0.54-1.14. Smith et al. (2006) compared postdeployment hospitalizations from August 1, 1990, to December 31, 2000, for active-duty military personnel deployed to the Gulf War, deployed to southwest Asia after the war, or deployed to Bosnia. Active-duty personnel deployed to Bosnia were at reduced risk of hospitalization for skin diseases or conditions compared with Gulf War veterans (HR 0.57, 95% CI 0.46-0.71). There was no difference in hospitalizations for skin diseases between those deployed during the Gulf War and those deployed to the region after the war (HR 0.99, 95% CI 0.88-1.11). The limitation of these studies is their inability to capture any but the most severe skin diseases as most would be treated on an outpatient basis.
The committee placed the greatest weight on studies that included medical evaluation and identification of specific dermatologic diagnoses. Both primary studies showed a higher prevalence of some skin diseases or conditions in deployed than in nondeployed Gulf War veterans. A nationally representative study of US Gulf War veterans found a relationship between deployment and atopic dermatitis and verruca vulgaris (warts) but not other skin conditions (Eisen et al., 2005), and a Danish study found increased prevalence of eczema and other unspecified skin conditions in deployed veterans (Ishoy et al., 1999b).
Secondary studies are largely consistent with the primary studies but lack specificity regarding dermatologic outcomes or rely only on self-reported symptoms or physician-diagnosed dermatologic conditions. Three secondary studies are somewhat more specific in reporting a greater prevalence of eczema or psoriasis in deployed veterans (Kang et al., 2000; Proctor et al., 1998; Wolfe et al., 1998).
In summary, there is a high frequency of self-reports of various types of rash and other skin conditions among deployed versus nondeployed veterans, and, in general, these reports are confirmed by dermatologic examination. Overall, very few studies have rigorously assessed the prevalence of skin conditions in Gulf War veterans, and results are mixed, with increases for some skin conditions but not for others. Furthermore, there is no consistency across these studies, which suggests that the findings could be occurring by chance. Finally, most of the studies are weak in design and limited by self-selection and possible reporting bias.
On the basis of the few studies of dermatologic conditions, unrelated skin conditions occur more frequently among Gulf War deployed veterans, but the findings as to specific skin conditions are not consistent among the studies. See Table 4-10 for a summary of the primary papers that the committee considered for dermatologic outcomes.
The committee concludes that there is inadequate/insufficient evidence of an association between deployment to the Gulf War and skin disorders.