Skin & Soft Tissue Infections

Skin problems are among the most frequent medical problems in returned travelers. A large case series of dermatologic problems in returned travelers showed that cutaneous larva migrans, insect bites, and bacterial infections were the most frequent skin problems in ill travelers seeking medical care, making up 30% of the 4,742 diagnoses (Table 11-7).

Table 11-7. Ten most common skin lesions in returned travelers, by cause
Skin Lesion	Percentage of all Dermatologic Diagnoses (N = 4,742)
Cutaneous larva migrans	9.8
Insect bite	8.2
Skin abscess	7.7
Superinfected insect bite	6.8
Allergic rash	5.5
Rash, unknown origin	5.5
Dog bite	4.3
Superficial fungal infection	4.0
Dengue	3.4
Leishmaniasis	3.3
Myiasis	2.7
Spotted fever group rickettsiosis	1.5
Scabies	1.5
Cellulitis	1.5
Modified from Lederman ER, Weld LH, Elyazar IR, et al. Dermatologic conditions of the ill returned traveler: an analysis from the GeoSentinel Surveillance Network. Int J Infect Dis. 2008;12(6):593–602.

There are several ways to approach the diagnosis and management of skin conditions in returned travelers. A useful approach is to consider whether the skin condition is accompanied by fever. Skin eruptions and cutaneous lesions that are accompanied by fever constitute a minority of travelers’ dermatoses, but fever may indicate a systemic infection, usually viral or bacterial, which may require prompt attention. A second consideration should focus on the geographic and exposure aspects of the travel history. A third consideration should focus on the morphology of the lesions as noted on physical examination. The most successful approach combines all of these considerations and may be supported by laboratory confirmation (skin biopsy, serology, cultures, microscopy) if required or indicated.

Diagnosis of skin problems in returned travelers should involve the following elements of the medical history and physical examination:

Systemic diseases: cancer, allergy to penicillin
Location and duration of travel
Exposure history: freshwater, ocean, insects, animals, plant contact, human contact, occupational and recreational exposures, sexual contact
Time of onset of lesions during or after travel
Whether other travelers have similar findings
Associated symptoms: fever, pain, pruritus
Vaccination status and adherence to standard travel precautions (food, water, personal protection from insects)
Medications taken during travel (that may have side effects or may provide adequate prophylaxis for certain conditions)
Existing skin conditions
Shape of lesions, such as papules, plaques, nodules, macular lesions, or ulcerated lesions
Number, pattern, and distribution of lesions
Location of lesions: exposed versus unexposed skin surfaces

It is important to recognize that skin conditions in returned travelers may not have a travel-related cause or may represent worsening of a preexisting condition.

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