skin infection/ infestation Flashcards
1
Q
What is Panton Valentine Leukocydin?
A
Staphylococcus receptor that allows it to bind to fibrin that is found in abundance on wound surfaces and in dermatitis
2
Q
What skin infections does staphylococcus play a role in?
A
Echtyma
Impetigo
Cellulitis
Folliculitis (furunculosis, carbuncles)
Staphylococcal scalded skin syndrome (SSSS)
Superinfects other dermatoses (atopic eczema, leg ulcers, HSV)
3
Q
What kind of hemolysis does streptococcus pygenes carry out?
A
B hemolysis
4
Q
Describe the virulence of streptococcus pygenes
A
Attaches to epithelial surfaces via lipoteichoic acid portion of fimbriae
Has M protein (anti-phagocytic) and hyaluronic acid capsule
Produces erythrogenic exotoxins
Produces streptolysins S and O
5
Q
What skin infections does streptococcus play a role in?
A
Echthyma Impetigo Cellulitis Erysipelas Scarlet Fever Necrotising fasciitis Superinfects other dermatoses (leg ulcers)
6
Q
What does the cutaneous manifestation of folliculitis look like?
A
Follicular erythema, sometimes papular
7
Q
Is folliculitis infection or non-infectious?
A
May be infectious or non-infectious
Eosinophilic (non-infectious) folliculitis is associated with HIV
8
Q
What could cause recurrent folliculitis?
A
Nasal carriage of staphylococcus aureus, particularly strains expressing PVL
9
Q
How is folliculitis treated?
A
Antibiotics, usually flucloxacillin or erythromycin
Incision and drainage is required for furunculosis
10
Q
What is the difference between a furuncle and a carbuncle?
A
A furuncle is a deep follicular abscess
Involvement with adjacent connected follicles- carbuncle
Cabuncles are more likely to lead to complications such as cellulitis and septicaemia
11
Q
Why do some patients develop recurrent staphylococcal impetigo or recurrent furunculosis?
A
Establishment as part of the resident microflora
-abundant in nasal flora
Immune deficiency
- chronic granulomatous disease
- AIDS
- Diabetes mellitus
- Hypogammaglobulinemia
- Hyper IgE syndrome- deficiency
12
Q
What kind of toxin does PVL Staphylococcus aureus produce and what are its effects?
A
B-pore forming toxin
Leukocyte destruction and tissue necrosis
Higher morbidity, mortality and transmission
skin: recurrent and painful abscesses, folliculitis, cellulitis (often painful, recurrent, more than 1 site, present in contacts)
extracutaneous: necrotising pneumonia, necrotising fasciitis, purpura fulminans
13
Q
What are the risk factors for acquiring PVL Staphylococcus aureus?
A
5Cs
Close contact (hugging, contact sports)
Crowding (living in crowded accommodation like boarding school, military accommodation, prison)
Cleanliness (of environment)
Contaminated items (gym equipment, towels, razors
Cuts and grazes (allowing bacteria to enter body)
14
Q
How is PVL staphylococcus aureus treated?
A
Consult local mocrobiologist/ guidelines
Antibiotics (often tetracycline)
Decolonisation often:
chlorhexidine body wash for 7 days
nasal application of mupirocin ointment, 5 days. )
Treatment of close contacts
15
Q
What is acquiring pseudomonas folliculitis associated with?
A
Hot tub use, swimming pools, wet suit, depilatories
16
Q
Describe the symptoms of pseudomonas folliculitis
A
Appears 1-3 days after exposure as a diffuse truncal eruption
follicular erythematous papule
rarely: abcesses, lymphangitis, fever
17
Q
How is pseudomonas folliculitis treated?
A
Most cases are self limited- no treatment required
Sever or recurrent cases can be treated with oral ciprofloxacin
18
Q
What is cellulitis and how does it manifest?
A
Infection of lower dermis and subcutaneous tissue
tender swelling with ill define, blanching erythema or oedema
19
Q
What is a predisposing factor for cellulitis?
