Returning from Iraq, a military dermatologist discusses the challenges of being a "jack of all trades" on the front line.
Maui, Hawaii - "I think what people are surprised to learn is that there is a large dermatology presence in the military," says Darryl Shaw Hodson, M.D., Maj., M.C., who spoke at the Winter Clinical Dermatology Conference here to share his experiences and those of military colleagues in treating dermatologic conditions.
"In the military, you have to be a 'jack of all trades,'" Dr. Hodson tells Dermatology Times.
A military dermatologist must be part specialist and part family practitioner. Patients include contract workers and local civilian families, in addition to the troops.
"The GWOT (global war on terrorism) is complex, and with it, the medical needs of our soldiers and the type of care we provide has changed," says Dr. Hodson, chief of cutaneous laser surgery, Brooke Army and Wilford Hall Air Force Medical Centers, San Antonio.
Dermatologic care is no longer available only at larger field hospitals, he says.
Since 2003, more than 30 Army dermatologists have deployed to Iraq and Afghanistan, mostly in general medical officer or flight surgeon roles.
'Summer vacation 2003'
During Dr. Hodson's "summer vacation 2003" - his first tour of duty in Iraq - he quickly learned to become a master of many things, from erecting a field hospital out of tents and doublewide trailers to diagnosing and treating a plethora of conditions - all while wearing cumbersome gear designed to protect against biologic and chemical warfare.
"You have to be able to chip in and work hard," regardless of the task at hand, Dr. Hodson says, while continuing to treat common dermatologic ailments, ranging from sunburn to chickenpox to cellulitis.
The dermatologist as allergist
The military dermatologist is often an allergist as well, Dr. Hodson says, and the doctor must be an expert on all vaccine reactions.
Anthrax and smallpox vaccines are very common. Fortunately, reactions are generally not serious, and "VIG (vaccinia immune globulin) is almost never needed," Dr. Hodson says.
"The only things that are really unusual out there are leish (leishmaniasis)," he says. "Most things are common disorders, only a little worse."
The dermatologist as podiatrist
"Jungle" camouflage has been replaced by the newer "desert" camouflage, even by troops stationed in the United States. This allows troops to "break in" their new boots before deployment. Improper footwear can lead to various foot ailments.
The most common treatments Dr. Hodson provided in Iraq were nail removals and remedies for boot blisters, corns and infections.
The dermatologist as surgeon
The military dermatologist quickly becomes a master surgeon. Beyond routine sutures, there is plenty for a doctor to do, Dr. Hodson says.
"If you do sclerotherapy, you may be the second-best 'stick' after anesthesia," he says.
In field hospitals, "If you can perform ED&C (electrodessication and curettage), you can curette out shrapnel," he says.
'Boots & bytes'
A "boots-on-ground" medical presence is crucial, and there is no substitute for immediate clinical care. In the modern world, military hands-on care is augmented by "telederm from theater" - online dermatology consultations.
Since April 2004, "telederm" has assisted in the treatment of 2,000 cases, with an average response time of four to five hours.
The synergy between deployed dermatologists on the ground and electronic assistance from doctors "back home" assures that military personnel, contract workers and local civilians receive prompt, appropriate disease management.