A practical approach to common skin problems in returning travellers.

Skin diseases are the third most common cause of morbidity in returning travellers and may affect 8% of travellers during travel. Classic tropical diseases account for one quarter and the remainder are cosmopolitan diseases. The majority are of infectious origin, and of these bacterial infections are the most common and lead to the most hospitalisations. The ten most frequently encountered diagnoses comprise four classical tropical infections (cutaneous larva migrans, myiasis, tungiasis and cutaneous leishmaniasis) and six nontropical diseases (bacterial skin infections, arthropod bites, allergic reactions, scabies, animal bites and superficial fungal infections). Other notable skin problems include swimmer's itch, dengue fever presenting with a rash and rickettsial infections presenting with a rash or eschar. Delayed diagnosis, especially of tropical diseases, is common and may be reduced by improved knowledge and a systematic approach to skin problems. This involves a thorough travel specific, traveller specific and skin problem based history, combined with targeted examination and investigations. A frequency weighted differential diagnosis of the most common skin lesions is presented. An increased emphasis on preventative advice in relation to skin disease is encouraged during pre-travel consultations.