A
Oedema
20
Q
What are the causative organisms of cellulitis?
A
Most commonly streptococcus pyogenes and staphylococcus aureus
21
Q
What is the treatment for cellulitis?
A
Systemic antibiotics
22
Q
Describe impetigo manifestation
A
Superficial bacterial infection with stuck on, honey coloured crusts overlying an erosion
23
Q
What organisms caused impetigo?
A
Streptococci (non-bulbous)
Staphylococci (bulbous)
caused by exfoliating toxins A and B
which split epidermis by targeting desmoglein I
24
Q
What parts of the body does impetigo often affect?
A
Face (perioral, ears, nares)
25
How is impetigo treated?
Topical +/- systemic antibiotics
26
In what skin condition can impetigisation occur and what causes it?
```
Atopic dermatitis (gold crust)
staphylococcus aureus
```
27
What is echthyma?
| What does it look like?
Sever form of streptococcal impetigo
Thick crust overlying a punch out ulceration surrounded by erythema
Usually on lower extremities
28
What is echthyma?
| What does it look like?
Sever form of streptococcal impetigo
Thick crust overlying a punch out ulceration surrounded by erythema
Usually on lower extremities
29
In what groups of people does staphylococcal scalded skin syndrome generally occur?
Neonates, infants, immunocompromised adults
30
What kind of toxin causes staphylococcal scalded skin syndrome?
Exfoliative toxin
| In neonates, kidneys cannot excrete the exfoliative toxin quickly
31
Why can organism not be cultured from denuded skin in staphylococcal scalded skin syndrome ?
Infection occurs at distant site (e.g. conjunctivitis, abscesses
32
Describe the progression of staphylococcal scalded skin syndrome.
diffuse tender erythema that rapidly progresses to flaccid bullae that wrinkle and exfoliate, leaving an oozing erythematous base
clinically resembles SJS/TEN
33
What organism causes toxic shock syndrome?
Group A Staphylococcus aureus strain that produces pyogenic exotoxin TSST-1
34
What are the symptoms of TSS?
Fever >38.9 0C
Hypotension
Hematologic (platelets <100,000/mm3)
Systemic involvement (Renal, Hepatic, GI, Muscular, CNS)
Diffuse erythema
Mucous membranes
Desquamation predominantly of palms and soles 1-2 weeks after resolution of erythema
35
What organism causes erythrasma?
Corynebacterium minitissimum
36
Describe the cutaneous manifestation of erythrasma
Well demarcated patches in intertriginous areas
Initially pink, become brown and scaly
37
What is pitted keratolysis?
Pitted erosions of the soles
38
What organisms cause pitted keratolysis?
Corynebacteria
39
How is pitted keratolysis treated?
Topical clindamycin
40
What occurs in erysipeloid?
Erythema and oedema of the hand after handling contaminated raw fish or meat
extends slowly over weeks
41
What organism causes erysipeloid?
Erysipelothrix rhusiopathiae
42
What organism causes anthrax?
Bacillus anthracis
43
How does anthrax manifest?
Painless necrotic ulcer with surrounding oedema and regional lymphadenopathy (with pain in lymph nodes) at site of contact with hides, wool or bone meal infected with Bacillus anthracis
44
What organisms cause blistering distal dactylitis?
Streptococcus pyogenes
| Staphylococcus aureus
45
In what group of the population does blistering distal dactylitis commonly occur?
Typically young children
46
Describe the cutaneous manifestation of blistering distal dactylitis.
One or more tender superficial bullae on an erythematous base on the volar fat pad of finger
toes may be rarely affected
47
What is erysipelas?
Infection of deep dermis and subcutis
48
What organisms cause erysipelas?
Staphylococcus aureus
B-hemolytic streptococci
49
Describe the symptoms of erysipelas.
