• Pediculosis capitis / (head louse)
• Pediculosis corporis/ (body or clothing
• Phitriasis pubis / (crab)
• Lice are wingless,dorsoventrally flattened
• Lice have three pairs of legs
• Head and body lice, which travel up to 23
cm/min, crab lice are sluggish and travel
a maximum of 10 cm/day
• Head and body lice develop in adults in 19
to 25 days from the time the egg is laid
and crab lice in 22 to 27 days.
Medical importance of lice
• Hypersensitivity reaction
• Endemic typhus , relapsing fever
• Excoriations frequently lead to pyoderma
Pediculosis capitis / (head louse)
• Transmission is head-to-head contact ,
shared towels ,brushes, and combs
• DX :
– Active infestation is based on finding live adult
lice, immature nymphs, and/or viable-
– Empty shells (nits) are not
diagnostic of active infestation.
Pediculosis capitis. Myriads of oval, grayish-white egg capsules
(nits) are firmly attached to the hair shafts.
Pediculosis corporis (body or
• Infestations of body lice are found mainly in low
income ,poor hygiene, homeless ,refugees
living in crowded conditions.
• The infestation is transmitted chiefly by
contaminated clothing or bedding
• Clinical feature :
• macules or papules at the site where the louse
punctures the skin to obtain blood
• Vertical excoriations xic
• Crusts and at times pus or serum may stain the
• Transitory wheals and bacterial infections may
complicate the process
• Post inflammatory pigmentation is common.
• Few or no adult organisms are seen except in
heavily infested persons
• Numerous nits are found in clothing seams,
particularly in contact with the crotch, armpits,
belt line, and collar
Phitriasis pubis / (crab)
• Transmitted sexually, frequently coexisting
with other sexually transmitted diseases.
• Most are self-diagnosed
Pediculosis pubis. Eyelash infestation with Pthirus pubis. Nits can be
seen attached to the eyelashes.
• Pediculosis capitis
5 % PERMETHRINE
• Method of application
– Hair is first washed with a regular
shampoo, rinsed with water, and towel-dried.
– Sufficient permethrin cream rinse is supplied
to coat the hair and scalp thoroughly.
– Left on for 10 min and rinsed off with water
• The hair should then be rinsed thoroughly with water and
• The patient should lather the scalp thoroughly for 4 min
with 30 to 40 mL of lindane shampoo .
• Unlike permethrine ,lindaine leaves the hair tangled and
difficult to comb.
• Toxic ….single application / not suitable for infants
• Caused by Sarcoptes scabies Var
• Fertilized female burrows in to the stratum
corneum and depoits her eggs .
• Sensitization begins 2-4weeks after the
• But with days if patient were already
(burrow is a pathognomonic lesion)
• Pruritic papular erruptions worse at bed
• Burrows : slightly elevated ,grayish
• Vesicle or pustule containing the mite
may be noted
• Site : finger webs,wrist,axillae, areola,
umblicus, lower abdomen, genitalia
• Circle of Hebra .
• In adults face and scalp are spared
• Impetigo / furunclosis if not treated
Scabies in infants
• Generalized (face and scalp are involved )
• Bullous lesions are seen on the palms and
• Also called Crusted scabies
• Seen in immunocompromised or debilitated
• Also patients with neurological abnormality like
down syndrome , leprosy
• C / F : contains millions of mites
• Heavy scaling and crusting on face ,scalp
,pressure bearing sites
• Psoriasis like changes are noted on the nail or
under it ,,,, nail deformity
• An itchy nodule on the scrotum is
to be considered like Scabies
unless proved other wise !!!!
5 % perimethrine is a DOC
• Single application , wash after 8 hours
• You may repeat after a week
• Treat close contacts
1 % Lindane (GHCB) : toxic to the
BBL 25 % for three consecutive days
10 % Sulphur PPt in white Petrolatum
Crotamiton for 5 consecutive nights
• Ivermectin 200 microgram / kg Q for
• IL steroide / excision for Nodular
- Myiasis can be caused by
several spp of arthropods
of the order Diptera
- Worldwide, the most
common flies in human
Cordylobia anthropophaga ( tumbu fly) :Deposit
eggs on soiled clothing → when a person in
contact eggs hatch, larvae burrow into the skin.
Clinical presenation of cutaneous myasis
- Furuncular : itchy papule- painful or tender
- Lesions consist of one or few larvae
- May feel sensation of movement
suffocation with Occlsuion
Inject lidocaine at the base of the
tissue cavity → local swelling force it to
- Infestation caused by the flea; Tunga
- Endemic in certain area of the world
• T. penetrans lives in warm, dry soil
- After contact, invade the unprotected skin ,
feet /interdigital, subungal
- C / F
- No symptom , pruritic , painful
- a black furuncular nodule surrounded by a
o Bacterial superinfection
o Autoamputation of a digit
Removal of the gravid female flea
In early case, lift by enlarging the orifice
with a sterile needle
Late, curettage, electrodessication or
Topical Rx- alternatives
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