Special Operations Forces Medical Handbook

4-64

Skin: Pinta

MAJ Joseph Wilde, MC, USAR

Introduction: Pinta is a chronic infectious disease affecting of the skin caused by Treponema pallidum
subspecies carateum. It is found only in low-altitude tropical areas of Central and South America. Transmis-
sion occurs by direct skin or mucous membrane contact with infected individuals. It is usually acquired
during childhood.

Subjective: Symptoms
Nonspecific, diffuse, red scaling papules which may coalesce and become hypopigmented over several years.

Objective: Signs
Using Basic Tools: Acute: Multiple erythematous macules that may be slightly raised on exposed skin.
Chronic: After a lapse of months or years, mottled hypopigmentation skin appears.

Assessment: Denitively diagnose by darkeld microscopy.
Differential Diagnosis - vitiligo (autoimmune hypopigmentation), tinea corporis (KOH positive)

Plan:
Treatment
Primary: Penicillin 600,000 U IM
Alternative: Tetracycline or erythromycin 250 mg qid x 14 days.

Patient Education
General: Avoid contact with infected persons.

Follow-up Actions
Evacuation/Consultation Criteria: No need to evacuate. Consult dermatology as needed.

Skin Disorders

Skin: Psoriasis

MAJ Daniel Schissel, MC, USA

Introduction: Psoriasis is a multifactorial genetic disorder of the skin that affects approximately 2% of
the population in western countries, with onset before age 20 in 1/3 of cases. There are many clinical
manifestations, but the most common (vulgaris) is typically expressed as chronic scaling papules and plaques
in a characteristic extensor surface distribution.

Subjective: Symptoms
Chronic history (months to years) of itching, especially in the anogenital crease and scalp; acute exacerba-
tions occur in guttate psoriasis and generalized pustular psoriasis; fever, chills, arthritis, and weakness will
accompany acute onset of generalized pustular psoriasis. Subtle cases may be suspected in patients with only
a slight gluteal crease "pinkening" and nail ndings.

Objective: Signs
Using Basic Tools: Skin: sharply demarcated, “salmon pink” erythematous, round to oval papules and
plaques with marked “silvery-white” scale. The arrangement ranges from a few scattered discrete lesions
to diffuse involvement without identiable borders. Lesions on the extensor surfaces are usually quite sym-
metrical. When one excoriates this scale, there is pinpoint bleeding (Auspitz sign). Fingernail: pitting,
subungal hyperkeratosis (thickening of the nail material), onycholysis (loosening of the nail plate from the nail
bed), and “oil spot” (yellowish-brown) spots under the nail.