Painful
Prodrome of fever, malaise, headache
presents as erythematous indurated plaque with a sharply demarcated border and cliff drop edge (+/- blistering)
Face or limb +/- red streak of lymphangitis and local lymphadenopathy
50
Name a possible portal of entry in erysipelas.
Tinea pedis
51
How is erysipelas treated?
Intravenous antibiotics
52
In which part of the population does scarlet fever occur?
Primarily a disease of children
53
What causes scarlet fever?
Upper respiratory tract infection with erythrogenic toxin producing streptococcus pyogenes
54
What are the symptoms of scarlet fever?
Preceded by fever, malaise, headache, sore throat, chills, anorexia
Eruption begins 12-48 hours later: blanch able, tiny pinkish red spots on chest, neck and axillae that spreads to the whole body within 12 hours. Sandpaper like texture.
55
What are the complications of scarlet fever?
Otitis, mastoiditis, sinusitis, pneumonia, myocarditis, rheumatic fever, meningitis, hepatitis, acute glomerulonephritis
56
What occurs in necrotising fasciitis?
Initial dusky induration (usually of a limb), followed by rapid painful necrosis of skin, connective tissue and muscle.
Potentially fatal
57
What organisms cause necrotising fasciitis?
Usually synergistic: streptococci, staphylococci, enterobacteriae and anaerobes
58
How is necrotising fasciitis treated?
Prompt diagnosis is essential (requires high index of suspicion), followed by broad-spectrum parenteral antibiotics and surgical debridement.
MRI can aid diagnosis.
Blood and tissue cultures can determine organisms and sensitivities.
59
What are the complications of necrotising fasciitis?
Mortality is high
| Can affect scrotum (Fournier's gangrene)
60
In what kind of individuals does atypical mycobacterial infection occur?
Immunocompromised
61
Give examples for atypical mycobacterium infection.
Mycobacterium marinum: causes indolent granulomatous ulcers (fish tank ulcer) in healthy adults. Sporotrichoid spread.
Mycobacterium chelonae and abscessus: puncture wounds, tattoos, skin trauma or surgery
Mycobacterium ulcerans: important cause of limb ulceration in Africa (Buruli ulcer) or Australia (Searle's ulcer)
62
What causes borreliosis/ Lyme disease?
Bite from an Ixodes tick infected with Borrelia burgdorferi
63
What is the initial cutaneous manifestation of borrelia/ Lyme disease?
Erythema migraines (only in 75%)
- erythematous papule at bite site
- progression to annular erythema >20cm
64
How does Lyme disease progress?
Fever, headache 1-30 days after infections
| multiple secondary lesions develop (similar to initial lesion but smaller)
65
What are complications of Lyme disease?
Neuroborreliosis- facial/ other CN palsies, aseptic meningitis, polyradiculitis
Arthritis- painful and swollen large joints (knee is the most affected joint)
Carditis
66
How is Lyme disease diagnosed?
Serology not sensitive
Histopathology- non specific
High index of suspicion required for diagnosis
67
What organism causes tularaemia?
Francisella tularensis
68
How is tularaemia acquired?
Handling of infectious animals (rabbits, squirrels)
Tick bites
Deerfly bites
69
How does tularaemia present?
Ulceroglandular form
Primary skin lesion is small papules at inoculation site which rapidly necroses- leading to painful ulceration
+/- local cellulitis
Painful regional lymphadenopathy
Systemic symptoms: fever, headache, malaise, chills
70
What is the causative organism of echthyma gangrenosum?
Pseudomonas aeruginosa
71
In what patients does echthyma gangrenosum occur?
Neutropenic patients
72
Describe the cutaneous manifestation of echthyma gangrenosum.
Red macules--> oedematous-->haemorrhagic bullae
May ulcerate in later stages/ form an escharotic lesion
73
In what diseases are escharotic lesions seen?
Lyme disease
Leishmaniasis
Necrotic arachidnism (brown recluse spider bite)
Tularaemia
Rat bite fever (Spirillum minus)
Cutaneous anthrax
Scrub typhus (orientia tsutsugamushi)
Staphylococcal/ streptococcal
Pseudomonas
Aspergillosis
Cryptococcosis
Lues Maligna
Rickettsial infection
Echthyma
74
What is the causative agent in Syphilis?
