Download MBBS Venereology and Leprosy Presentations 3 Scabies and Pediculosis Lecture Notes

? R.H., a 26 year old woman comes to see you with a seven week

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history of a rash which is worse on her hands. It is extremely itchy,

particularly at night, and she also, gives history of taking a course of

antibiotics for sore throat 3 weeks to the onset of the rash. She is

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worried that she could give "this itching" to her 4 year old son
? What are your differential diagnoses?

Differential diagnoses

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? Adverse cutaneous drug interaction
? Eczema
? Urticaria
? Pediculoses

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? Scabies
? Superficial dermatophytosis
? Delusions Of Parasitosis

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? A 10 year old child is brought

with the complaints swelling in

the neck. Examination revealed

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occipital lymphadenopathy.

? What is Your Differential

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Diagnosis?

Differential diagnoses

? Adverse cutaneous drug interaction

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? Eczema
? Urticaria
? Pediculoses
? Scabies
? Superficial dermatophytosis

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? Delusions Of Parasitosis


? A 44 year old destitute man

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brought to emergency after he

was found unconscious in the

roadside. Examination revealed

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the following

? So What is Your Differential Diagnosis?
Differential diagnoses

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? Adverse cutaneous drug interaction
? Eczema
? Urticaria
? Pityriasis Rosea

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? Pediculoses
? Scabies
? Superficial dermatophytosis
? Delusions Of Parasitosis

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Scabies

? Sarcoptes scabei var hominis: specific for humans
? Sarcoptes scabei var canis: animal mite, rarely causes infection in

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humans

? Tramsmission
1. Acquired through direct, prolonged, skin-to-skin contact with an

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infected person(i.e., same household).

2. Sexual contact. It is an STI
3. ?Fomite ( infected clothing, bedding)

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Clinical features

Hypersensitivity lesion:
? Small erythematous papules / papulovesicles

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? Persistent nodular lesions (penis)

Secondary changes
? Pustules: due to secondary infection
? Eczematised : common infants, children

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Sites
? Burrows ? finger webs, sides of finger, flexural aspects of wrists, feet, male genitalia

? Hypersensitivity ?

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Excoriated papules,
papulovesicles

Infants: scalp, face,
palms, soles

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Line Of Hebra

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? Diagnosis of scabies is made by looking at the burrows or rash.
? Confirmation of diagnosis
Skin scraping papule/ pustule : mites, eggs, or faeces

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? R.H., a 26 year old woman comes to see you with a seven week

history of a rash which is worse on her hands. It is extremely itchy,

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particularly at night, and she also, gives history of taking a course of

antibiotics for sore throat 3 weeks to the onset of the rash. She is

worried that she could give "this itching" to her 4 year old son

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Treatment

TOPICAL

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? 5% permethrin : apply for 8 hours on days 1 & 8
? 1% GBHC: apply for 8 hours on days 1 & 8
? 25% Benzyl benzoate: 3 application for 12 hourly
? 10% Crotamiton: apply for 8 hours on days 1,2,3 & 8
? 10% Precipated Sulphur: twice daily for 14 days; DOC in pregnancy

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ORAL
? Ivermectin 200g/kg body weight on day 1, 8 and 15

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General principles
1. Apply to whole body below jaw line including genitals, soles, under

free edge of nails

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2. Treat all family members simultaneously
3. Ordinary laundering of linen
4. Antihistamines: for 4-6 weeks
5. Persistent nodular lesion ? topical steroid may be required

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Norwegian scabies or crusted scabies

? Immunocomprised patients

? Mentally challenged

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C/F: widespread crusted, hyperkeratotic lesion
? Innumerable mites (hundreds)

? Very contagious

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Treatment - Topical 5% permethrin or
topical 5% benzoyl benzoate
applied daily for seven days, then twice weekly until cure
Keratolytic creams on alternate days to scabicide
Oral ivermectin on days 1, 2, 8, 9, and 15

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(add days 22, 29 if infestation is severe).


Animal scabies

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? Mite - Sarcoptes Scabiei var Canis

? Transmission - Infected animal to human;

human to human transmission does not occur

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? Source ? horses, cattle, dogs, cats; (this infection in animals is called

Mange)

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? C/F ? small, pruritic papules " temprorary"

no burrows

site - front of trunk,

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medial aspect of upper extremities

? Treatment ? antihistamines

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? specific antiscabetic not required

Pediculosis

(Louse infestation)

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? Pediculus humanus
? var capitis ? `head louse' - infestation of scalp
? var humanus - `body louse' - infestation of body & clothing

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? Phthirus pubis ? `pubic louse' infestation of pubic area, axillae,

eyelash

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Lice

? Flat wingless blood sucking, live as parasites on hairy skin

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? Obligate human parasite
? Nits ? Eggs attached to hair ( scalp, other body hair)
eggs attached to seams of clothes

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? A 10 year old child is brought

with the complaints swelling in

the neck. Examination revealed

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occipital lymphadenopathy.

? What is Your Differential

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Diagnosis?

Clinical features Pediculosis Capitis

? Transmission- head to head contact, fomites (shared combs)

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? Severe itching ? scalp, also sides and back of scalp

? Complication- crusting due to eczematization

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secondary infection

occipital lymphadenopathy

? O/E ? nits (firmly attached to hair shaft,

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have to be glided off the

whole hair to remove)

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adults lice difficult to find


Treatment Pediculosis Capitis

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TOPICAL

1. 1% Permethrin

2. 1% Gama Benzene Hexachloride

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10-15 minutes contact then rinse; repeat application day 8

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3. 0.5% Malathion ? overnight application then rinse

PHYSICAL TREATMENT ? hairbrushing with fine toothed comb

ORAL THERAPY ? Ivermectin 200g/kg body weight on day 1, 8 and 15

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Antihistamines

Antibiotics if secondary infection

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Pediculosis Corporis (Vagabond's Disease)

? Transmission- infested clothing , bedding
? Predisposing factors

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? Poor hygiene

? social deprivation

? Mentally challenged

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? Severe itching ? trunk
? O/E ? self neglect
poor hygiene
linear excoriations with haemorrhagic crust

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eczematization
lymphadenopathy


Nits on inner seams of clothes

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Treatment Pediculosis Corporis

? Complication- crusting due to eczematization

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secondary infection
lymphadenopathy

? Treatment - treatment of infested clothes by high temperature

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laundry and ironing

Antihistamines
Antibiotics if secondary infection
Topical steroid for eczematization

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Phthirus Pubis

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? Transmission ? sexual and direct
fomite (contaminated clothing, towels, bedding)
? Severe itching ? pubic area, thighs,eyelashes
? O/E ? shiny translucent nits
adult mite as yellowish black specks

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clinging to base of hairs

? Maculae Ceruleae ? presence of small blue- grey macules

? Treatment- 1% Permethrin rinse

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1% Gama Benzene Hexachloride
0.5% Malathion
(Affected areas treated and on day 8)

THANK YOU

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