Skip to main content

Military Health System

Update: Plant Dermatitis Among Active Component Service Members, U.S. Armed Forces, 2010–2020

Image of Poison ivy (Toxicodendron radicans). As the name implies, poison ivy (Toxicodendron radicans) usually grows as an ivy. However, in Zion it occurs in its shrub state growing only a few feet tall in the wetter canyons of the park. Poison ivy can also be identified by the greyish-white fruit that is produced in the fall. Although it may appear harmless, beware of this plant as its oils can produce an allergic reaction in the form of an irritating rash. (NPS Photo/Jonathan Fortner)

Recommended Content:

Medical Surveillance Monthly Report

What are the New Findings?

Incidence of plant dermatitis remained stable between 2010 and 2015, increased in 2016 and 2017, then decreased in 2018 through 2020. The highest rates were seen among male and non-Hispanic White service members, in the younger age groups and among those in combat-related occupations. Most cases occurred in the summer months and at combat training installations.

What is the Impact on Readiness and Force Health Protection?

Plant dermatitis can cause significant disability and lost duty time particularly in highly sensitized individuals. Service members should be informed of the risk of exposure particularly during combat-training, and advised on poisonous plant identification and personal protective measures to prevent exposure.

Abstract

Dermatitis (skin inflammation) caused by the oil of poisonous plants is an occupational hazard for U.S. military members who are assigned and train in endemic areas. Plant dermatitis can cause significant disability, substantial medical costs, and lost duty time. During the 11-year surveillance period there were 73,725 cases of plant dermatitis diagnosed in active component service members (rate: 5.3 per 1,000 person-years [p-yrs]). The overall incidence rates remained relatively stable between 2010 and 2015, increased in 2016 and 2017, then decreased in 2018 through 2020. Compared to their respective counterparts, incidence rates were highest among male service members (5.7 per 1,000 p-yrs), the youngest (<20 years) service members (8.4 per 1,000 p-yrs), non-Hispanic White service members (7.5 per 1,000 p-yrs), members of the Army (7.7 per 1,000 p-yrs) and Marine Corps (6.5 per 1,000 p-yrs), and among those in combat-related occupations (11.9 per 1,000 p-yrs). More than half of the cases occurred during summer months and about one-third of all cases were diagnosed at 4 installations: Fort Benning, Georgia (n=11,257); Camp Pendleton, CA (n=5,399); Fort Bragg, NC (n=4,259), and Fort Campbell, KY (n=3,221). Service members, particularly young individuals in combat-training in endemic states, should be informed of the risks associated with exposures to toxic plants and advised on personal protective measures.

Background

Plant dermatitis is an allergic inflammatory skin reaction in response to the oils of poisonous plants. In the U.S., the most common dermatitis-causing plant genus is Toxicodendron (formerly Rhus) (i.e., poison ivy, poison oak, and poison sumac).1 Approximately 50%–75% of the U.S. adult population are susceptible to skin reactions upon exposure to Toxicodendron oil or oleoresin, called urushiol. In these sensitized individuals, responses to the oils at the sites of exposure produce intense redness and pruritus (itch); severe cases can result in edema, fluid-filled vesicles or bullae, and extreme discomfort. Plant dermatitis is generally self-resolving and lasts approximately 3 weeks; however, symptoms can persist up to 6 weeks in highly susceptible individuals.1

Toxicodendron species are indigenous to the United States and flourish in forests, fields, wetlands, road sides, parks, and backyards. Poisonous plants are an occupational hazard for U.S. military members who are assigned to and train in endemic areas. Plant dermatitis can cause significant disability as well as result in substantial medical costs and lost duty time. This report describes the numbers and incidence rates of plant dermatitis in active component service members, its seasonality, and its distribution across U.S. military installations during 2010–2020.

