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.

I 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.

After 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!)

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 laurleavdermpa@gmail.com.

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

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