Carter et al. Journal of MedicalCase Reports 201, 5:474Page 2 of 4 htp:/www.jmedicalcasereports.

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Case presentation 2 A 31-year-oldAfrican-American man with amedical history of eczema developed itchy miliaria-like rash (smal red rash with papules) to his inner thighs, bilateral posterior calves, and inner elbow (Figure 2). Our patient sought medical atention fromthe military dermatologist, who diagnosed the rash as eczema and treated it with a cortisone IM injection (name and dose unknown). Our patientdeployed to southern Afghanistan several months later, and began to have a reoccurence of the rash. The rashwas similarin nature to the previous rash; however, the itching worsened and afected a greater surface area of his skin. Our patient sought medical atention from his unit smedical staf. Figure 1 Photograph oftheposteriorkne ofcase 1. The figure shows thearea two weksafter the initial appearanceof rash. NoteThe rashwas obser ved to be erythematous (red) papules the smalred rashwith papules ontheposterior kne and thewith no blisters or disch arge. Our patient confirmed spreadoftherash on thelateral thigh.extreme itching when physicaly active and sw eating. The diagnosed was confirmed as miliaria rubra. He was covering a greater surface area of the skin and develop-instructed to avoid dire ct sun exposure and discontinue ing blister-like lesions with intense burning and itching.wearing theFRACUs unti lthe rash cleared, and was treaApproximately two weeks after the initial appearance ofted with 250mg methylpred nisolone IM injection. During the rash, our patient sought medical atention from hera folow-up visit one week later, complete resolution of unit Physician Asistant (PA). On initial observation, thethe rash was confirmed. Our patient reported that when rash appeared flesh-colored, beet red, with clear fluid-he wore his flame retard ant uniform several weeks later, filed blisters, and clear fluid discharge. The diagnosisfor one day he noted the return of a milder form of the was confirmed as miliaria rubra with posible superim-rash to his arms and thighs . Our patient discontinued use posed Staphylococus infection. Our patient was treatedof the uniform immediately and the rash resolved two with daily silver sulfadiazine cream 1% applied todays later. He self-laundered the uniform using commerafected areas until the rash resolved (about 10 days),cialy availablelaundrydete rgentand liquidfabricsoftener. and cephalexin 500 mg, one capsule oraly four times aAnalyses were conducted on uniform and the pH of the day for seven days. She was instructed to avoid directtrousersand jacket were 8. 6and 8.9,respectively. Analysis sun exposure and discontinue wearing the FRACUsof the uniform also showed signif icant shrinkage had until the rash cleared.occurred, likely afecting air permeability and los of Hersymptoms slightlyimprovedafter four daysof anti-perspiration. biotic and topical cream treatment. At this time, our

patient s treatment plan was modified to include 250 mgAdditional cases methylprednisolone inter-muscular (IM) injection. On aA total of 16 additional p atients presented with similar folow-up visit five days later, the blisters and wepingchief complaints and clin ical symptoms as case 1 and areas had resolved and silver sulfadiazine cream use was discontinued. Thereafter, our patient was placed on triamcinolone acetonide cream 0.1% twice a day for a wek, resulting in complete resolution of the rash. Incidentaly, after the rash completely resolved, our patient began wearingthe FRACUs again. Withina wek the rash reappeared, and our patient was advisedbythe medicalstaf to discontinueuseof FRACUs indefinitely. The uniformswere self-laundered with commercialy available laundry detergent and fabric softener dryer shets. FRACUsare made ofa tri-fiber (65% rayon/ 25%kevlar/10%nylon) blend.Analyses wereconducted on the uniform and the pH of the trousers and jacket were 8.8 and 8.5, respectively. Analysis of the uniform alsoFigure 2 Photograph of th e medial upper arm of case 2. The showed significant shrinkagehad occured, likely afectingfigureshows the area one wekafter the initial appearanceof rash. Note the smal red rashwith papulesonthemedial uper arm. airpermeability and los ofperspiration.