Medical Missions: A Life Changing Experience with Dermatology Included

Lauren Leavitt, PA-C


Dermatology on Medical Mission Trips

Do I still own an otoscope? Was there a mnemonic for remembering the diabetes medications? I asked myself these questions as I packed to embark on my first medical mission trip. Eager to deliver healthcare to the rural inhabitants of Nicaragua, I printed out some notes from my PA school days, crossing my fingers that all knowledge of primary care medicine had not dissolved from my brain. Because my practice as a physician assistant has been solely in dermatology, I remained optimistic that Nicaraguans must have some cutaneous concerns awaiting me.

nica-MMAP-mdI traveled to the capital, Managua, with a team of 90 medical professionals including two other dermatology PAs. One of our attending dermatologists, Dr. Jere Mammino, encouraged us to join him on this special mission. He has participated on the trip for over a decade. His experience as a volunteer healthcare provider in Nicaragua and many other foreign countries prompted him to create a list of the ten most common skin conditions he sees on these trips. This serves as an educational guide for medical students and providers who practice in other fields.

OmetepeConcepcionAfter a day of enjoying scenic landscapes that included crater lakes and volcanoes, we got down to business. On the first morning of our mission, my doubt diminished that Nicaraguans would seek help for their skin problems. I was excited to spend the entire day practicing in dermatology. Patients lined up and waited for hours to address their cutaneous issues. Dr. Mammino’s “top ten” list reflected what we saw on our patients to a tee. I suggest that anyone going on a medical mission trip pack this resource. (At the conclusion of this text, please check out the table I made to summarize his original article!)

As the trip continued, providers in other fields frequently consulted our dermatology team for their patients’ skin concerns. We reassured mothers that their children did not have fungus when they had pityriasis alba, we treated painful tinea pedis that made it difficult for patients to work on their feet, and we emphasized the importance of using soap while bathing to limit millaria and infections. Our trip donated dozens of sunscreen bottles to a young albino man, who was already developing pre-cancerous lesions in his twenties due to his susceptibility to the Nicaraguan sun. It was memorable to become an in-house Dermatology PA to the other volunteers on the trip, as several of my peers developed acute skin conditions including contact dermatitis and urticaria. My pride for my profession radiated in the hottest climate I have ever worked in.


Year after year, this medical mission trip serves those who lack access to healthcare. Patients recognize our group and anticipate our help. In my second year on the mission, I saw familiar faces and appreciated the congruity of our care. As I eventually became more comfortable seeing internal medicine patients, I watched medical students begin to identify diseases on Dr. Mammino’s “top ten.” Medical mission trips are a meaningful way to step out of one’s comfort zone and witness the need for medical care in underserved areas. If you have the opportunity to participate in one, I highly recommend you go. Just remember to read and pack your “top ten” dermatological conditions article, as these were more prevalent than I could have imagined!

Dr. Mammino’s “Top 10” Dermatologic Conditions*

Condition Clinical Findings Treatment on Medical Mission Trips Photos taken by Dr. Mammino
Pityriasis Alba -Faint white asymptomic patches on the face or arms of children -None needed

-Advise parents to moisturize their children more frequently

Milliaria “Heat Rash” -Faint red papules in clusters

-Secondary to heat and sweat

-Wash skin twice daily with soap and water

-Low potency topical steroid creams if needed

Impetigo -Crusted eroded ulcers on an erythematous base (usually Staph bacteria)

-Often secondary to picking or scratching

-Wash skin twice daily with soap and water

-Topical antibiotic ointment

-Oral antibiotics if needed

Atopic Dermatitis -Erythematous eczematous patches, often with excoriations

-Frequently seen in the flexural skin areas

-Low to mid potency topical steroid creams

-Moisturize after each bath or shower

Lichen Simplex Chronicus -Pruritic localized thickened plaques

-Common on the posterior neck, lower legs, and forearms

-High potency topical steroid cream or ointment

-Educate patients to stop scratching

Tinea -Tinea capitis (scalp): Patches of hair loss with scaling

-Tinea cruris (groin): well-defined erythematous patches in the groin folds

-Tinea pedis (feet): erythema and scaling in a moccasin (shoe) distribution

-Onychomycosis (nails): yellow thickened nail plate with subungal (undernail) debris

-Tinea corporis (other parts of the body): annular erythematous scaling patches

-Topical antifungal creams in localized disease

-Oral antifungals in widespread disease

Intertrigo -Inflamed and sometimes eroded patches in the body folds

-Secondary to heat, sweat, and friction; may be secondarily infected with yeast or bacteria

-Wash skin twice daily with soap and water

-Low potency topical steroids

-Topical antifungals if needed

-Encourage weight loss

Melasma -Dark patches of tan to brown pigment

-Typically seen on the faces of women

-Secondary to hormone fluctuations causing pigment cells to be more susceptible to the sun

-Hydroquinone cream

-Encourage proper use of SPF

Tinea Versicolor -Coalescing hypo or hypermigmented macules with very fine scale

-Secondary to yeast

-Topical and oral antifungals


Warts -Hard and rough skin-colored papules

-Secondary to human papillomavirus

-Salicylic acid solution (avoid healthy skin) with occlusive bandage (or duct tape)

-Destruction by liquid nitrogen if available


*For Dr. Mammino’s original article, please e-mail me at


Photo Credit: Jere Mammino DO, Shoreline Church, Severns Vally,,, & University of Miami Health System and Miller School of Medicine

Please note, our medical disclaimer applies to all information, images, recommendations, and comments published on this page.


Published by Dr. Paul M. Graham

Paul M. Graham, D.O. (Founder/Editor-in-chief) founded Dimensional Dermatology in May 2016 with the vision to provide concise, easy to read, up-to-date dermatology and aesthetic medicine information to patients, medical staff, providers, and the general public. Dr. Graham is currently completing his training as a cosmetic dermatologic surgery fellow in Virginia Beach, Virginia at the McDaniel Laser and Cosmetic Center. He completed his dermatology training at St. Joseph Mercy Hospital and was a clinical instructor at Michigan State University. He received his B.S. degree as Summa Cum Laude at Old Dominion University, his D.O. degree as Cum Laude at Edward Via College of Osteopathic Medicine, completed his internship at Largo Medical Center in Largo, Florida as chief intern, and completed his dermatology residency training at St. Joseph Mercy Hospital Ann Arbor, Michigan.

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