Cutaneous Diseases from the Peruvian Amazon Jungle Mayha Patel, DO, Donna Tran, DO, David C. Horowitz, DO Western University of Health Sciences, Dermatology Department, California

INTRODUCTION DISCUSSION DISCUSSION

In early August 2015 myself, a fellow resident and our Program Director A total of over 370 dermatology cases were seen by our team; of which 270 were seen in Iquitos, Peru and 100 were seen at the various villages in the Amazonian It was interesting to discover that the Amazonian people were actually traveled to Peru for a medical mission which consisted of two main projects Jungle. healthier in terms of systemic diseases than the people of Iquitos, the nearest serving as the focus: the Iquitos Medical Campaign and the Amazon River large town in Peru. This was due to the processed food and unhealthy diet the Campaign. We arrived in Lima, where we spent three days becoming The Amazon River originates in Peru and exists as a world of mystery and grandeur. Its towering forest and rushing waters harbor such an incomparable diversity of people of Iquitos eat while those in the amazon eat fish, rice, fruits and acquainted with the new environment and culture. Two of those days were life that scientists are still working to classify it all: 2,000 species of fish, more than those in the Atlantic Ocean; 4,000 species of birds, including 120 hummingbirds; vegetables all found in the jungle and river or grown on their land. spent touring a medical school and then a teaching hospital in Lima. We then 60 species of reptiles such as the caiman and anaconda, the world’s largest non-poisonous snake; and mammals such as the marmoset, anteater, tapir, capybara, and flew to Iquitos where we spent the majority of the next four days providing pink dolphin. At its widest point in Brazil, the mighty Amazon River is 40 miles across. Oceangoing vessels can sail the 2,300 miles from the Atlantic Ocean upriver medical care and education to locals from the surrounding areas. Iquitos is to Iquitos, Peru’s major port on the Upper Amazon. In both Iquitos, Peru and the Amazonian villages the predominant cases were infectious, followed by situated beautifully on the base of the Amazon in the shadows of the great inflammatory diseases and then pigmentary diseases. The hot and humid environment we believe was the leading cause of the majority of infectious cases. Andes mountains. We had patients travel from all across the region to meet us in Iquitos. Some even came from over 14 hours away (on foot!) over the Andes to reach us. For most patients, those four days of clinic are an annual Table 1 highlights the estimated number of cases by disease category in Iquitos and the Amazonian Jungle. sojourn that provide relief and healing. Table 1. Summary of Cases Disease Category Diagnosis No. Cases We then ventured down the Amazon on a medically-stocked river boat, called Disease Category Diagnosis No. Inflammatory Psoriasis 6 Eczema 20 The Amazon Queen IQ17051 where we traveled down the river making Cases Dishydrotic eczema 15 Leishmaniasis Pyoderma Faciale Psoriasis medical stops at various villages. We provided medical care on the boat to the Benign neoplasms Giant cell tumor of tendon sheath 1 Digital myxoid cyst 1 Contact dermatitis 20 SUMMARY Amazonian people and were named 'The River Docs.' The impovished Seborrheic dermatitis 30 Acrochordon 4 • Of the over 300 cases that were seen in Iquitos and the Amazon, the most Amazonian people don’t have access to medical care as their villages were Lichen simplex chronicus 28 Seborrheic keratosis 40 common were infectious followed by inflammatory and then pigmentary very isolated from the nearest town. In addition, their living conditions were Prurigo nodularis 10 Pigmentary Dermal nevus 2 disorders. very simple. They were given one solar panel per hut that would light one Benign self healing histiocytosis 1 Halo nevus 1 lightbulb. They built small canoes that would allow them to visit nearby Malignant neoplasms Basal cell carcinoma 2 Lentigo 19 • The Mayor of Iquitos welcomed us very graciously as we arrived at our Melasma 20 villages and also allow them to fish and provide food for their families. Infectious Tinea corporis 60 clinic location in Iquitos, Peru and upon our departure we established a site Postinflammatory hyperpigmentation 17 Tinea manuum 55 for continuing medical care in Iquitos, Peru. Pityriasis alba 3 Tinea cruris 25 Nevus anemicus 1 • It is important to note the significance of awareness in the prevention of Our goal was to treat our patients condition and then educate them about Tinea capitis 10 Vitiligo 3 skin disease in the Peruvian people. prevention and recurrence. We highlight some of the interesting and common Tinea versicolor 50 but unique presentations of various cases from our medical mission. Onychomycosis 40 Other Neurodermatitis 20 • We learned to be creative mixing various creams in small tubs as we had Candida 15 Acne vulgrais 5 limited medical supplies and medicines available. Miliaria crystallina 2 Impetigo 24 • We were able to treat each patients skin disease temporarily however in Paronychia 11 Lichen amyloidosis 15 Verruca vulgaris 4 Rosacea 20 order to prevent the disease form returning we educated the patients on Herpes zoster 1 Pyoderma faciale 1 healthy skin practices. Actinic pruritus 28 Infestations Arthropod assault 30 • We are rejuvenated and inspired to learn and continue to help others. Drug reaction 1 Scabies 5 2nd degree burn 2 Cutaneous larva migrans 1 Keratoderma 1 Congenital Linear epidermal nevus 2 Unknown Leishmaniasis* 1

Our clinic in Iquitos

Seeing patients on the Amazon Queen The Amazon Queen boat First Clinic day in the Amazon Jungle

Scabies in an infant boy Basal Cell carcinoma Basal cell Carcinoma Benign Self-healing histiocytosis

Some of the Amazon Jungle children The River Docs References Severe burn patient treated with normal saline and 1. Tyring, S. Lupi, O. Hengee, U. Tropical Dermatology. 1edition. 2014 Herpes zoster x 2 days duration. Treated Miliaria crystallina Tineas Capitus Tinea Versicolor Tinea Facei Tinea Corporis silver sulfadiazine with Acyclovir and Calamine lotion 2. Schaller, K. Colour Atlas of Tropical Dermatology and Venerology. 2000

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