Methods

The surveillance period was from Jan. 1, 2010 to Dec. 31, 2020. The surveillance population included all individuals who served in the active component of the Army, Navy, Air Force, or Marine Corps at any time during this period. For this analysis, the Defense Medical Surveillance System (DMSS) was searched for records of inpatient and outpatient care for diagnoses of plant dermatitis. A case was defined by the recording of 1 inpatient or outpatient diagnosis of plant dermatitis (International Classification of Diseases, 9th Revision Clinical Modification [ICD-9-CM]: 692.6; ICD-10-CM: L23.7, L24.7, L25.5) in any diagnostic position; an individual could be an incident case once every 30 days. Diagnoses were also derived from records of medical encounters of deployed service members documented in the Theater Medical Data Store (TMDS), which is incorporated into the DMSS.

Results

During the surveillance period, there were 73,725 diagnoses of plant dermatitis (crude incidence rate: 5.3 per 1,000 person-years [p-yrs]) (Table 1). Most of the cases (99.9%) were diagnosed in outpatient facilities; 111 service members had hospitalizations with a case-defining diagnosis for plant dermatitis. Sixty-four hospitalizations (57.7%) had a case-defining diagnosis in the first or second diagnostic position compared to 98.0% of outpatient encounters (data not shown). Overall incidence rates remained relatively stable between 2010 and 2015, increased in 2016 and 2017, then decreased in 2018 through 2020 (Figure 1). The highest annual rate was in 2017 (6.6 per 1,000 p-yrs).

Compared to their respective counterparts, incidence rates of plant dermatitis were higher among male service members (5.7 per 1,000 p-yrs) and in the youngest (<20) and oldest (40+) service members (8.4 and 6.2 per 1,000 p-yrs, respectively) (Table 1). The annual incidence rates among those under age 20 were highest during the period 2016–2020 (Figure 2). Incidence rates among non-Hispanic White service members (7.5 per 1,000 p-yrs) were more than 6 times those among non-Hispanic Black service members (1.1 per 1,000 p-yrs). Rates were also higher among members of the Army and Marine Corps (7.7 and 6.5 per 1,000 p-yrs, respectively) compared to their respective counterparts. The increases in the rates of plant dermatitis from 2015 through 2017 were driven by increases in the Army and Marine Corps; rates in the Air Force and Navy remained comparatively low and stable (Figure 1). Of note, in 2020, the rate of plant dermatitis among Marine Corps members exceeded that of the Army for the first time since 2011.

The incidence rate among those in combat-related occupations (11.9 per 1,000 p-yrs) was almost double the rate among the next highest occupational rate, pilot/air crew (6.0 per 1,000 p-yrs) (Table 1). The rates in combat-related occupations remained consistently higher than other military occupations; there was a notable increase in incidence rates from 2015 (6.8 per 1,000 p-yrs) to a high in 2017 (16.7 per 1,000 p-yrs) (Figure 3).

There was distinct seasonality to plant dermatitis incidence; more than two-thirds of the cumulative cases (67%) occurred during the 5 months of May to September (Figure 4). More cases were diagnosed among service members serving in Georgia (n=12,874), California (n=8,764), North Carolina (n=7,707) and Virginia (n=7,125) than any other states (data not shown). While numbers of cases in California, North Carolina, and Virginia remained relatively stable during the period, cases in Georgia increased steadily from a low of 659 in 2013 to a high of 1,885 in 2017 (data not shown). Of all military installations in the U.S. with cases, nearly one-third of all cases were diagnosed at 4 installations: Fort Benning, GA (n=11,257); Camp Pendleton, CA (n=5,399); Fort Bragg, NC (n=4,259), and Fort Campbell, KY (n=3,221) (data not shown).

During the 11-year surveillance period, a total of 107 service members received a plant dermatitis diagnoses while deployed (data not shown). Most cases were among soldiers, male and non-Hispanic White service members, service members aged 20–29, and those in repair/engineering occupations (data not shown). Almost three-quarters (71.0%) of cases occurred during the 5 months of May to September (data not shown).

Editorial Comment

The crude incidence rates of plant dermatitis increased approximately 27% from 2010 to the peak annual incidence rate in 2017. This change was driven by increases among service members in the Army and Marine Corps (data not shown), among those in combat-specific occupations, and among those under age 20. Furthermore, plant dermatitis cases were most numerous among those serving at installations that support extensive ground combat training in Georgia, California, and North Carolina. The relatively high rates among the youngest (and most junior and inexperienced) service members may be related to their relatively frequent and intensive exposures to field conditions during recruit and subsequent occupation-specific training.

