Soldiers, Civilians Returning from Middle East: Be Aware of Baghdad Boil

According to a retrospective study published in the June 2005 issue of the Journal of the American Academy of Dermatology, Baghdad boil, or cutaneous leishmaniasis (CL), among military personnel and civilians returning from assignments in the Middle East, where the condition is widespread, responds well if promptly diagnosed and treated.

Despite the self-healing nature of CL, prompt diagnosis and treatment, especially for lesions on the face, hands or joints, may reduce healing time, prevent an exposed, ulcerated lesion, and improve the appearance of any residual scar, said dermatologist Robert J. Willard, MD, one of the authors of the study. As conflict in this part of the world is likely to continue for many years, its important that soldiers, reservists and civilians returning from Iraq or other parts of the Middle East with skin lesions seek medical attention promptly.

From December 2003 through June 2004, the researchers saw suspected CL skin lesions in approximately 360 of the estimated 20,000 soldiers returning to Ft. Campbell after a yearlong deployment in Iraq. Of those, 237 soldiers (181 male and 56 female) were diagnosed with CL.

Caused by a bite from a female sand fly infected with a parasite, CL usually begins as a small, dark purplish or reddish bump. The bump then starts to turn crusty in the center and becomes a chronic sore. The lesions can easily be confused with other conditions like tuberculosis, syphilis, leprosy or skin cancer. If left untreated, the lesions will self-heal in approximately 12 to 18 months and will leave a variable amount of scarring.

Almost all of the soldiers who were diagnosed with CL had been stationed in northern Iraq, particularly northwest Iraq in and around the cities of Tikrit, Kirkuk, Tal Afar and Salamaniya at some point in their tour of duty. CL is prevalent in these locations and, although protective measures like applying insect repellent, wearing insect repellent clothes and using insect repellent bed netting are encouraged, the study authors found that few soldiers use these precautions.

The study found that laboratory confirmation of clinical diagnosis was superior to clinical diagnosis alone. Of the current available therapies, the researchers found that radiofrequency heat therapy and cryotherapy, or freezing, proved the most effective and safe methods.

Anyone who has been in the Middle East and develops a suspicious skin lesion should see a dermatologist as soon as possible, Willard said. Untreated CL can cause disfiguring scarring and, in rare cases, can spread into the lymph nodes. Prompt treatment can help reduce scarring and speed healing.

Source: American Academy of Dermatology