title: Skin disorders among travellers returning from tropical and non-tropical countries consulting a travel medicine clinic.
abstract: OBJECTIVE
  To evaluate the causes and risks for imported skin disorders among travellers.
  
  
  METHODS
  Data of 34,162 travellers returning from tropical and non-tropical countries and presenting at the outpatient travel medicine clinic of the University of Munich, Germany, between 1999 and 2009 were analyzed for this study. Of these, 12.2% were diagnosed with skin disorders.
  
  
  RESULTS
  Main destinations visited were Asia (40%), Africa (27%) and Latin America (21%). Tourism in the form of adventure travel/backpacking (47%) and package holidays (23%) was the most common purpose of travel. The leading causes of skin disorders were arthropodal (23%), bacterial (22%), helminthic (11%), protozoan (6%), viral (6%), allergic (5%) and fungal (4%). The 10 most frequently diagnosed specific skin diseases associated with specific destinations were insect bites (17%, Southern Europe), cutaneous larva migrans (8%, Asia and Latin America), cutaneous leishmaniasis (2.4%, Mediterranean Region/Middle East), dengue fever (1.5%, Asia), rickettsioses (1.3%, Southern Africa), myiasis (0.8%, Central America), filarioses (0.7%, Africa), tick bites (0.6%, Central/Eastern Europe), schistosomiasis (0.6%, Africa) and tungiasis (0.6%, Africa). Travellers in sub-Saharan Africa had the highest relative risk of acquiring skin disorders.
  
  
  CONCLUSIONS
  As more than 20% of all skin disorders among returned travellers were caused by arthropods and about 50% by infectious pathogens, pre-travel consultations should include specific prophylaxis and consider the most important risk factor for the travel destination.
authors.affiliation: Department of Infectious Diseases and Tropical Medicine, University Hospital, Ludwig-Maximilians University of Munich, Germany. herbinger@lrz.uni-muenchen.de
authors.forename: K-H
authors.initials: KH
authors.lastname: Herbinger
authors.forename: C
authors.initials: C
authors.lastname: Siess
authors.forename: H D
authors.initials: HD
authors.lastname: Nothdurft
authors.forename: F
authors.initials: F
authors.lastname: von Sonnenburg
authors.forename: T
authors.initials: T
authors.lastname: Löscher
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012871:Skin Diseases / Q000175:diagnosis / Q000209:etiology*; D014195:Travel / Q000706:statistics & numerical data; D057236:Travel Medicine; D014329:Tropical Climate; D055815:Young Adult