It is estimated that 50% to 75% of U.S. adults are clinically sensitive to Toxicodendron species.1 This report documented that crude incidence rates of plant dermatitis were nearly 7 times higher among non-Hispanic White than non-Hispanic Black service members. This finding should be interpreted cautiously because the analysis did not account for potentially confounding differences between race/ethnicity groups of service members (e.g., occupational/leisure time activities, medical care seeking behaviors). There are no other studies or surveillance reports that confirm or indicate that there are strong demographic correlates of susceptibility to Toxicodendron species.

In light of the geographic distributions of Toxicodendron species in the U.S., cases in Georgia, North Carolina, and Virginia are most likely attributable to Eastern poison ivy, while cases in California are most likely due to poison oak.2 Not surprisingly, summer months pose the greatest risk of exposure; however, plant dermatitis affects U.S. military members throughout the year and in every U.S. state as well as abroad. To some extent, plant dermatitis incidence may be related to weather patterns; for example, moderate drought tends to increase the growth of Toxicodendron species. During drought conditions, water sensitive trees, shrubs, and plants may be overrun by Toxicodendron species which are invasive and opportunistic.4,5 Toxicodendron species have been shown to outgrow other woody species and produce more potent urushiol under higher levels of CO2.5 A previous MSMR article demonstrated an increase in cases of plant dermatitis at Fort Benning following reported drought conditions.6 From 2014 through 2016, Georgia experienced moderate to extreme drought conditions followed by an overabundance of rain in 2017.7,8 It is plausible that the dramatic increase in cases from 2014 and peak in 2017 may have been driven by the specific drought conditions in the state of Georgia causing an increase in poison ivy growth.

Although small in number, plant dermatitis cases do occur during deployment. In addition to animal and insect threats, service members should be advised of potential poisonous plant species that occur in foreign locations.

There are several limitations to this report that should be considered when interpreting the results. Cases presenting for care in health care facilities may represent more severe cases where the individuals were more motivated to seek treatment. Minor cases of poison ivy are most likely underreported as individuals may self-treat and not seek care. Additionally, it cannot be determined the extent to which cases may be exposed and acquire plant dermatitis during non-military activities (e.g., hiking, camping, lawn care).

In this report, hospitalized cases may include individuals who were not explicitly hospitalized for plant dermatitis. Approximately one-third of hospitalizations (n=35) had a case-defining code in the primary diagnostic position; an additional 29 cases (26.1%) and 19 cases (17.1%) had a case-defining code in the second and third diagnostic position, respectively (data not shown). Future studies may consider refining the case definition for hospitalizations to be more restrictive and thus more likely to capture true hospitalizations for plant dermatitis.

Military members, particularly those in ground combat units, should be informed of the risks associated with exposures to toxic plants and personal protective measures. For example, awareness and concern should be heightened during summer months, particularly during/after periods of drought. Proper identification and avoidance of Toxicodendron plants, and use of protective clothing are effective preventive measures against plant dermatitis.

Author Affiliations: Defense Health Agency, Armed Force Health Surveillance Branch (Ms. Daniele and Dr. Taubman).

