An international network of clinics seeing international travelers identified skin conditions as a major cause of travel-related medical consultations.1 Helpfully, the current review provides clinically relevant details about travel-related dermatologic problems.
Skin and soft-tissue infections are the main dermatologic concern among returned travelers. Group A Streptococcus and Staphylococcus aureus are common causative pathogens. Some methicillin-resistant S. aureus carry a cytotoxin (Panton-Valentine leucocidin) that can destroy white cells and cause tissue necrosis; these cytotoxic organisms are especially likely to be transmitted to other people after return from travel. Long-term travelers often develop staphylococcal furuncles that can persist for several months and only fully resolve after return to the home country.
Relevant to sports enthusiasts traveling to Brazil, hookworm-related cutaneous larva migrans is commonly identified in travelers who have been in Brazil. This “creeping dermatitis” can be associated with furuncles. Treatment is with either ivermectin or albendazole.
Larvae of some insects can burrow into skin, causing tungiasis and myiasis. More novel species are being reported to cause these bothersome local lesions.
COMMENTARY
Eric Caumes, editor-in-chief of Journal of Travel Medicine, and Gentiane Monsel provide a great editorial overview of travel-related skin problems. This is important, since 20% of travel-related medical consultations are for skin problems, and the majority of those skin problems are due to infections and infestations.1 In addition, several other original research papers in the July-August 2015 issue of Journal of Travel Medicine provide new information about skin problems related to international travel.
Eli Schwartz’s group in Israel reviewed 90 patients who returned from foreign trips with myiasis.2 Most had been in Latin America, and many had been at Madidi National Park in the Amazon region of Bolivia. Some flies deposit eggs directly on human skin, and then the larvae burrow into the skin; other flies deposit their eggs onto drying clothes that are subsequently put on skin and allow the larvae to embed. In areas where both sorts of transmission occur, prevention can be achieved both by the use of insect repellents and by ironing clothes that have been dried outside (especially on the ground). More than 10% of patients had been incorrectly initially diagnosed as having furunculosis and had been given unnecessary antibiotics. With correct diagnosis, manual extraction was effective — even though about one-fourth of patients required surgical intervention to facilitate larval removal.
Sand fleas can cause a similar infestation, tungiasis. In this situation, female sand fleas lay their eggs in the human epidermis. Developing baby fleas remain burrowed in the skin to cause irritating local lesions, often on the toes. Seven individuals in a group of 16 backpacking travelers to Madagascar presented to the same French clinic with sand fleas (mean of 1.7 embedded fleas per traveler) on their toes.3 Wearing open-toed shoes was a risk factor for acquisition of Tunga penetrans. Wearing closed shoes and/or using DEET-containing insect repellant on exposed feet would likely have prevented these infestations. Treatment was successful with simple excision.
Infectious disease practitioners providing pre-travel care should also warn travelers about other dermatologic risks. Sunburn should be prevented by appropriate use of clothes and sunscreen, but even severe cases are still reported.4 The infectious risks of tattoos are well-known, but it is also possible that even henna tattoos can lead to severe contact dermatitis, especially when black henna is used.5 The skin can also be the portal of entry for marine envenomations, such as occur with lionfish in the Caribbean; immersion of the affected body part in non-scalding hot water for 30-90 minutes can inactivate the venom.6
REFERENCES
- Leder K, Torresi J, Libman MD, et al. GeoSentinel Surveillance Network: GeoSentinel surveillance of illness in returned travelers 2007-2011. Ann Intern Med 2013;158:456-458.
- Lachish T, Marhoom E, Mumcuoglu, et al. Myiasis in travelers. J Travel Med 2015;22:232-236.
- Belaz S, Gay E, Rovert-Gangneux R, et al. Tungiasis outbreak in travelers from Madagascar. J Travel Med 2015;22:263-266.
- Ozturk S, Karagoz H. Severe sunburn after a hot air balloon ride: A case report and literature review. J Travel Med 2015;22:267-268.
- Choovichian V, Chatapat L, Piyaphanee W. A bubble turtle: Bullous contact dermatitis after a black henna tattoo in a backpacker in Thailand. J Travel Med 2015;22:287-288.
- Diaz JH. Marine Scorpaenidae envenomation in travelers: Epidemiology, management, and prevention. J Travel Med 2015;22:251-258.
Skin infections and infestations account for significant concern among returned travelers. Appropriate diagnosis and treatment makes long-term morbidity unlikely.
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