Acne, UV Light-Induced Allergies And Eczema Surge Among Lowlanders Posted In Ladakh, Study Finds

A study, led by dermatologists from Base Hospital Delhi Cantt, has found that acne, allergic skin conditions such as alopecia areata due to UV or extreme sunlight, polymorphic light eruption (PMLE), and chronic eczemas are the most common skin disorders among soldiers temporarily posted to high-altitude Ladakh.

The retrospective analysis, conducted at a military hospital in Leh, showed that lowlanders—those posted from the plains—bear a disproportionately higher burden of inflammatory and photo-induced skin conditions compared to native highlanders serving in the same environment.

The study reviewed dermatology outpatient records of 1,832 patients over an 18-month period between September 2021 and February 2023. Of these, 1,528 patients (83.4%) were lowlanders, while 304 (16.6%) were native highlanders. The mean age of the study population was 32.5 years.

Appendageal disorders involving hair and sebaceous glands emerged as the most common category, accounting for 25.1% of all cases in both groups. Acne alone contributed nearly 11% of the total disease burden, making it the single most frequent diagnosis. Alopecia areata was seen at an unusually high rate among lowlanders—far exceeding national prevalence estimates—suggesting a possible link with altitude-induced immune dysregulation. Alopecia areata is an autoimmune condition where the immune system attacks hair follicles, causing sudden, patchy hair loss, usually in coin-sized spots on the scalp, but it can affect any body hair and become extensive (totalis or universalis).

Infections and infestations formed the second most common disease group overall, affecting 18.2% of patients. However, the distribution differed notably between the two populations. Among lowlanders, infections ranked second, while native highlanders showed a greater prevalence of photodermatoses, reflecting long-term physiological adaptation to intense solar radiation at altitudes exceeding 3,600 metres. Photodermatoses are a group of skin conditions causing abnormal reactions (like rashes, itching, burning) to sunlight or UV light.

Eczemas were another major contributor, affecting nearly 17% of patients. Lowlanders were significantly more prone to discoid eczema, allergic contact dermatitis, and seborrhoeic dermatitis. Researchers attribute this to a combination of cold, dry winds, low humidity, and impaired skin barrier function—factors that heighten vulnerability among those not acclimatised to the harsh environment, said lead author Dr. Manas Chatterjee, from the Department of Dermatology, Base Hospital Delhi Cantt, New Delhi.

Photodermatoses accounted for 12.5% of all cases and ranked as the second most common disorder among native highlanders. PMLE was the predominant condition in this category, affecting both groups but with a higher proportional burden among natives. The findings reinforce concerns about amplified ultraviolet exposure in Ladakh due to altitude, minimal cloud cover, and reflective terrain.

Pigmentary disorders, including melasma and vitiligo, were seen in nearly 8% of patients, with comparable distribution across both groups. Prolonged outdoor exposure linked to occupational duties was identified as a key contributing factor.

Papulosquamous disorders such as psoriasis and lichen planus constituted just over 5% of cases. Most patients had longstanding disease predating their posting to high altitude, suggesting limited direct influence of environmental factors in these conditions.

Despite sub-zero temperatures, chilblains were relatively uncommon, particularly among natives, a finding attributed to better acclimatisation and protective clothing used by troops. Notably, no cases of malignant skin cancer were reported, despite high solar exposure—an observation consistent with earlier studies from the region.

Co-author Dr. Ruchi Hemdani, from the Dermatology Department at Himalayan Institute of Medical Sciences, Dehradun, noted that high-altitude environments exert complex effects on the skin through hypoxia, reduced atmospheric pressure, cold stress, and immune modulation.

Prior studies have documented changes in lymphocyte profiles, cytokine balance, and immunoglobulin levels among individuals stationed at high altitude, which may predispose susceptible individuals to inflammatory, autoimmune, and photo-induced skin disorders, said the authors in the study published in the Indian Journal of Dermatology.

By systematically comparing temporary residents with native populations, the study fills an important gap in Indian dermatological literature. While limited to male military personnel, the findings carry significant implications for occupational health planning, preventive skin care protocols, and targeted dermatological surveillance for personnel deployed in high-altitude regions.

The study “Epidemiology of Skin Diseases amongst Lowlanders in the High-Altitude Ladakh Region: A Retrospective Cross-Sectional Study,” concluded that lowlanders posted to Ladakh face a distinctly higher risk of acne, alopecia areata, PMLE, allergic and discoid eczema, and keratosis pilaris, underscoring the need for anticipatory care, strict sun protection measures, and early dermatological intervention during high-altitude deployments