References

  1. Gladman AC. Toxicodendron dermatitis: poison ivy, oak, and sumac. Wilderness Environ Med. 2006;17(2):120–128.
  2. NIOSH Workplace Safety and Health Topics: Poisonous plants. Centers for Disease Control. Accessed July 20, 2011. https://www.cdc.gov/niosh/topics/plants/
  3. National Oceanic and Atmospheric Administration, National Climatic Data Center: Historical Palmer Drought Indices. Accessed 20 July 2011. https://www.ncdc.noaa.gov/temp-and-precip/drought/historical-palmers/
  4. Dickinson CC, Jelesko JG, Barney JN. Habitat Suitability and Establishment Limitations of a Problematic Liana. Plants (Basel). 2021;10(2):263.
  5. Schnitzer SA, Londré RA, Klironomos J, Reich PB. Biomass and toxicity responses of poison ivy (Toxicodendron radicans) to elevated atmospheric CO2: comment. Ecology. 2008;89(2):581–585.
  6. Armed Forces Health Surveillance Center. Plant dermatitis, active component, 2001–2010. MSMR. 2011;18(7):19–21.
  7. Pendered D. Georgia drought free, suffering from overabundance of rain. Saporta Report. Published August 11, 2017. Accessed 14 October 2021. https://saportareport.com/georgia-drought-free-suffering-overabundance-rain/sections/reports/david/
  8. United States Department of Agriculture. 2016 Drought Map. Accessed 14 Oct. 2021. https://www.nrcs.usda.gov/wps/portal/nrcs/detail/ga/technical/dma/?cid=nrcseprd1301268

FIGURE 1. Annual incidence rates of plant dermatitis, by service, active component, U.S. Armed Forces, 2010–2020

FIGURE 2. Annual incidence rates of plant dermatitis by age group, active component, U.S. Armed Forces, 2010–2020

FIGURE 3. Annual incidence rates of plant dermatitis, by military occupation, active component, U.S. Armed Forces, 2010–2020

 FIGURE 4. Cumulative numbers of cases of plant dermatitis, by month, active component, U.S. Armed Forces, 2010–2020

TABLE 1. Incident cases and incidence rates of dermatitis due to plants, by demographic and military characteristics, active component, U.S. Armed Forces, 2010–2020

You also may be interested in...

Hospitalizations, Active Component, U.S. Armed Forces, 2021

Article
6/1/2022
Hospitalizations, Active Component, U.S. Armed Forces, 2021

The hospitalization rate in 2021 was 48.0 per 1,000 person-years (p-yrs), the second lowest rate of the most recent 10 years. For hospitalizations limited to military facilities, the rate in 2021 was the lowest for the entire period. As in prior years, the majority (71.2%) of hospitalizations were associated with diagnoses in the categories of mental health disorders, pregnancy-related conditions, injury/poisoning, and digestive system disorders.

Recommended Content:

Medical Surveillance Monthly Report

Ambulatory Visits, Active Component, U.S. Armed Forces, 2021

Article
6/1/2022
Ambulatory Visits, Active Component, U.S. Armed Forces, 2021

In 2021, the overall numbers and rates of active component service member ambulatory care visits were the highest of any of the last 10 years. Most categories of illness and injury showed modest increases in numbers and rates. The proportions of ambulatory care visits that were accomplished via telehealth encounters fell to under 15% in 2021, compared to 19% in 2020.

Recommended Content:

Medical Surveillance Monthly Report

Medical Evacuations out of the U.S. Central and U.S. Africa Commands, Active and Reserve Components, U.S. Armed Forces, 2021

Article
6/1/2022
Medical Evacuations out of the U.S. Central and U.S. Africa Commands, Active and Reserve Components, U.S. Armed Forces, 2021

The proportions of evacuations out of USCENTCOM that were due to battle injuries declined substantially in 2021. For USCENTCOM, evacuations for mental health disorders were the most common, followed by non-battle injury and poisoning, and signs, symptoms, and ill-defined conditions. For USAFRICOM, evacuations for non-battle injury and poisoning were most common, followed by disorders of the digestive system and mental health disorders.

Recommended Content:

Medical Surveillance Monthly Report

Surveillance snapshot: Illness and injury burdens, recruit trainees, U.S. Armed Forces, 2021

Article
6/1/2022
Surveillance snapshot: Illness and injury burdens, recruit trainees, U.S. Armed Forces, 2021

Recommended Content:

Medical Surveillance Monthly Report

Surveillance Snapshot: Tick-borne Encephalitis in Military Health System Beneficiaries, 2012–2021

Article
5/1/2022
iStock—The castor bean tick (Ixoedes ricinus). Credit: Erik Karits

