4-45
Medications: Some medications can be toxic, so periodic blood tests are necessary during treatment.
Prevention and Hygiene: If exposed to an infected individual (several days of living or working in close
quarters) test with PPD. Those who test positive need CXR to evaluate for active infection and should start
prophylaxis. See Pulmonary TB section for details.
Follow-up Actions
Evacuation/Consultation Criteria: Evacuation is not usually necessary. Within 1-2 months, refer to
dermatologist or infectious disease specialist for complete evaluation and choice of multiple drug therapy.
Skin: Leprosy (Hansen’s disease)
MAJ Joseph Wilde, MC, USARIntroduction: An inflammatory disease caused by infection with Mycobacterium leprae. It may be localized
to the skin only or may involve internal organs. Infection of cutaneous nerves is very common. Leprosy
is endemic in India, sub-Saharan Africa, South and Central America, the Pacific Islands and the Philippines.
India, Myanmar and Nepal account for 70% of all the cases in the world. It is found in the Southeastern
US and Hawaii. Most patients in the United States have a history of exposure to armadillos, a natural host
for M. leprae.
Subjective: Symptoms
Hypopigmented or reddish skin lesions with decreased or no sensation.
Objective: Signs
Using Basic Tools: Circular patches and plaques with variable color including erythema, hyperpigmentation,
or hypopigmentation; tissue swelling with nodules or ulcerations; lesions are common on the face, ears, and
extremities.
Assessment:
Differential Diagnosis
Tinea corporis, mycosis fungoides, cutaneous TB, other causes of erythema nodosum (GI infections, drug
reactions, sarcoidosis, others).
Plan:
Treatment
Dapsone, rifampin and clofazimine in combination as per specific protocols. Treatment lasts 6-12 months or
longer. The relapse rate is very low (0.1% per year on the average).
Prevention: Isolate known patients until therapy is instituted.
Follow-up Actions
Evacuation/Consultation Criteria: Evacuate to receive specialty care. Diagnosis may be confirmed by skin
biopsy (acid-fast stain) or slit skin smears.
Viral Skin Infections
Skin: Ecthyma Contagiosum
MAJ Daniel Schissel, MC, USAIntroduction: Ecthyma contagiosum infections (Milker's nodules, human orf) are caused by a genus of parapox-
viruses which normally infect animals and only cause human infections when one handles infected livestock or