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D28 Dermatology
Infections Toronto Notes 2019 • microscopicexaminationofrootandcontentofburrowandmineraloilmountformite,eggs,feces
• skinbiopsymaysometimesshowscabiesmite
Management
• bathe,thenapplypermethrin5%cream(i.e.Nix®)fromneckdowntosolesoffeet(mustbeleftonfor 8-14 h and requires second treatment 7 d after first treatment)
• changeunderwearandlinens;washtwicewithdetergentinhotwatercyclethenmachinedry
• treatfamilyandclosecontacts
• pruritusmaypersistfor2-3wkaftereffectivetreatmentduetoprolongedhypersensitivityreaction
• midpotencytopicalsteroidsandantihistaminesforsymptommanagement
LICE (PEDICULOSIS)
Clinical Presentation
• intenselypruritic,redexcoriations,morbilliformrash,causedbylouse(aparasite)
• scalplice:nits(i.e.louseeggs)onhairs;red,excoriatedskinwithsecondarybacterialinfection,
lymphadenopathy
• pubiclice:nitsonhairs;excoriations
• bodylice:nitsandliceinseamsofclothing;excoriationsandsecondaryinfectionmainlyonshoulders,
belt-line, and buttocks
Etiology
• Phthiruspubis(pubic),Pediculushumanuscapitis(scalp),Pediculushumanushumanus(body):attaches to body hair and feeds on the nearby body site
• cantransmitinfectiousagents(e.g.BartonellaQuintana,Rickettsiaprowazekii) Differential Diagnosis
• bacterialinfectionofscalp,seborrheicdermatitis
Diagnosis
• licevisibleoninspectionofaffectedareaorclothingseams
Management
• permethrin1%(Nix®creamrinse)(ovicidal)orpermethrin1%(RC&Cor®,Kwellada-P®shampoo)
• combhairwithfine-toothedcombusingdilutevinegarsolutiontoremovenits
• repeatin7dafterfirsttreatment
• shavehairiffeasible,changeclothingandlinens;washwithdetergentinhotwatercyclethenmachine
dry
BED BUGS (HEMIPTERA)
Clinical Presentation
• burningwheals,turningtofirmpapules,ofteningroupsofthree–“breakfast,lunchanddinner”–in areas with easy access (face, neck, arms, legs, hands)
Etiology
• causedbyCimexlectularius,asmallinsectthatfeedsmainlyatnight(hidesincrevicesinwallsand furniture during the day)
Differential Diagnosis
• dermatitisherpetiformis,drugeruptions,ecthyma,otherinsectbites,scabies
Investigations
• nonerequired,butlesionalbiopsycanconfirminsectbitereaction
Management
• professionalfumigation
• topicalsteroidsandoralH1-antagonistsforsymptomaticrelief
• definitivetreatmentisremovalofclutterinhomeandapplicationofinsecticidestowallsandfurniture
Investigations
