1. Sarcoptes scabiei via close contact transmx; HIGHLY contagious
2. Pathognomic burrow sign; Intense pruritus worse at night or after hot shower. Small pink papules +/- excoriations, can turn into vesicles.
Check interdigital spaces, genital area, axillae, umbilicus, behind ears. Elderly, immunocompromised, or infants can be all over.
3. Dx by scraping and KOH prep. Mites, eggs, and turds visible under microscope.
4. Topical permethrin or oral ivermectin. Also must treat house and others living in it.
1.Capitis, corporus, or pubis variants.
2. Pruritus, visible mites
3. Diagnosis: visible mites and or nits on hairs in scalp or body, may visualize with magnifying lens. Can use Wood lamp to ID.
4. Permethrin. Also treat contacts, bedding, and clothing.
CUTANEOUS LARVA MIGRANS
1. Ancylostoma braziliense
2. Pruritic, curvilinear red line, usually on foot.
4. Thiabendazole, mebendazole
1. Enterobius vermicularis - ingestion of eggs
2. Perianal and perineal pruritus, restlessness
Asymptomatic in most patients
3. Diagnose by detection of eggs via adhesive cellophane tape pressed against perianal skin, or by seeing at night.
4. Mebendazole, Albendazole, Pyrantel pamoate
1. Cimex lectularius - infestation of baseboards, cracks, can move from house to house, nocturnal feeder.
2. Nonsensitized - macule to nodule, 14 days
sensitized - pruritic wheals, papules, vesicles, and possible 2* infection. Linear group of 3 bites, bfast-lunch-dinner sign.
3. Fleas, mosquitoes, scabies
4. Chlordane, lindane. Clean or dispose of bedding and furniture.
1. Pulex irritans (human), Ctenocephalides felis (cat)
2. Intensely pruritic papulovesicles, usually located on the lower legs. Urticarial wheal with central hemorrhagic puncture.
3. Scabies, bed bugs, mosquitoes
4. Malathion, lindane powder to treat areas and pets. Topical mild corticosteroid for itch relief.
1. Trombicula (Eutrombicula) alfreddugesi
2. Intensely pruritic. Bites present as grouped papules, vesicles or bullae on the lower extremities, or where elastic meets the skin
Arthropod attack sign (bites of 3).
3. Scabies, bedbugs, fleas.
4. Topical antipruritics or anesthetics
1. Dermatobia hominis - larval infestation under skin.
2. Boil-like lesion
4. Oral ivermectin may be given; surgical removal not necessary as larvae will be sloughed in 2 weeks. Abx if secondary infection. Can smother with BACON!
1. Bees, wasps, hornets, and ants - up to 25% of anaphylaxis related to these stings.
2. grouped or disseminated 1- to 4-mm urticarial erythematous papules that are itchy and excoriated. Painful pustules in case of ant bites. Nodular and vesiculobullous reactions can occur
4. Camphor and menthol formulations for pruritus. Topical anesthetics, topical corticosteroids
BLACK WIDOW BITE
1. Black widow spider
2. Initially two small red fang marks. Acute pain and edema occurs at the bite site. Systemic symptoms mimic acute abdomen and may include rhabdomyolysis.
4.Benzodiazepines and intravenous calcium gluconate, antivenin.
BROWN RECLUSE BITE
1. Loxosceles reclusa
2. Can present as urticarial plaques with dusky centers, dry, necrotic eschars, or ulcerations.
Tissue necrosis. Systemic reactions include shock, hemolysis, renal insufficiency and disseminated intravascular coagulation (DIC)
4. Most bites with rest, ice and elevation, tetanus toxoid, antivenin if available
1. Spirochete Borrelia Burgdorferi delivered via tick bite.
2. Initially small papule at site. At avg. of 7 days after tick bite, see gradual expansion of redness around papule: ERYTHEMA MIGRANS
Annular erythema can range from 3 to 68 cm, can be multiple; spares palms and soles.
Malaise, fever, headache, regional LAD, dry cough, conjunctivitis, stiff neck, arthralgias, myalgias, anorexia, nausea, vomiting may occur (Flu-like symptoms). PCR or ELISA to confirm.
3. Erythema multiforme
4. DOXYCYCLINE 100mg BID for at least 3 weeks
ROCKY MOUNTAIN SPOTTED FEVER
1. Ricketssia rickettsii via Wood tick, dog tick, lonestar ticks
2. Infections begin with fever (>102°F during the first 3 days of the illness), severe headache, myalgia +/- nausea, vomiting, abdominal pain/tenderness. Rash appears around day 3-6.
Begins as macules around the wrists and ankles and spreads to most of the body, with relative sparing of the face. Maculopapular lesions are seen on the palms and soles.
4. doxycycline 100 mg BID for 10 days