Back to Top Skip to main content Skip to sub-navigation

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 October 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...

Diagnosis of hepatitis C infection and cascade of care in the active component, U.S. Armed Forces, 2020

Article
2/1/2022
Navy Petty Officer 2nd Class Cecil Dorse, left, and Navy Petty Officer 3rd Class Janet Rosas test blood samples aboard the Military Sealift Command hospital ship USNS Comfort while the ship is in New York City in support of the nation’s COVID-19 response, April 6, 2020. Photo By: Navy Petty Officer 2nd Class Sara Eshleman

Hepatitis C virus (HCV) infection rates are rising in the U.S. despite widely available tools to identify and effectively treat nearly all of these cases. This cross-sectional study aimed to use laboratory data to evaluate the prevalence of HCV diagnoses among active component U.S. military service members.

Recommended Content:

Medical Surveillance Monthly Report

Surveillance Snapshot: Lengths of Hospital Stays for Service Members Diagnosed with Sepsis, Active Component, U.S. Armed Forces, 2011–2020

Article
1/1/2022
The (left to right) Senior Airman Austin Shrewsbury, 88th Diagnostics and Therapeutic Squadron medical laboratory technician, works with student, Airman 1st Class Taylor Altman, 88th Diagnostics and Therapeutic Squadron medical laboratory technician, to identify bacteria of patient’s cultures inside the microbiology laboratory at Wright-Patterson Air Force Base medical center June 30, 2017.

Sepsis is a serious and life-threatening organ dysfunction caused by a dysregulated host response to infection. In the U.S., sepsis is a leading cause of in-hospital mortality and 1 of the most expensive conditions treated in U.S. hospitals.

Recommended Content:

Medical Surveillance Monthly Report

Description of a COVID-19 Beta Variant Outbreak, Joint Base Lewis-McChord, WA, February–March 2021

Article
1/1/2022
U.S. Army Soldiers from 1-17th Infantry Battalion, 2nd Stryker Brigade, 2nd Infantry Division, clear an objective during the training exercise Bayonet Focus 19-02 at Yakima Training Center, Wash., May 6, 2019. Bayonet Focus is a training exercise designed to assess Soldiers’ ability to preform tasks and complete objectives under conditions experienced during combat situations. (U.S. Army photo by Spc. Angel Ruszkiewicz)

This report describes an outbreak of SARS-CoV-2, the causative agent of COVID-19, that peaked during 21–26 February 2021 and was tied to a single military training event. A total of 143 laboratory-confirmed cases were identified.

Recommended Content:

Medical Surveillance Monthly Report

COVID-19 and Depressive Symptoms Among Active Component U.S. Service Members, January 2019–July 2021

Article
1/1/2022
With the holiday season upon us, the cold, dark days that winter brings, and the social distancing and movement restrictions brought about by COVID-19, it’s not uncommon for people to feel depressed. (Photo by Erin Bolling)

This study examined the rates of depressive symptoms in active component U.S. service members prior to and during the COVID-19 pandemic and evaluated whether SARS-CoV-2 test results (positive or negative) were associated with self-reported depressive symptoms.

Recommended Content:

Medical Surveillance Monthly Report

Update: Osteoarthritis and Spondylosis, Active Component, U.S. Armed Forces, 2016–2020

Article
12/1/2021
Osteoarthritis (OA) knee . film x-ray AP ( anterior - posterior ) and lateral view of knee show narrow joint space, osteophyte ( spur ), subchondral sclerosis, knee joint inflammation. Photo by: iStockPhoto

Osteoarthritis (OA), the most com­mon adult joint disease, is primarily a degenerative disorder of the entire joint organ, including the subchondral bone, synovium, and periarticular structures (e.g., tendons, ligaments, bursae). Spondylosis, often referred to as OA of the spine, is characterized by degenerative changes in the vertebral discs, joints, and vertebral bodies.

Recommended Content:

Medical Surveillance Monthly Report

Surveillance Snapshot: Donovanosis Among Active Component Service Members, U.S. Armed Forces, 2011–2020

Article
12/1/2021
This photomicrograph of a tissue sample extracted from a lesion in the inguinal region of the female granuloma inguinale, or Donovanosis patient, depicted in PHIL 6431, revealed a white blood cell (WBC) that contained the pathognomonic finding of Donovan bodies, which were encapsulated, Gram-negative rods, representing the responsible bacterium Klebsiella granulomatis, formerly known as Calymmatobacterium granulomatis. Photo credit: CDC/ Susan Lindsley

Recommended Content:

Medical Surveillance Monthly Report

Incident COVID-19 Infections, Active and Reserve Components, Jan. 1, 2020–Aug. 31, 2021

