Lice, Scabies, Pinworm, Ringworm, Impetigo Infections of the Skin Lice, Scabies, Pinworm, Ringworm, Impetigo

Bacterial p. 694 IMPETIGO CONTAGIOSA— Appearance: maculovesicular lesion; ruptures easily; crusts form; itchy! Etiology: Staphylococci Management: carefully remove crusts with solution; apply topical antibiotic ointment; may need PO or IV antibiotics. Contagious!--CONTACT precautions indicated if hospitalized.

Bacterial MRSA: http://www.cdc.gov/mrsa / Appearance:often appears as atopic dermatitis in nares and under fingernails Furuncle or Carbuncle Etiology: Methicillin Resistant Staph Aureus Management: provide washcloths & towels separate from other family members. Soak in tub with ½ c bleach w/ 5inches of water. Apply mupirocin (Bactroban) to nares bid for 2-4 wks. May require I&D and hospitalization

Viral Infections p. 696 Warts Herpes Simplex type 1 Herpes zoster, Shingles Molluscum contagiosum weblink

Fungal infections Dermatophytoses—Ringworm also referred to as Tinea Capitis, or Tinea Corporis, or Tinea cruris, or Tinea Pedis Appearance: ring-like shape, scaly, unilateral, non-pruritic except tinea cruris Etiology: filamentous fungi— Trichophyton, Microsporum, & Epidermophyton Management: Oral GRISEOFULVIN, topical antifungal creams e.g. clotrimazole; nystatin, or miconazole, wet compresses or soaks

Scabies Appearance: maculopapular lesions in any skin fold: between fingers, inside elbow, axilla, inguinal area. Watch for discrete papules, burrows, or vesicles Etiology: scabies mite, Sarcoptes scabiei. Mite burrows into stratum corneum of epidermis. Management:Apply scabicide—drug of choice is permethrin 5% cream (Elimite). 2oz for adults and 1oz for children. Massage into all skin surfaces. May use lindane 1% cream—only if others are ineffective. Ivermectin—PO used if topical is not effective. It is NOT recommended for children <5 yrs or <15kg. Treat all family members and friends who have been in contact. Wash all linens in hot water and dry in hot setting of dryer. Itching will persist for 2-3 weeks so lotions and antihistamines may be helpful

ENTEROBIASIS—Pinworms p.620-1 Diagnosis: Tape test: clear, transparent tape is placed around the end of a tongue depressor. Press firmly against perianal region early in the morning before bath or BM. Place specimen in jar or plastic bag for examination. Treatment: Anthelmintics are med of choice. (If pyrantel pamoate is RX, teach parents that BM & emesis will be bright red.) Treat ALL family members with oral med and repeat dose in 2 weeks to eradicate eggs. Wear pajamas and underwear to sleep, take a bath every day, and wash (not shake) all bedding in HOT water and nightclothes (pajamas) after treatment to help prevent reinfection. . Appearance: Etiology: nematode Enterobius vermicularis. Crowded conditions, in classrooms and daycare centers favor transmission. Manifestations: gen’l irritability, restlessnes, poor sleep, bed-wetting, distractibility, short attention span, peranal dermatitis and pruritis,

PEDICULOSIS CAPITIS (Head Lice) Appearance:see photos Etiology:Pediculosis humanus capitis—a common parasite in school-age children. Louse is blood-sucking. Eggs(nits) are laid at night and attach to the hair shaft Manifestations: itching is only symptom. Often seen in occiput of scalp, behind the ears, nape of neck. Management:Apply pediculicides and manual removal of nits. Drug of choice: permethrin 1% cream rinse (Nix)— kills lice and nits. No RX needed. Retreat in 7-10 days. Daily removal of nits with metal nit comb essential. Wash all clothing and bedding in HOT WATER and DRY setting on Dryer. Vacuum everything. See p. 699 for more

Aren’t you glad to have healthy skin?? The End