Creepy crawlies… Dr Maya Mistry 13th April 2011

A 41-year-old man presents with an itchy rash over his arms and abdomen. It has got gradually worse over the past three days What is the most likely diagnosis? Scabies Pityriasis rosea Erythema multiforme Urticaria Guttate psoriasis

Scabies Classical Scabies Female mite burrows in skin (webs of fingers, wrist, heels, armpit, buttocks) and lays eggs Itch – worse at night and due to delayed IV hypersensitivity reaction to mites/eggs 30 days after initial infection Only 5-15 mites Direct contact Children/young adults Norwegian Scabies Very contagious – indirect contact Institutions Millions of mites Scaly ‘crusted’ rash

Management General advice 1st line 2nd line Cut nails Wash bedding/towels/clothes in hot cycle Treat household and close contacts even if asymptomatic Avoid close physical contact until treated Once treated, itching can last for up to 6 weeks Apply washes from chin and ears downwards unless immunosupressed/children/elderly then wash face and scalp also Repeat after 7 days 1st line Permethrin 5% cream For adults and children older than 2 months Apply to cool skin and after 8-12 hours wash off in hot bath 2nd line Malathion 0.5% liquid Washed off after 24 hours

Which one of the following is not a recommended management option for head lice? Isopropyl myristate and cyclomethicone Wet combing Dimeticone Malathion Benzyl benzoate

Which one of the following is a recommended management option for head lice in a 3 year old child with atopy? Isopropyl myristate and cyclomethicone Dimeticone Coconut, anise, and ylang ylang spray

Lice - pediculosis Head lice (eggs are called nits Suck blood from scalp 5 times/day 12 lice but 100 eggs Body lice – usually in homeless/neglected Stick to clothes fibres not hair Can live up to 30 days off human Pubic lice (crabs)

Management Only treat if see live lice on fine tooth combing General advice All household should check for lice and treat affected simultaneously No school exclusion Wet comb every 2-3 days for 2 weeks Stop when 3 consecutive sessions no lice seen Washes repeat after 7 days Dimeticone 4% lotion (Hedrin® lotion), For all ages Left for 8 hours then washed off with shampoo Isopropyl myristate and cyclomethicone (Full Marks Solution®) Not suitable for < 2 year olds and skin conditions Leave for 10 mins, comb using fine tooth, then wash off Coconut, anise, and ylang ylang spray (Lyclear SprayAway®) Not suitable for < 2 year olds and skin conditions and asthma Leave for 15 minutes, wash hair, then use fine tooth comb.

Fleas

Bedbugs