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Parasitic skin infestation
 

Parasitic skin infestation

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    Parasitic skin infestation Parasitic skin infestation Presentation Transcript

    • ‫الرحيم‬ ‫الرحمن‬ ‫ال‬ ‫بسم‬‫الرحيم‬ ‫الرحمن‬ ‫ال‬ ‫بسم‬
    • PARSITIC SKIN DISEASESPARSITIC SKIN DISEASESBYBYDr Nagat SobhyDr Nagat SobhyAssistant prof .of dermatologyAssistant prof .of dermatology
    • Intended learningIntended learningobjectivesobjectives1- Knowledge about parasitic skin diseases1- Knowledge about parasitic skin diseasesand method of transmissionand method of transmission..
    • •Mr. Salem, 30 yearsMr. Salem, 30 yearsold, complaining ofold, complaining ofitching at nightitching at nightaffecting the skinaffecting the skinaround umbilicus ,around umbilicus ,axillae and groin ofaxillae and groin of2weeks duration. Also2weeks duration. Alsohis wife affected byhis wife affected bythe same conditionthe same condition..
    • Skin examination revealedSkin examination revealed::Multiple papules and scratch marks aroundMultiple papules and scratch marks aroundthethe umbilicus and in the axillaeumbilicus and in the axillae
    • What is the probableWhat is the probablediagnosisdiagnosis??
    • ScabiesScabies
    • ScabiesScabiesScabies is anScabies is an ectoparasite infestationectoparasite infestation..It is caused by theIt is caused by the mitemite Sarcoptes scabieiSarcoptes scabiei varietyvarietyhominishominis an obligate human parasite thatan obligate human parasite thatburrows tunnels downwards into the epidermisburrows tunnels downwards into the epidermis(not deeper than the stratum granulosum(not deeper than the stratum granulosum(.(.Mites of all developmental stages tunnel into theMites of all developmental stages tunnel into thestratum corneum and deposit faeces behindstratum corneum and deposit faeces behindthem; the female also lays eggs in the tunnelsthem; the female also lays eggs in the tunnels..
    • AA photomicrographphotomicrograph of an itch miteof an itch mite))Sarcoptes scabieiSarcoptes scabiei(.(.
    • Photograph of the mite,Photograph of the mite, S. scabieiS. scabiei, seen, seenon a skin scraping from scabetic patienton a skin scraping from scabetic patient
    • In classic scabies, there are onlyIn classic scabies, there are onlyaboutabout 11-1211-12 female mites perfemale mites percasecase..HypersensitivityHypersensitivity of both immediateof both immediateand delayed types to the mite orand delayed types to the mite orits products has been implicatedits products has been implicatedin the development ofin the development of lesionslesionsother thanother than burrowsburrows..
    • Mode of transmissionMode of transmission--CloseClose person-to-personperson-to-personcontactcontact..--Sexual intercourseSexual intercourse..--Fomites may transmit theFomites may transmit theinfectioninfection..
    • Clinical pictureClinical pictureItching : Nocturnal , scratchingItching : Nocturnal , scratching……………………………………………………………………………………………………………………………………....The affected sites : Delicate skin asThe affected sites : Delicate skin as………………………………………………………………………………………………………………………………....Morphology of the lesion : poly morphicMorphology of the lesion : poly morphic………………………………………………………………………………………………………………………………..
    • A scabies burrow underA scabies burrow undermagnificationmagnification
    • Clinical variations of scabiesClinical variations of scabies11--Scabies incognitoScabies incognito..22--Scabies in infants and young childrenScabies in infants and young children..33--Nodular scabiesNodular scabies..44--Crusted ( Norwegian ) scabiesCrusted ( Norwegian ) scabies..55--Animal scabiesAnimal scabies..
    • CrustedCrusted (Norwegian)(Norwegian) scabiesscabiesThis type represents an abnormal hostThis type represents an abnormal hostimmune response to the sarcoptesimmune response to the sarcoptesscabiei.The condition is primarily seen inscabiei.The condition is primarily seen inthe following groupsthe following groups::11--The mentally retarded ( DownThe mentally retarded ( Down,,s syndromes syndrome((22--Patients with poor cutaneous sensation ( leprosyPatients with poor cutaneous sensation ( leprosy,syringomelia ,and tabes dorsalis,syringomelia ,and tabes dorsalis. (. (33--Patients with severe systemic diseasesPatients with severe systemic diseases( leukemia( leukemia –– diabetesdiabetes((44--Patients with severe immunesuppressionPatients with severe immunesuppression..
    • Crusted scabies in a patient with noCrusted scabies in a patient with noovert immunosuppressive illnessovert immunosuppressive illness
    • Photograph of patient withPhotograph of patient withhyperkeratotic rash typical ofhyperkeratotic rash typical ofcrusted (Norwegian) scabiescrusted (Norwegian) scabies..
    • Crusted scabies in a patient with claw handCrusted scabies in a patient with claw handfrom past leprosyfrom past leprosy..
    • Bullous ScabiesBullous Scabies--These scabies can be seen in adults overThese scabies can be seen in adults over65 years of age65 years of age..--There is no linkage to an underlyingThere is no linkage to an underlyingcondition or diseasecondition or disease..--It can mimic bullous pemphigoid clinically,It can mimic bullous pemphigoid clinically,pathologically,and immunopathologicallypathologically,and immunopathologically..
    • Diagnosis of scabiesDiagnosis of scabiesHistoryHistoryExaminationExaminationInvestigations : ScrapingInvestigations : Scraping
