Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Venereology and Leprosy 3 Scabies and Pediculosis PPT-Powerpoint Presentations and lecture notes
? 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,
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
? What are your differential diagnoses?
Differential diagnoses
? Adverse cutaneous drug interaction
? Eczema
? Urticaria
? Pediculoses
? Scabies
? Superficial dermatophytosis
? Delusions Of Parasitosis
? A 10 year old child is brought
with the complaints swelling in
the neck. Examination revealed
occipital lymphadenopathy.
? What is Your Differential
Diagnosis?
Differential diagnoses
? Adverse cutaneous drug interaction
? Eczema
? Urticaria
? Pediculoses
? Scabies
? Superficial dermatophytosis
? Delusions Of Parasitosis
? A 44 year old destitute man
brought to emergency after he
was found unconscious in the
roadside. Examination revealed
the following
? So What is Your Differential Diagnosis?
Differential diagnoses
? Adverse cutaneous drug interaction
? Eczema
? Urticaria
? Pityriasis Rosea
? Pediculoses
? Scabies
? Superficial dermatophytosis
? Delusions Of Parasitosis
Scabies
? Sarcoptes scabei var hominis: specific for humans
? Sarcoptes scabei var canis: animal mite, rarely causes infection in
humans
? Tramsmission
1. Acquired through direct, prolonged, skin-to-skin contact with an
infected person(i.e., same household).
2. Sexual contact. It is an STI
3. ?Fomite ( infected clothing, bedding)
Clinical features
Hypersensitivity lesion:
? Small erythematous papules / papulovesicles
? Persistent nodular lesions (penis)
Secondary changes
? Pustules: due to secondary infection
? Eczematised : common infants, children
Sites
? Burrows ? finger webs, sides of finger, flexural aspects of wrists, feet, male genitalia
? Hypersensitivity ?
Excoriated papules,
papulovesicles
Infants: scalp, face,
palms, soles
Line Of Hebra
? Diagnosis of scabies is made by looking at the burrows or rash.
? Confirmation of diagnosis
Skin scraping papule/ pustule : mites, eggs, or faeces
? 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,
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
Treatment
TOPICAL
? 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
ORAL
? Ivermectin 200g/kg body weight on day 1, 8 and 15
General principles
1. Apply to whole body below jaw line including genitals, soles, under
free edge of nails
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
Norwegian scabies or crusted scabies
? Immunocomprised patients
? Mentally challenged
C/F: widespread crusted, hyperkeratotic lesion
? Innumerable mites (hundreds)
? Very contagious
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
(add days 22, 29 if infestation is severe).
Animal scabies
? Mite - Sarcoptes Scabiei var Canis
? Transmission - Infected animal to human;
human to human transmission does not occur
? Source ? horses, cattle, dogs, cats; (this infection in animals is called
Mange)
? C/F ? small, pruritic papules " temprorary"
no burrows
site - front of trunk,
medial aspect of upper extremities
? Treatment ? antihistamines
? specific antiscabetic not required
Pediculosis
(Louse infestation)
? Pediculus humanus
? var capitis ? `head louse' - infestation of scalp
? var humanus - `body louse' - infestation of body & clothing
? Phthirus pubis ? `pubic louse' infestation of pubic area, axillae,
eyelash
Lice
? Flat wingless blood sucking, live as parasites on hairy skin
? Obligate human parasite
? Nits ? Eggs attached to hair ( scalp, other body hair)
eggs attached to seams of clothes
? A 10 year old child is brought
with the complaints swelling in
the neck. Examination revealed
occipital lymphadenopathy.
? What is Your Differential
Diagnosis?
Clinical features Pediculosis Capitis
? Transmission- head to head contact, fomites (shared combs)
? Severe itching ? scalp, also sides and back of scalp
? Complication- crusting due to eczematization
secondary infection
occipital lymphadenopathy
? O/E ? nits (firmly attached to hair shaft,
have to be glided off the
whole hair to remove)
adults lice difficult to find
Treatment Pediculosis Capitis
TOPICAL
1. 1% Permethrin
2. 1% Gama Benzene Hexachloride
10-15 minutes contact then rinse; repeat application day 8
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
Antihistamines
Antibiotics if secondary infection
Pediculosis Corporis (Vagabond's Disease)
? Transmission- infested clothing , bedding
? Predisposing factors
? Poor hygiene
? social deprivation
? Mentally challenged
? Severe itching ? trunk
? O/E ? self neglect
poor hygiene
linear excoriations with haemorrhagic crust
eczematization
lymphadenopathy
Nits on inner seams of clothes
Treatment Pediculosis Corporis
? Complication- crusting due to eczematization
secondary infection
lymphadenopathy
? Treatment - treatment of infested clothes by high temperature
laundry and ironing
Antihistamines
Antibiotics if secondary infection
Topical steroid for eczematization
Phthirus Pubis
? 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
clinging to base of hairs
? Maculae Ceruleae ? presence of small blue- grey macules
? Treatment- 1% Permethrin rinse
1% Gama Benzene Hexachloride
0.5% Malathion
(Affected areas treated and on day 8)
THANK YOU
This post was last modified on 08 April 2022