affected military members’ ability to serve during times of peace and conflict. These conditions range from chronic dermatologic diseases to environment- or occupation-related dermatologic diseases. Mild to moderate atopic dermatitis (AD) typically is a manageable skin condition. However, in a deployed setting, a flare of AD can result in the inability of a member to perform their military duty, which directly compromises mission safety and effectiveness. The military developed and updates medical standards for entry and retention of service members. These standards are designed to ensure the greatest potential for a military member to successfully serve at home station and during combat operations.

Impact of Injuries in Military

Historically, disease and nonbattle injuries have resulted in notably more hospitalizations and time lost than injuries sustained on the battlefield.1 A review of major conflicts dating from World War II shows approximately 10% of all dermatologic concerns were related to eczematous dermatitis, with 2% specifically related to AD. These numbers varied remarkably depending on the location and environment of the conflict, with eczema accounting for 25% of dermatologic concerns during the Gulf War.2 During the initial phases of Operation Iraqi Freedom, approximately 75% of hospitalizations were from disease and nonbattle injuries, of which dermatologic disease accounted for 3%.1 From 2003 to 2006 in Iraq, 35 service members were evacuated from combat zones specifically for uncontrolled AD.3 In a deployed environment, each member is critical to the unit’s success in completing their mission. A single member of a unit often is the only person qualified to perform a function for that team. There are rarely extra people with similar skills to replace a member unable to complete his/her duties. The loss of a single member compromises the effectiveness and safety of the team and can lead to mission failure. Therefore, AD can have a profound impact on military operations in a deployed environment.

Military Medical Standards for Accession and Retention

There are 2 main goals of the military medical standards. First, the individual health of the applicant or military member is of utmost importance. Applicants with medical conditions that will be exacerbated by military service or that limit the ability for successful military operations are not accepted for military service. Once an active-duty member is diagnosed with a medical condition, the military determines if limitations are needed for military assignments and deployments based on available medical care in those locations. Second, mission accomplishment in combat operations requires that healthy military members are able to complete their jobs in extreme environments and under notable stress. If an applicant has a medical condition unsuitable for military service, it is in the best interest of the applicant and the military to deny entry.

The Medical Standards for Appointment, Enlistment, or Induction Into the Military Services (DoD Instruction 6130.03) lists conditions that are disqualifying for military service.4 Section 5.21 lists the following as disqualifying for military service in relation to eczematous dermatitis:

d. History of AD or eczema after the 12th birthday. History of residual or recurrent lesions in characteristic areas (face, neck, antecubital or popliteal fossae, occasionally wrists and hands).

e. History of recurrent or chronic nonspecific dermatitis within the past 2 years to include contact (irritant or allergic) or dyshidrotic dermatitis requiring more than treatment with topical corticosteroid.4

Although cases of incorrect diagnosis or very mild AD can be considered for a waiver, the process can be laborious and consideration or approval is not guaranteed. For current military members with new chronic eczematous dermatitis, each service has a process for evaluation and treatment. Some special operational jobs, such as aircrew, missile operators, and divers, have more restrictive medical requirements that are monitored by physicians with special training in these populations.

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