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 broughtwith 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 hewas 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 ofantibiotics 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 principles1. Apply to whole body below jaw line including genitals, soles, under
free edge of nails
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2. Treat all family members simultaneously3. 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 ortopical 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 requiredPediculosis
(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 broughtwith 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 infectionoccipital 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 findTreatment Pediculosis Capitis
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TOPICAL1. 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 rinsePHYSICAL 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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eczematizationlymphadenopathy
Nits on inner seams of clothes
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Treatment Pediculosis Corporis
? Complication- crusting due to eczematization
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secondary infectionlymphadenopathy
? Treatment - treatment of infested clothes by high temperature
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laundry and ironingAntihistamines
Antibiotics if secondary infection
Topical steroid for eczematization
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Phthirus Pubis
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? Transmission ? sexual and directfomite (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 Hexachloride0.5% Malathion
(Affected areas treated and on day 8)
THANK YOU
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