Tick-borne Encephalitis in Military Health System Beneficiaries, 2012–2021. Tick-borne encephalitis (TBE) is a viral infection of the central nervous system that is transmitted by the bite of infected ticks, mostly found in wooded habitats in parts of Europe and Asia

Recommended Content:

Medical Surveillance Monthly Report

Evaluation of ICD-10-CM-based Case Definitions of Ambulatory Encounters for COVID-19 Among Department of Defense Health Care Beneficiaries

Article
5/1/2022
SEATTLE, WA, UNITED STATES 04.05.2020 U.S. Army Maj. Neil Alcaria is screened at the Seattle Event Center in Wash., April 5. Soldiers from Fort Carson, Colo., and Joint Base Lewis-McChord, Wash. have established an Army field hospital center at the center in support of the Department of Defense COVID-19 response. U.S. Northern Command, through U.S. Army North, is providing military support to the Federal Emergency Management Agency to help communities in need. (U.S. Army photo by Cpl. Rachel Thicklin)

This is the first evaluation of ICD-10-CM-based cased definitions for COVID-19 surveillance among DOD health care beneficiaries. The 3 case definitions ranged from highly specific to a lower specificity, but improved balance between sensitivity and specificity.

Recommended Content:

Medical Surveillance Monthly Report

Update: Sexually Transmitted Infections, Active Component, U.S. Armed Forces, 2013–2021

Article
5/1/2022
This illustration depicts a 3D computer-generated image of a number of drug-resistant Neisseria gonorrhoeae bacteria. CDC/James Archer

This report summarizes incidence rates of the 5 most common sexually transmitted infections (STIs) among active component service members of the U.S. Armed Forces during 2013–2021. In general, compared to their respective counterparts, younger service members, non-Hispanic Black service members, those who were single and other/unknown marital status, and enlisted service members had higher incidence rates of STIs.

Recommended Content:

Medical Surveillance Monthly Report

The Association Between Two Bogus Items, Demographics, and Military Characteristics in a 2019 Cross-sectional Survey of U.S. Army Soldiers

Article
5/1/2022
NIANTIC, CT, UNITED STATES 06.16.2022 U.S. Army Staff Sgt. John Young, an information technology specialist assigned to Joint Forces Headquarters, Connecticut Army National Guard, works on a computer at Camp Nett, Niantic, Connecticut, June 16, 2022. Young provided threat intelligence to cyber analysts that were part of his "Blue Team" during Cyber Yankee, a cyber training exercise meant to simulate a real world environment to train mission essential tasks for cyber professionals. (U.S. Army photo by Sgt. Matthew Lucibello)

Data from surveys may be used to make public health decisions at both the installation and the Department of the Army level. This study demonstrates that a vast majority of soldiers were likely sufficiently engaged and answered both bogus items correctly. Future surveys should continue to investigate careless responding to ensure data quality in military populations.

Recommended Content:

Medical Surveillance Monthly Report

Exertional Heat Illness at Fort Benning, GA: Unique Insights from the Army Heat Center

Article
4/1/2022
Navy Petty Officer 3rd Class Ryan Adams is being used as an example victim for cooling a heat casualty at the bi-annual hot weather standard operating procedure training aboard Marine Corps Base Camp Lejeune, N.C., Aug. 24. Adams is demonstrating the "burrito" method used to cool a heat related injury victim. Photo by Pfc. Joshua Grant.

Exertional heat illness (hereafter referred to as heat illness) spans a spectrum from relatively mild conditions such as heat cramps and heat exhaustion, to more serious and potentially life-threatening conditions such as heat injury and exertional heat stroke (hereafter heat stroke).

Recommended Content:

Medical Surveillance Monthly Report

Exertional Hyponatremia, Active Component, U.S. Armed Forces, 2006–2021

Article
4/1/2022
Marine Corps Cpl. Luis Alicea drinks water after a combat conditioning exercise at Naval Air Station Joint Reserve Base New Orleans, May 20, 2019. Photo By: Marine Corps Lance Cpl. Jose Gonzalez.

