Cutaneous infestations

Presentation and management

 Dermatology  MRCP  Parasites

Head liceScabiesBed bugsTungiasis
OrganismPediculus humanus capitisSarcoptes scabieiCimex lectulariusTunga penetrans
PresentationItching of head and neck often with small crusted lesions from scratching.Itching with or without superficial burrows on hands, feet, wrists, elbows, back, buttocks, and external genitals.Scattered insect bites - itchy macules and papules. Usually avoiding axillae and popliteal fossae. Classically a cluster of bites 'breakfast, lunch, and dinner'.Spread by sand fleas in resource poor settings. Typically affecting unprotected feet with numerous cutaneous lesions caused by embedded parasite.
DiagnosisDirect observation of eggs or lice in hair.Classic presentation. Dermoscopy may be used.Direct observation of the organism in sleeping environment.Typical presentation and observation of engorged flea cysts.
ManagementPermethrin lotion, benzyl alcohol solution.Permethrin lotion or ivermectin orally especially in severe cases.Antihistamines / corticosteroids. Eradication of organism from environment.Removal of the parasite with minor surgery. Antibiotics if secondary infection.
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Further reading:

Studdiford JS, Conniff KM, Trayes KP, Tully AS. Bedbug infestation. Am Fam Physician. 2012 Oct 1;86(7):653-8.

Feldmeier H, Heukelbach J. Epidermal parasitic skin diseases: a neglected category of poverty-associated plagues. Bull World Health Organ. 2009 Feb;87(2):152-9.


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