Why is eczema a disqualifier for the military

Visit va. Eczema in the Armed Forces. Articles By Emily Delzell. Related Posts Articles. How to Nurse Your Baby When You Have Eczema on… Experts share their tips and advice on how to prevent problems with eczema and breastfeeding before your skin becomes irritated.

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The service announced two updates to its tattoo policy this week, adding new locations for finger and head tattoos. The Coast Guard received multiple reports of a possible fuel spill off the Southern California coast earlier than previously Military News. All rights reserved. This material may not be published, broadcast, rewritten or redistributed. You May Also Like. The Army secretary is open to admitting recruits with less-than-perfect hearing if they are otherwise stellar candidates.

I mean, eyesight used to be a disqualifier. But corrective surgery has become more and more popular and affordable. One facet of modern American life is still off the table, though, as far as Esper is concerned. A survey found that 38 percent of American high school students report using marijuana, and the drug is currently legal for recreational use for adults in eight states.

Former Army Recruiting Command chief Maj. Jeff Snow told the Associated Press in that he had an open mind about waivers for marijuana, but habitual use is still a no-go as far as the Army Department is concerned. Severe cases can be treated with systemic cyclosporine. In the context of atopic dermatitis cataracts are divided into anterior subcapsular cataracts that are rarely part of the natural progression of the disease and posterior subcapsular cataracts that form as a sequelae of long-term periocular or ocular treatment with topical steroids or with systemic steroids.

A cataract is an opacity in the normally clear lens of the eye. Usually the initial presentation of atopic dermatitis precedes the development of cataracts by years.

The pathogenesis for this phenomenon is complicated and not well-elucidated but is thought to relate to oxidative stress by free radicals, corticosteroid use as mentioned above, elevated IgE levels, filaggrin mutations in some patients and phototherapy. Unfortunately, the development of this complication has not been reliably associated with time of onset, duration or severity of the underlying atopic dermatitis. Finally, keratoconus and retinal detachment can also be associated with atopic dermatitis.

Keratoconus is defined as the protrusion of the central part of the cornea and is caused by constant rubbing of the eye in some patients with atopic dermatitis. The association of this condition with atopic dermatitis has recently been called into question. This potentially catastrophic complication was postulated in one case series with 80 patients to be associated with increased anterior vitreoretinal traction. Among the many characteristics of a successful pilot, the importance of visual acuity cannot be understated.

Aviation is a crucial pillar in the military and subsequently the national defense of the USA and other developed countries. It is also incredibly expensive with modern fighter aircraft approaching and, in some cases, reaching million-dollar individual price tags. Additionally, training pilots is time intensive and expensive with the cost of training a fifth-generation fighter pilot estimated at approximately 11 million dollars.

The risk of cataracts is especially important as pilots are already at an increased risk for cataract formation when compared to the general population. The skin is a major component of the innate immune system. As such, patients with atopic dermatitis, especially children, are at an increased risk of secondary infection with both bacteria and viruses as a result of an impaired skin barrier and modified cutaneous immune milieu.

The skin of the vast majority of patients with atopic dermatitis is colonized with staphylococcus aureus. This taken with the potential for breaks in the skin provided by eczematous skin and the above-mentioned cutaneous immune dysregulation creates a scenario in which secondary impetiginization may occur quite frequently. Impetigo and other cutaneous bacterial infections are already an issue in military populations where the potential for warmer climates, crowded conditions, shared living conditions and close physical contact is common for certain subsets of the military.

There are various reports of impetigo and methicillin resistant staphylococcus aureus MRSA outbreaks affecting up to soldier and military recruits. A rarer but more serious issue relates to the entity eczema vaccinatum EV , a potential complication of the vaccinia vaccination for smallpox. This condition is characterized by the cutaneous and sometimes systemic dissemination of vaccinia that almost exclusively occurs in individuals with a history of active or even quiescent atopic dermatitis.

It classically involves the midface, neck and antecubital and popliteal fossae but can preset in any location. Variola major smallpox was officially declared eradicated in after an extensive vaccination campaign utilizing the vaccinia virus. This makes the vaccinia vaccine one of the most successful vaccines in human history. A re-emergence of this illness would almost certainly be due to deliberate release 32 and it is highly likely if not inevitable that the US Military would be involved either as a target of or in the response to such an attack.

As such, large numbers of military members, close to , in a 6-month period in one report, 33 undergo vaccinia vaccination as it is thought that pre-vaccination is the best way to prepare for this type of attack.

It has also historically been associated with high rates of vaccine-associated adverse events such as EV. The vaccinia vaccine can complicate atopic dermatitis in two ways: these patients are more susceptible to infections and the design of the vaccinia vaccine creates a scenario where the likelihood of autoinoculation is high. A single drop of vaccine is placed on bifurcated needle and the skin is punctured approximately 15 times until a drop of blood is seen.

If a patient does not have a major cutaneous reaction at the site of the inoculation within 6—8 days they require re-vaccination because there needs to be an inflammatory reaction. The desired reaction starts as papules that progress to vesicles and eventually form a scab that resolves with an underlying scar. If this does not happen, the vaccination is unlikely to work. There is viral shedding until the scab falls off usually at least 2 weeks later. In a landmark publication by Copeman and Wallace, two-thirds of patients with eczema vaccinatum who had a history of atopic dermatitis did not have active disease at the time of exposure, some without active disease for up to 10 years.

Of note, EV was more common and more severe in individuals who were under the age of one. One thought explaining this is that those with obvious atopic dermatitis would not be vaccinated with no such screening happening with accidental exposures. He survived but his treatment course required a day hospital admission and skin grafts.

Atopic dermatitis is not currently a clinically significant problem in the military. From to , there were between , and , troops in Iraq and Afghanistan 38 with 35 evacuations directly attributable to atopic dermatitis. If this were the case that is a casualty rate of 0. There are two potential reasons for these low numbers. The first is that the theoretical concerns relating to atopic dermatitis and military service are not born out in actual practice or at least are less severe in adults than children.

In reality, there is further pre-deployment screening as well so most if not all of these cases likely represent flared quiescent or previously undiagnosed mild atopic dermatitis. In other words, the numbers are low because the system works. The numbers for eczema vaccinatum are also deceptively low. A revealing report mentioned above describes a mass vaccinia vaccination of approximately , service members during and in which there was not a single case of eczema vaccinatum.

This can partially be explained by the fact that rates of EV are lower in adults, but not entirely as the rate in adults older than 20 years old was still 30 per million primary vaccines.

Again, this highlights the benefits of the current medical screening guidelines for atopic dermatitis. By selecting against those with a history of atopic dermatitis after the age of 8—12 years of age the military has effectively avoided dealing with many of the potential complications of this condition and subsequently has decreased risk to personnel and mission.

However, as the entrance standards become less stringent more people with history of well-controlled atopic dermatitis will find their way into the military after receiving medical waivers. An interesting report out of West Point looked at cadets who had received medical waivers for atopic dermatitis. It was shown that having received a waiver did not increase the likelihood of attrition although these cadets were more likely to utilize medical resources.

The relative relaxation of the medical standards likely reflects a level of pragmatism in the military in seeking to find qualified candidates in a population with an ever decreasing percentage of physically qualified candidates for military service.

Atopic dermatitis is a very common disease that has the potential to complicate military service in many ways that are unacceptable.