Exertional (or exercise-associated) hyponatremia refers to a low serum, plasma, or blood sodium concentration (below 135 mEq/L) that develops during or up to 24 hours following prolonged physical activity. Acute hyponatremia creates an osmotic imbalance between fluids outside and inside of cells.

Recommended Content:

Medical Surveillance Monthly Report

Exertional Rhabdomyolysis, Active Component, U.S. Armed Forces, 2017–2021

Article
4/1/2022
The Embry-Riddle Army ROTC Ranger Challenge team heads out on the 12-mile road march after completing the timed obstacle course event of the 6th Brigade Army ROTC Ranger Challenge January 14, 2022 at Fort Benning, Ga. The Titan Brigade’s Ranger Challenge took place at Fort Benning, Ga. January 13-15, 2022. Photo by Capt. Stephanie Snyder

Exertional rhabdomyolysis is a potentially serious condition that requires a vigilant and aggressive approach. Some service members who experience exertional rhabdomyolysis may be at risk for recurrences, which may limit their military effectiveness and potentially predispose them to serious injury.

Recommended Content:

Medical Surveillance Monthly Report

Heat Illness, Active Component, U.S. Armed Forces, 2021

Article
4/1/2022
Airmen participate in the 13th Annual Fallen Defender Ruck March at Joint Base San Antonio, Nov. 6, 2020. The event honors 186 fallen security forces, security police and air police members who have made the ultimate sacrifice. Photo By: Sarayuth Pinthong, Air Force.

From 2020 to 2021, the rate of incident heat stroke was relatively stable while the rate of heat exhaustion increased slightly

Recommended Content:

Medical Surveillance Monthly Report

Surveillance Snapshot: Medical Separation from Service Among Incident Cases of Osteoarthritis and Spondylosis, Active Component, U.S. Armed Forces, 2016–2020

Article
3/1/2022
Marines hike to the next training location during Exercise Baccarat in Aveyron, Occitanie, France, Oct.16, 2021. Exercise Baccarat is a three-week joint exercise with Marines and the French Foreign Legion that challenges forces with physical and tactical training. Photo By: Marine Corps Lance Cpl. Jennifer Reyes

Osteoarthritis (OA) is the most common adult joint disease and predominantly involves the weight-bearing joints. This condition, including spondylosis (OA of the spine), results in significant disability and resource utilization and is a leading cause of medical separation from military service.

Recommended Content:

Medical Surveillance Monthly Report

Obesity prevalence among active component service members prior to and during the COVID-19 pandemic, January 2018–July 2021

Article
3/1/2022
Maintaining a healthy weight is important for military members to stay fit to fight. The body mass index is a tool that can be used to determine if an individual is at an appropriate weight for their height. A person’s index is determined by their weight in kilograms divided by the square of height in meters. (U.S. Air Force photo illustration by Airman 1st Class Destinee Sweeney)

This study examined monthly prevalence of obesity and exercise in active component U.S. military members prior to and during the COVID-19 pandemic. These results suggest that the COVID-19 pandemic had a small effect on the trend of obesity in the active component U.S. military and that obesity prevalence continues to increase.

Recommended Content:

Medical Surveillance Monthly Report

Brief report: Using syndromic surveillance to monitor MIS-C associated with COVID-19 in Military Health System beneficiaries

Article
3/1/2022
Air Force 1st Lt. Anthony Albina, a critical care nurse assigned to Joint Base Andrews, Md., checks a patient’s breathing and heart rate during an intubation procedure while supporting COVID-19 response operations in Cleveland, Jan. 20, 2022.

SARS CoV-2 and the illness it causes, COVID-19, have exacted a heavy toll on the global community. Most of the identified disease has been in the elderly and adults. The goal of this analysis was to ascertain if user-built ESSENCE queries applied to records of outpatient MHS health care encounters are capable of detecting MIS-C cases that have not been identified or reported by local public health departments.

Recommended Content:

Medical Surveillance Monthly Report
<< < 1 2 3 4 5  ... > >> 
Showing results 16 - 30 Page 2 of 13
Refine your search
Last Updated: October 18, 2022
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery