1. Skin parasitic disorders
By:DR Neda Adibi
DERMATOLOGIST of isfahan university of medical sciences

2. Parasitic skin infections
PEDICULOSIS: - (Lice infestation)
PEDICULOSIS CAPITIS:-
pediculus huminis
Life Cycle: the adult fertilized female lay about 8 eggs per a day each one hatch in about 8 days NYMPH
mature into adult lice in 8 days The adult female repeat the cycle

3. PARASITIC INFESTATIONS 3 Categories
PEDICULOSIS – Louse (lice) infestations
HEAD LICE – common among children
Spread from head to head (direct)
Indirect – combs, scarves, hats, bed linen,etc
Itching – caused by saliva of lice penetrating skin & engorging on human blood
Scratching – can open up skin to other invading organisms
Adult head lice – hard to see, lay white eggs “NITS” along hair shaft
TX – Medicated shampoo followed by fine tooth comb to remove nits

4. NITS_____________DANDRUFF
1-regular oval shape irregular shape
2-shiny appearance dull
3- attach at angle of 45 to hair 3- around hair
4-firmly attached to hair 4- loosely attach
5- Viable structure with click
when compress
between nail plate “click sign” ve
Mode of transmission

5. Clinical features
any child with repeated impetigo or crusted eczema on the scalp should be suspected to have pediculosis capitis.
Diagnosis

6. Treatment Malathion & carbaryl kill both adult & ova
Gamma- benzene hexacloride, pyrthrin and permethrin.
when not available (kerosene )
Shampoo
Lotion

7. Pediculosis Corporis
vagabonds disease

8. PARASITIC INFESTATIONS
PUBIC LICE – infest pubic hair and generally spread by sexual contact.
Lice does not spread other STD’s
TX – RX Cream
BODY LICE – most common among underprivileged, transient people.
Lice CAN SPREAD DISEASE – such as typhus epidemics among soldiers during war
Prevention – good grooming & hygiene

9. Pediculosis pubis
phthirus pubis

11. SCABIES: Sarcoptes scabeii var hominis Life Cycle
adult fertilized Female (strtum corneum) burrow 3 mm/day
Lay 3 eggs /day hatch after 3 days into larvae passes through 3 phases mature adult in 3 weeks
the adult female repeat the cycle
Incubation period

12. The entire life is in the epidermis
Secondary infection with staph or strep may occur
All races and socio economic groups are vulnerable (prevalance;4-100%)
In overcrowded situations and more prevalent in children and sexually active disease

13. Crusted(norvegian scabies) in elderly,HIV and transplanted patient

14. Clinical Features
Primary lesions
Secondary lesions

15. Diagnosis Treatment: General principles of treatment:
These drugs should be applied to the whole body below the neck or even to the face and scalp in infants.
Disinfection of beds & clothes for one week.
The whole family must be treated.
Duration of treatment depends on the used agent.

16. Permethrin ointment 5% Treatment of choice
- Gamma benzene hexa-chloride .must avoided in infants and pregnant females because it may caused neurotoxicity
- benzyl benzoate 25% lotion.
- sulfur 5% in children & pregnant females and 10%in adults. It is available, cheap and safe.
- crotamiton mild scabicdal .mainly in children, may be useful in adults as antipruritic.
Ivermectin (200 µg/kg body weight, two weeks apart)

17. LEISHMANIASIS
This disease caused by flagellated protozoa called leishmania with many subspecies.
Classification:
(1) Cutaneous Leishmaniasis: caused by L. tropica ,L. major ,L. ethiopica , L.mexicana, L. braziliensis
(2)mucocutaneous Leishmaniasis:- caused by L.etheopica and L.braziliensis
(3) Diffuse cutaneous Leishmaniasis: caused by L aethcopica and L.mexicana
(4) Visceral Leishmaniasis:-caused L. donovani.

18. Cutaneous leishmaniasis:- Baghdad boil
Transmission by sand fly of genus phlebotomas (vector)
the infective stage is flagellated form (promastigote) that enters the body by sandfly bite and taken inside body by macrophages and changed into the non-flagellated form (amastigote).
Reservoir: - may be human but mostly domestic animals like cat, dogs

19. Clinical Features Acute form :- (1) Dry type (2) Wet type
Chronic form: -lupoid leishmaniasis

20. Leishmaniasis usually leaves life long immunity
Leishmaniasis usually leaves life long immunity. Recurrence is very rare and may be due to
-immunosuppression by drugs or disease.
In elderly when the immunity reduced with the age.
very early treatment before the immunity fully developed
infection by new strain because the immunity against the disease is strain specific

21. Diagnosis
is mainly clinical in our country and the golden role is:-any boil >l month duration is leishmaniasis until prove other wise
Direct smear
Culture in NNNmedia.
Leishmanin skin test
immunological tests
Polymerase chain reaction

22. Treatment
LOCAL:-
- Chemical treatment mainly Na stibogluconate (pentostam), hyper tonic saline 7% or zinc sulfate
Physical treatment: as Cryotherapy, infra red therapy, Excision or cautery
Systemic:
Na stibogluconate (pentostam) intramuscular - zinc sulfate orally
Rifadin, Metheprim, Metronidazole, Ketoconazole, itraconazole and even allopurinol