Travel-acquired skin problems

Travellers returning from the tropics frequently present with skin problems. The vast majority will have a common dermatosis, such as eczema, acne, psoriasis or a simple skin infection. A small proportion will have contracted one of the tropical or exotic skin diseases such as leishmaniasis, tungiasis, cutaneous larva migrans or myiasis. A clear history and careful examination are needed to determine exactly where they have been, what they have done and what the lesions look like. It is important to remember that some imported infections may be latent for some time after a traveller returns. Most conditions respond to simple treatments. Creeping eruption (cutaneous larva migrans) is usually caused by the dog hookworm migrating through the skin after contact with dog faeces on the beach. Cutaneous leishmaniasis is a nodulo-ulcerative disease caused by protozoa; a biopsy for histology, culture or polymerase chain reaction are needed to confirm the diagnosis and determine treatment, often with pentavalent antimonials. Tungiasis, caused by the jigger flea, causes an extremely itchy nodule, most commonly on the sole of the foot, between the toes. Myiasis is the development of fly larvae in the skin. This article explains how to assess the returning traveller with skin disease. It describes the clinical features, diagnosis and treatment of some common tropical skin diseases.