HX24 Battle scars: the role of dermatology in war, both past and present

Abstract Throughout human history, humans have engaged in war for political, social and religious reasons. While it has been costly to human life and often hindered scientific progress, war has been a powerful force in shaping medical progress, including in dermatology. The role of dermatology remains a relatively underexplored aspect of military medicine despite the importance in soldiers’ lives. While much attention is given to areas such as trauma surgery and infectious disease management in wartime, the profound impact from dermatological conditions in soldiers health, combat ability and long-term physical and mental wellbeing is often overlooked. The skin, as the body’s first line of defence, is particularly vulnerable to warfare. Each war brought its own plights, which have varied based on timelines and locations. In World War I, the itch of scabies and dermatitis and the numbness of trench foot were the scourges of the front line. Others included disfigurement from mustard gas burns in World War I, radiation burns from Hiroshima, and the dreadful outcomes from exposure to Agent Orange in Vietnam, which caused lifelong disabilities. Exposures to these chemicals and hazards have driven the development of modern antiseptics, artificial skin grafting and corticosteroid therapies, which have allowed us to treat wounds effectively. Alongside the physical ailments, there are psychosocial dimensions of wartime dermatology. Disfigurements secondary to burns, infections and noxious gases have carried profound psychological consequences. The stigma surrounding wartime facial injuries led to the pioneering reconstructive efforts by surgeons such as Harold Gilles and Archibald McIndoe. These doctors not only transformed the field of plastic and reconstructive surgery but also reshaped attitudes towards those with visible skin injuries. A crucial, but lesser known aspect of dermatology in war was in preventative dermatology and camouflage. Dermatologists in the British Army became familiar with rare tropical diseases ranging from cutaneous leishmaniasis in North Africa (aka Baghdad Boil) to tropical ulcers in Burma (aka Jungle Rot), and were able to both recognize and treat these conditions accordingly. Knowledge of the understanding of pigmentation and light reflection on human skin provided the ability to perfect military camouflage techniques to adapt soldiers to their surrounding environments and hopefully prevent injury entirely. For many years the dermatologist has been an unsung hero, playing a vital role in assuring the fitness of soldiers, as well as reducing the morbidity and mortality associated with skin disease.