Article
12/1/2021
U.S. Marines with Marine Rotational Force - Darwin receive a second COVID-19 test during quarantine on Royal Australian Air Force Base Darwin in Darwin, NT, Australia, June 12, 2020. The COVID-19 test was administered to each Marine after arriving from California. All Marines will be quarantined for 14 days and undergo an additional test before quarantine release. No Marines tested positive for COVID-19. The U.S. Marine Corps and Australian Defence Force service members are working together to ensure the safety of the local community. (U.S. Marine Corps photo by Lance Cpl. Natalie Greenwood)

Incident COVID-19 Infections, Active and Reserve Components, 1 January 2020–31 August 2021

Recommended Content:

Medical Surveillance Monthly Report

Sepsis Hospitalizations Among Active Component Service Members, U.S. Armed Forces, 2011–2020

Article
11/1/2021
SAN DIEGO (Oct. 19, 2020) Hospital Corpsman 2nd Class Brittni Porter, a laboratory technician assigned to Naval Medical Center San Diego’s (NMCSD) microbiology laboratory, exams agar slides during a drug susceptibility tests Oct. 19. Drug susceptibility tests are conducted to see if a particular antibiotic will react with a patient’s sample on an agar slide. NMCSD’s mission is to prepare service members to deploy in support of operational forces, deliver high quality healthcare services and shape the future of military medicine through education, training and research. NMCSD employs more than 6,000 active duty military personnel, civilians, and contractors in Southern California to provide patients with world-class care anytime, anywhere. (U.S. Navy photo by Mass Communication Specialist 3rd Class Jake Greenberg)

Recommended Content:

Medical Surveillance Monthly Report

Brief Report: Prevalence of Hepatitis C Virus Infections in U.S. Air Force Basic Military Trainees Who Donated Blood, 2017–2020

Article
11/1/2021
U.S. Army Staff Sgt. Brandon Sousa, 424th Engineer Vertical Construction Company, donates blood to the 379th Expeditionary Medical Group’s Blood Support Center, Aug. 30, 2021, at Al Udeid Air Base, Qatar. The blood support center conducted a walking blood bank to collect blood from prescreened and cleared donors. The blood was sent downrange to support Afghanistan evacuation operations. The DoD is committed to supporting the U.S. State Department in the departure of U.S. and allied civilian personnel from Afghanistan, and to evacuate Afghan allies to safety. (U.S. Air Force photo by Senior Airman Kylie Barrow)

Recommended Content:

Medical Surveillance Monthly Report

Surveillance Snapshot: Influenza Immunization Among U.S. Armed Forces Health Care Workers, August 2016–April 2021

Article
10/1/2021
Staff Sgt. James H. Wagner, William Beaumont Army Medical Center, vaccinates Maj. Gen. M. Ted Wong, commanding general, William Beaumont Army Medical Center, with the seasonal flu vaccines.

Recommended Content:

Medical Surveillance Monthly Report

Surveillance Snapshot: History of COVID-19 Vaccination Among Air Force Recruits Arriving at Basic Training, March 2–June 15, 2021

Article
10/1/2021
COVID-19 vaccine bottle and syringes

Recommended Content:

Medical Surveillance Monthly Report

Update: Cold Weather Injuries, Active and Reserve Components, U.S. Armed Forces, July 2016–June 2020

Article
10/1/2021
A student in the army participates in a cold-water immersion training

Recommended Content:

Medical Surveillance Monthly Report

Brief Report: The Challenge of Interpreting Repeated Positive Tests for SARS-CoV-2 Among Military Service Members, Fort Jackson, SC, 2020–2021

Article
10/1/2021
Gloved hand holding an example of a negative rapid test for the SARS-CoV-2 virus (COVID-19).

Recommended Content:

Medical Surveillance Monthly Report

Update: Routine Screening for Antibodies to Human Immunodeficiency Virus, Civilian Applicants for U.S. Military Service and U.S. Armed Forces, Active and Reserve Components, January 2016–June 2021

Article
9/1/2021
HIV Awareness graphic showing test tubes with HIV + and HIV - labels

Recommended Content:

Medical Surveillance Monthly Report

Is Suicide a Social Phenomenon during the COVID-19 Pandemic? Differences by Birth Cohort on Suicide Among Active Component Army Soldiers, Jan.1, 2000–June 4, 2021

Article
9/1/2021
Spc. Brittney VerBerkmoes speaks among fellow Soldiers in a group centered on finding a way for the Army to mitigate the amount of suicides that occurs among Soldiers.

Is Suicide a Social Phenomenon during the COVID-19 Pandemic? Differences by Birth Cohort on Suicide Among Active Component Army Soldiers, 1 January 2000–4 June 2021

Recommended Content:

Medical Surveillance Monthly Report
<< < 1 2 3 4 5  ... > >> 
Showing results 16 - 30 Page 2 of 12
Refine your search
Last Updated: January 21, 2022

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.