The burden of skin disease on deployed servicemembers

Introduction: Skin diseases have had a significant impact on the health of deployed military servicemembers throughout history. Given the high prevalence historically of cutaneous disease among United Statesdeployed servicemembers, we review the burden of skin disease on the modern military by analyzing the most common dermatologic diagnoses made in deployed settings from 2008 to 2015. Furthermore, we compare the most common dermatologic diagnoses made in the deployed setting with those made by dermatologists and nondermatologistsin the civilian healthcare system to highlight the differences between the civilian and deployed military practice environment. Methods: This study queried the Theater Medical Data Store for International Classification of Diseases,Ninth Revision (ICD-9) codes to determine the total number of dermatologic encounters as part of all medical encounters from 2008 to 2015 in a deployed setting. These data were provided by the Armed Forces Health SurveillanceBranch. For all statistical tests, analyses were conducted using R statistical software, with type I error controlled at 5%.Results: From 2008 to 2015, 92 dermatology-specific ICD-9 codes accounted for 429,837 dermatologic diagnoses thatwere made in a deployed setting, equating to 10% of all diagnoses. The top 20 dermatologic diagnoses were identified,and the percentage of total medical diagnoses (TMD) was calculated. Once the individual diagnoses were categorized,a direct comparison was made between the top 20 most prevalent disease categories among deployed military servicemembers and those of the United States (US) population as a whole, based on claims. The most prevalent diagnoseswere compared amongst four different settings: Deployed military, military teledermatology, civilian dermatologists,and civilian nondermatologists. Overall comparison of the prevalence between each of these groups showed an association between setting and diagnosis prevalence. Conclusions: The total burden of disease based on diagnostic codesfrom 2008 to 2015 is 429,837 diagnoses. This accounts for 10% of TMD from 2008 to 2015 in the deployed setting.Diagnoses most prevalent in the deployed military setting had more in common with those made by civilian nondermatologists compared with military teledermatology and civilian dermatologists. At 10% of diagnoses made in thedeployed military setting in this timeframe, skin disease accounts for a substantial burden on deployed servicemembers.Deployed servicemembers with skin disease should be supported through use of teledermatology resources andimproved dermatology education for primary care and deployed medical personnel.