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Carter et al. Journal of MedicalCase Reports 201, 5:474Page 3 of 4htp:/www.jmedicalcasereports.com/content/5/1/474

case 2. The demographics and clinical diagnoses of theseacidmantle is a combination ofsebum (oily fats) andper-patients are summarized in Table 1. Al of these patientsspiration that is constantlysecreted tocoverthe skins sur-initialy discontinued wearing the FRACUs until the rashface and maintain a proper skin pH. Since the launderedcleared and were treated with topical cream. Most ofcoats and trousers had an average pH of 8.8, which isthese patients returned to wearing the FRACUs aftermore than 100 times the desiredalkalinity of targetlinenscorective measures were implemented.(6.0 to 6.5), it is quite posible that skiniritation couldocur in sensitive individuals. The distribution of the skinDiscussionreaction in the reported cases were where the uniformsThe main finding of this report is that the excesive pHfited snugly and were worse in areas (that is, waistband(approximately 8.8) of the FRACUs, due to inadequateand lowerextremities) ofhigh

friction andperspiration.detergent removal during the laundering proces inAlergic reactions to the dyes used in fabrics are morecombination with the heat retention from perspiration-common than a reaction tothe fabric material that hassoaked clothing in hot working environments, contribu-ben dyed [5].The dyeing proces usedin FRACUs isveryted to the development of miliaria-like rashes in 18similar to thatusedin advanced combat uniforms (ACUs).patients.Al fibers cancauseiritant and alergiccontact dermatitisMiliaria, commonlyknownasprickly heat rash, is mostalthoughalergic contact dermatitis specificaly to fibers iscommon in tropical environments, especialy amongrare [5]. However, fiber content

diferences betwen thenon-acclimated individuals who recently moved to suchregularACU (nylon/coton) and theFRACU (flame-resis-environments from more temperate zones. Significanttant rayon/p-aramid/nylon) may be a minor factor givencontributing factors for the development of miliaria arethat the skin iritationswere aleviated when the afectedconditionsof high heatand humiditythatleadto excesiveindividuals switchedto wearing the nylon/cotonACU.sweating [2,3]. Although Kandahar has relatively lowSensitivity to flame-retardant materials added to cloth-humidity, itis known that oclusion ofskin due to cloth-ing is rare [6]. Alergiccontact dermatitis from the

ing can further contribute topooling ofsweat on theskinflame-retardants Tris (2,3-dibromopropyl) phosphatesurfaceand overhydration of the stratumcorneum (outer-and 2,3-dibromocresylglycidyl ether [7] has beenmost layer of the epidermis skin) causing blockage ofreported. Chronic generalized dermatitis that was asweatducts.Bacteriaocuring naturaly on theskin,suchreaction to the Basic Red 46dye in flame-retardantas Staphylococus epidermidis and Staphylococus aureus,clothing [8] has been reported. It remains posible that

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arealso thought to play arole inthe pathogenesis of mili-flame retardant agentsadded to the FRACUs contribu-aria [4]. Furthermore, an individual diagnosed as havingted to the patern of skin iritations.miliariarubra should be monitored forrisk ofheat ilnes,as it is a sign of heat stres. Normal skin pH is somewhatConclusionsacidic and ranges from pH 4.2 to 5.6. It varies from oneClothing, in particularFRACUs and blend fabrics, mustpart of the body to another and, in general, the pH of abe properly laundered toadequately remove detergentmans skin is lower (more acidic) than a womans. Theresidue. While in hot environments, individuals with

Table 1 Demographics and clinical diagnoses of additional cases

CaseGenderRace/ethnicityAgeDiagnosisMedical historyUniform treatment

3FemaleCaucasian19MiliariaEczemaOutsourced

4MaleBlack21MiliariaNoneOutsourced

5MaleHispanic25MiliariaNoneOutsourced

6MaleBlack27MiliariaNoneOutsourced

7MaleCaucasian37MiliariaNoneOutsourced

8MaleCaucasian23MiliariaEczemaSelf-laundered

9FemaleBlack24MiliariaNoneSelf-laundered

10FemaleCaucasian31MiliariaNoneOutsourced

1MaleCaucasian23MiliariaNoneOutsourced

12MaleCaucasian24MiliariaNoneOutsourced

13MaleCaucasian21MiliariaNoneOutsourced

14MaleCaucasian19MiliariaNoneOutsourced

15MaleCaucasian26MiliariaNoneOutsourced

16MaleCaucasian23MiliariaEczemaOutsourced

17MaleCaucasian29MiliariaNoneOutsourced

18MaleHispanic32MiliariaNoneSelf-laundered