Dermatological Manual of Outdoor Hazards

Abstract

Hazardous exposures to arthropods and plants involve millions of patients annually and are becoming more frequent due to an ever-expanding array of outdoor occupational and recreational activities and increased domestic and international travel. Such exposures can result in skin conditions and systemic manifestations which range from minor annoyances to life-threatening illnesses. Arthropod vectors transmit diseases affecting millions and resulting in significant public health issues worldwide. Exposures to plants can affect exposed populations and result in significant morbidity (and rarely mortality), necessitating alteration in occupational/ recreational activities or requiring limitations in dietary consumption of implicated plants. Media reports of exaggerated information on the adverse effects of plant and arthropod exposures abound. Physicians and healthcare providers in a variety of practice settings are in a unique position to provide accurate information about such exposures as well as to diagnose and manage adverse reactions to plants and arthropods. It is hoped that this manual will be utilized as a trusted reference for those seeking information on accurately diagnosing and managing such hazardous plant and arthropod exposures. This manual provides an organized approach to recognition, diagnosis, and management of hazardous exposure to plants and arthropods. Following a review of skin lesion morphology and terminology, the subsequent chapters review the broad range of skin manifestations due to plant exposures based on the underlying pathogenic mechanism (plant-induced urticaria, irritant plant dermatitis, allergic contact dermatitis, phytophotodermatitis). The full spectrum of plant-induced dermatitis, emphasizing routes of exposure, plant identification, and clues to arriving at a diagnosis and providing effective management and preventative strategies, is presented. The remainder of the manual reviews the broad array of skin manifestations and related systemic findings due to exposure to a wide variety of arthropods. Due to their individual bites/stings and their role as vectors of disease worldwide, arthropod injuries to the skin and the systemic diseases resulting from some arthropod exposures can present significant diagnostic and therapeutic challenges to clinicians. The chapters on arthropod exposures will provide guidance to healthcare professional in the diagnosis, management, and prevention of such exposures. Throughout the manual, emphasis is placed on obtaining pertinent historical information (e.g., exposure through occupational or recreational activities, pet/animal exposure, clothing worn, fragrances used, travel history), recognition of characteristic clinical findings, and appropriate patient evaluation and management. Preventative measures (use of repellants, protective clothing, barrier creams) and patient education are also emphasized as relate to the various exposures. While clinical manifestations of the various exposures can range from non-specific to highly characteristic, the manual provides a framework for healthcare professionals to comprehensively assess suspected plant and arthropod exposures and ultimately arrive at an accurate diagnosis. Depending on practice location, physicians and providers may see some of these conditions infrequently and thus a review and update on this information is essential. With increasing mobility of populations and the ease of worldwide travel, a condition normally seen thousands of miles away can now suddenly present to a practitioner anywhere on the planet for evaluation. Physicians/providers should be familiar with potentially serious medical consequences and infectious conditions/complications related to cutaneous reactions resulting from specific plants and arthropods in order to deliver a rapid diagnosis, effective treatment, and comprehensive education to patients regarding safe and effective measures for management and prevention of hazardous plant and arthropod exposures. This manual will serve as a trusted resource to clinicians seeking to deliver outstanding care to such patients.