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Creepy crawlies…

Creepy crawlies…. Dr Maya Mistry 13 th 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.

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Creepy crawlies…

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  1. Creepy crawlies… Dr Maya Mistry 13th April 2011

  2. 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

  3. 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

  4. Management • General advice • 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

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

  6. 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

  7. 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)

  8. 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.

  9. Fleas

  10. Bedbugs

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