or in Bosnia or had been on active duty but not deployed to either location. Disability was defined as reduced physical functioning according to the SF-36. All participants were examined by a dermatologist who was blinded as to deployment and health status. The prevalence of any skin condition was 47.7% in disabled Gulf War veterans, 36.7% in nondisabled Gulf War veterans, and 42.8% in disabled non-Gulf War veterans. The investigators found no differences among groups in any dermatologic conditions other than seborrheic dermatitis (8.1% in deployed vs 2.3% in nondeployed), which was more common in Gulf War veterans than in the two comparison groups. The prevalence of seborrheic dermatitis in the general UK population is estimated to be about 3%. The excess in deployed veterans was irrespective of disability status.

Ishoy et al. (1999) reported on Danish peacekeepers deployed to the gulf during 1990-1997. The 686 deployed veterans and 231 nondeployed age-, sex-, and profession-matched veterans each received a medical examination and were interviewed for a full medical history by a physician. Veterans indicated whether any condition had its onset before or after deployment to the gulf. The examinations found that the prevalence of the following conditions with onset during or after deployment or August 1990 was higher in deployed veterans than in nondeployed veterans: eczema (15.0% vs 3.0%, p < 0.001), retarded wound healing (6.0% vs 1.7%, p < 0.01), other skin problems (17.1% vs 5.2%, p < 0.001), hair loss or hair disease (4.2% vs 0.9%, p < 0.01), and sweaty, clammy, or damp hands (7.9% vs 3.9%, p < 0.05). The study limitations included performance of only multiple univariate observations and a lack of information on possible confounders, although such lifestyle factors as smoking, alcohol use, and physical activity were reported.

The VES was a major study of all U.S. Army veterans conducted 17 years after the Vietnam War (CDC 1988b). It surveyed a random sample of the 5 million Army veterans who served during the Vietnam era: 2490 Vietnam-theater veterans and 1972 era veterans were interviewed and examined in 1985-1986. During the medical-examination phase of the study, a significantly higher prevalence of skin conditions as a global category (excluding chloracne) was found in theater veterans than in era veterans (33.0% vs 21.8%, OR 1.7, 95% CI excludes 1.0, p < 0.05). Upon dermatologic examination, none of the selected dermatologic conditions were found to be more prevalent in theater veterans than in era veterans; ORs for hyperpigmentation, hirsutism, folliculitis, tinea, any skin infection, and postinflammatory scars were all 0.9-1.2 (95% CIs 0.8-1.7).

Secondary Studies

The committee identified numerous large well-designed studies of Gulf War veterans that it considered secondary studies primarily because they lacked a dermatologic examination or were imprecise regarding specific dermatologic disorders. Most secondary studies found higher prevalence of dermatologic conditions in deployed vs nondeployed veterans. In the first phase of the VA National Health Survey of Gulf War Era Veterans and Their Families, Kang et al. (2000b) used a stratified random-sampling method to compare 11,441 Gulf War-deployed veterans with 9,476 nondeployed veterans on the basis of the DMDC. The study found that dermatologic conditions were in the top five self-reported medical conditions diagnosed by physicians in the preceding 12 months. The skin conditions listed were eczema or psoriasis (7.7% vs 4.4%, rate difference 3.34, 95% CI 3.26-3.42), other dermatitis (25.1% vs 12.0%, rate difference 13.16, 95% CI 13.04-13.28), and diseases of the hair or scalp or hair loss (16.9% vs 7.2, rate difference 9.65, 95% CI 9.55-9.75). A sample of participants were later evaluated by clinical examination in the Eisen et al. study (2005), which was the study’s final phase.

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