In the current study, the point prevalence of at least one or more skin diseases in military personnel in Korea was 60.4% (95% CI, 57.6%-63.0%). To date, there have been no appropriate epidemiologic studies measuring the prevalence of skin diseases in army personnel. The first Health and Nutrition Examination Survey (HANES I), which was conducted from 1971-1974 in the USA, demonstrated that 312.4 per 1,000 persons (31.2%) in the general population had one or more significant skin conditions, which had been reviewed at least once by a physician (7
). A study from Lambeth, UK, which was also conducted in the 1970s, revealed a self-reported frequency of 554.7 per 1,000 people (55.4%) with some type of skin condition (8
). The results of the current study showed that skin diseases in military personnel in Korea are as common as in the general population, although the population in the study was limited by age and gender distributions for it to be compared directly with the general population.
Acne (35.7%) was the most common skin disease among the soldiers. Acne is often mistakenly thought to exclusively affect teenagers. However, a significant number of patients continue to experience acne or develop new-onset acne after the teenage years. A study involving the prevalence of acne in adults in Alabama, USA, showed that acne in the 20s was reported by 42.5% of men (9
). Another report from Australia revealed that the prevalence of acne was 42.0% in the 20-29 yr old group (10
). The current study also showed acne to be a very common skin problem in military personnel in Korea. Moreover, the patients with acne significantly increased as the period of service increased (30.1% in rank 0 to 41.6% in rank 4) and the stress index increased after adjustment (P
= 0.047). It might be assumed that the stress from a class society, such as the military, can influence the development or aggravation of acne. The overall prevalence of bacterial folliculitis was 3.5% and was not related to rank, smoking, and the stress index.
Skin fungal infections are also very common in military personnel. Our results showed that the prevalence of tinea pedis, tinea cruris, tinea corporis and onychomycosis in the soldiers was 15.2%, 2.7%, 0.6%, and 0.9%, respectively. Interestingly, the prevalence of tinea pedis significantly increased as the rank increased (P < 0.001). It is likely that the common foot problems observed in the soldiers were mostly related to inappropriate footwear (occlusive leather shoes), foot trauma during increased sports activities, and poor hygiene. It is also possible that living in a group setting and common bathing facilities, which increased the risk of cross-infection, might have aggravated the conditions. In addition, tinea cruris was the second most common fungal infection soldiers acquired, and also increased significantly with rank (P = 0.010). Although the prevalence of tinea cruris was much lower than that of tinea pedis, many patients with tinea cruris complained of the emotional effect of these skin conditions.
In our survey, the prevalence of atopic dermatitis in military personnel in Korea was 5.1%. From a recent study conducted in Korea, the prevalence of atopic dermatitis in male adults was 4.2% (11
). According to two recent studies involving Japanese adults, the prevalence of male adults in their 20s was 5.7% and 4.9% (12
). Although those who have severe atopic dermatitis are exempted from military duty, there are still many soldiers who suffer from atopic dermatitis. The prevalence of atopic dermatitis significantly correlated with the stress scale (P
= 0.003). Moreover, atopic dermatitis was the most troublesome skin disease with respect to symptoms and function. The prevalence of seborrheic dermatitis was 2.1% in the current study, which was similar to the general population (1%-3%) (14
). The occurrence of seborrheic dermatitis also correlated with the amount of stress reported (P
= 0.003), and this disease significantly influenced the daily lives of soldiers functionally and emotionally. In addition, contact dermatitis (1.7%) and hand dermatitis (1.6%) were not rare in army personnel.
Viral warts and corns were also very common problems in military personnel, and the point prevalences were 4.7% and 3.0%, respectively. Interestingly, the prevalence of viral warts increased significantly with increasing rank (P = 0.006); the high prevalence might be due to sharing common living places and bathing facilities, factors also implicated in tinea pedis. The prevalence of corns increased marginally significantly with the period of service (P = 0.085), and we suggest that this condition is related with poor fitting footwear and frequent military marches.
There were many other skin conditions detected during the examinations, but most of the skin conditions did not occur in sufficient numbers to show a true prevalence. The prevalence of transient skin diseases, such as acute urticaria and insect bite allergies, might be underestimated because of the short duration of symptoms. In contrast, seasonal skin diseases, such as frostbite, would also be underestimated due to the times the examinations were conducted.
Korean military service is compulsory; therefore, studies of people in the military service may provide some information about the general population if the sample population is corrected with respect to age and gender distributions. However, patients who are exempted from military service due to severe skin diseases, such as atopic dermatitis and psoriasis, were not included in this study, and this could be a major limitation in applying the results of our study to the general population. Army life has some unique characteristics, such as a ranked society and communal living, and we earnestly desire to reveal the influence of these factors on skin diseases.
In conclusion, we suggest the prevalence of skin diseases among military personnel in Korea is very high and some of the skin diseases have a significant influence on daily life. Thus, the military authorities should be aware of common skin diseases and prepare countermeasures.