Tropical bacterial pyodermas have been a leading cause of disability among American soldiers in Vietnam. The predominant lesions were ecthymatous ulcers of the lower extremities, 90% of which yielded group A β-hemolytic streptococci on culture. Combat-related exposure to environmental sources of minor skin trauma appeared to account for the greater than threefold difference between combat and support troops in prevalence of pyoderma involving the foot and ankle. Pyodermas were more than 21/2 times as prevalent in whites as in those with darker skins, a difference which existed independent of environmental exposure. Systemic addition of penicillin to standard topical treatment significantly reduced healing time. Coagulase-positive staphylococci were commonly isolated from pyodermas, but evidence is adduced that they were secondary wound colonizers rather than primary pathogens.
Allen AM, Taplin D, Twigg L. Cutaneous Streptococcal Infections in Vietnam. Arch Dermatol. 1971;104(3):271-280. doi:10.1001/archderm.1971.04000210045008