Summer holiday skin problems with dr. Niels Horst (NL)

In this episode, Dr. Niels Horst offers a systematic review of the dermatological conditions most frequently encountered in returning travellers. Drawing on clinical experience, he examines the diagnostic clues, differential considerations and management principles that underpin sound decision-making in travel dermatology.

The discussion is structured around five domains. The first addresses photo-induced dermatoses, including sunburn, polymorphic light eruption, and the clinical distinction between phototoxic and photoallergic reactions, alongside miliaria. The second considers aquatic exposures, covering seabather's eruption, swimmer's itch, hot tub folliculitis and the management of coral injuries with their attendant risk of marine infection, including Vibrio species. The third focuses on arthropod-related conditions, with particular attention to cutaneous larva migrans, tungiasis, bedbug bites, and the threshold for empirical treatment of erythema migrans. The fourth examines tropical and infectious presentations, including pityriasis versicolor, impetigo and secondary bacterial infection, myiasis, and the cutaneous manifestations of arboviral disease such as dengue and Zika. The final section addresses contact and allergic reactions, encompassing jellyfish envenomation, phytodermatoses, photocontact allergy to cosmetics and sunscreens, and the clinically significant sensitisation associated with paraphenylenediamine in black henna tattoos.

Each topic is approached with an emphasis on history-taking, recognition of pathognomonic features, and the avoidance of common diagnostic and therapeutic pitfalls. The episode concludes with three guiding principles for the assessment of any patient presenting with a dermatosis following international travel.

Essential listening for dermatologists seeking to refine their approach to travel-associated skin disease.