    • Complications of scabiesComplications of scabies--Bacterial infectionsBacterial infections--EczematizationEczematization--UrticariaUrticaria--AcarophobiaAcarophobia
    • Treatment of scabiesTreatment of scabies--InstructionsInstructions--Drugs : Topical and systemicDrugs : Topical and systemic..
    • Topical scabicidesTopical scabicides11--Benzyl benzoate 10% and 25% lotionsBenzyl benzoate 10% and 25% lotions22--Pyrethrins: permethrin 5% cream, lotionPyrethrins: permethrin 5% cream, lotion33--Malathion 0Malathion 0··5% lotion5% lotion44--Sulphur (precipitated) 2Sulphur (precipitated) 2––10% in petrolatum10% in petrolatum55--Crotamiton 10% cream (EuraxCrotamiton 10% cream (Eurax((66--Gamma benzene hexachloride 1% cream orGamma benzene hexachloride 1% cream oremulsionemulsion..Special care fore Infant------ PregnantSpecial care fore Infant------ Pregnant
    • Systemic drug for scabiesSystemic drug for scabies•Ivermectin.Ivermectin. (200 μg/kg once and repeated(200 μg/kg once and repeatedafter 1-2 weeksafter 1-2 weeks( .( .
    • IvermectinIvermectin11--The full benefit becomes evident whenThe full benefit becomes evident wheneradication of scabies in epidemic or endemiceradication of scabies in epidemic or endemicsituationssituations22--in nursing homes and prisonsin nursing homes and prisons is needed sinceis needed sinceivermectin leads to reliable disease controlivermectin leads to reliable disease control..33--Along the same lines,Along the same lines, crusted scabiescrusted scabies has beenhas beeneffectively treated with ivermectin in adults andeffectively treated with ivermectin in adults andchildren, sometimes in combination with topicalchildren, sometimes in combination with topicalpermethrinpermethrin..
    • Mechanism of actionMechanism of actionIvermectinIvermectin interrupts the GABA-interrupts the GABA-induced neurotransmission ofinduced neurotransmission ofmany parasites.leading tomany parasites.leading toparalysis of the parasitesparalysis of the parasites..
    • Novel drugNovel drugRecently, the essential oil of the tea treeRecently, the essential oil of the tea tree((Melaleuca alternifoliaMelaleuca alternifolia), containing), containingoxygenetic terpenoids, was found to haveoxygenetic terpenoids, was found to haverapid scabicidal and antibacterial activityrapid scabicidal and antibacterial activity..
    • vaccine developmentvaccine developmentThe multifunctional enzymeThe multifunctional enzymeglutathione S-transferaseglutathione S-transferase ofof SSscabieiscabiei could represent a specificcould represent a specifictarget for vaccination againsttarget for vaccination againsthuman scabieshuman scabies..
    • 1313years old female patientyears old female patientcomplaining of itching in the scalp ofcomplaining of itching in the scalp of10 days duration with post auricular10 days duration with post auricularand occipital swellingand occipital swelling
    • What is the probableWhat is the probablediagnosisdiagnosis??
    • PediculosisPediculosisPediculosisPediculosis is an infestation of liceis an infestation of lice —— blood-blood-feeding ectoparasitic insects of the orderfeeding ectoparasitic insects of the orderPhthiraptera. The condition can occur in almostPhthiraptera. The condition can occur in almostany species of warm-blooded animal (i.e.,any species of warm-blooded animal (i.e.,mammals and birds), including humans.Althoughmammals and birds), including humans.Although"pediculosis" in humans may properly refer to"pediculosis" in humans may properly refer tolice infestation of any part of the body, the termlice infestation of any part of the body, the termis sometimes used loosely to refer tois sometimes used loosely to refer to pediculosispediculosiscapitiscapitis, the infestation of the human head with, the infestation of the human head withthe specific head lousethe specific head louse..
    • Pediculus humanus capitisPediculus humanus capitis (♀) Lice are small gray(♀) Lice are small graybrown,blood sucking insects which crawl among thebrown,blood sucking insects which crawl among thehairshairs
    • ClassificationClassificationPediculosis may be divided into thePediculosis may be divided into thefollowing typesfollowing types11--Pediculosis capitis (Head lice infestationPediculosis capitis (Head lice infestation((22--Pediculosis corporis (PediculosisPediculosis corporis (Pediculosisvestimenti, Vagabonds disease) typhusvestimenti, Vagabonds disease) typhus$relapsing fever$relapsing fever33--Pediculosis pubis (Crabs) STDPediculosis pubis (Crabs) STD
    • Pediculosis, or louse infestation, remains aPediculosis, or louse infestation, remains aworldwide problem. The lice that infestworldwide problem. The lice that infesthuman beings are almost always suckinghuman beings are almost always suckinglice that live in close association with thelice that live in close association with thehost and lay their eggs on hair shafts or inhost and lay their eggs on hair shafts or inthe seams of clothingthe seams of clothing
    • AA andand B,B, Identifying characteristics of a headIdentifying characteristics of a headlouselouse..
    • Head louse nit attached to hairHead louse nit attached to hairshaftshaft
    • Identifying characteristics of a crabIdentifying characteristics of a crablouselouse
    • TreatmentTreatmentMalathion o.5 % lotionMalathion o.5 % lotionAnti scabetic drugsAnti scabetic drugs