Treponema pallidum
75
What happens during the primary infection in syphilis?
Chancre- painless regional ulcer with a firm, indurated border (appears within 10-90 days)
Painless regional lymphadenopathy one week after primary chancre
76
When does secondary syphilis begin?
50 days after chancre
77
What are the symptoms of secondary syphilis
Malaise, fever, headache, pruitis, it is, loss off appetite
'great mimicker'- low threshold for testing
- rash (88-100%)- pityriasis rosea-like rash
- moth eaten alopecia
- mucus patches
- lymphadenopathy
- hepatosplenomegaly
- residual primary chancre
- condylomata lata
78
What can condylomata late of syphilis in anogenital regions be misdiagnosed as?
HPV infection (condylomata acuminata)
79
What is lues maligna?
Rare manifestation of secondary syphilis (more common in HIV manifestation)
80
Describe the cutaneous manifestation of lues maligna.
Pleomorphic skin lesions with pustules, nodules and ulcers with necrotising vasculitis.
81
What are the cutaneous manifestations of tertiary syphilis?
Gumma skin lesions (nodules and plaques)
Extend peripherally while central areas heal with scarring and atrophy
mucosal lesions extend and destroy nasal cartilage
82
What are the complications of tertiary syphilis?
Cardiovascular disease
Neurosyphilis (general paresis, tabes dorsalis)
83
How is syphilis diagnosed?
Clinical findings
Serology
Strong index of suspicion required in 2ndary syphilis
84
How is syphilis treated?
IM benzylpenicillin/ orał tetracycline
85
What is the causative organism of leprosy?
Mycobacterium leprae (obligate intracellular bacteria)
86
What organs does leprosy affect?
Predominantly skin and nerves but can affect any organ
87
What are the two types of leprosy?
Lepromatous leprosy- multiple lesions (macules, papules, nodules). Sensation and sweating normal (early on)
Tuberculoid leprosy- solitary/ few lesions (elevated border, atrophic centre, sometimes annular)
hairless, anhidrotic and numb
88
What systems does tuberculosis affect?
Any organ systems including skin
89
what percentage of TB infections lead to clinical disease?
5-10%
90
How can cutaneous TB be acquired?
Exogenously- primary-innoculation TB, tuberculosis verrucosa cutis
Contiguous endogenous spread- scrufuloderma
Autoinnoculation- periorificial TB
Hematogenous/ lymphatic endogenous spread- lupus vulgarisms, military TB, gummas
91
What investigations are carried out for TB?
Interferon gamma release assay (quantiferon-TB)
Histology- ZN stain
Culture/ PCR
92
What are the cutaneous manifestations of tuberculous chancre?
painless, firm, reddish -brown papulonodule that forms an ulcer
93
What are the cutaneous manifestations of TB verrucosa cutis?
wart-like papule that evolves to form a red-brown plaque
94
What are the cutaneous manifestations of scrufuloderma?
subcutaneous nodule with necrotic material.
becomes fluctuant and drains with ulceration and sinus tract formation
95
What are the cutaneous manifestations of orificial TB?
non-healing, painful ulcer of the nasal mucosa
96
What are the cutaneous manifestations of lupus vulgaris?
red brown plaque +/- central scarring, ulceration
97
What are the cutaneous manifestations of military TB?
pinhead sized blush red papule capped by minute vesicles
98
What are the cutaneous manifestations of tuberculous gumma?
firm subcutaneous nodule, later ulcerates
99
What virus infection causes molluscum contagiosum?
Poxvirus
100
In what populations is molluscum contagiosum common?
Children
Immunocompromised
101
What are the cutaneous signs of molluscs contagiosum?
Verrucae
Condylomata acuminata
Basal cell carcinoma
Pyogenic granuloma
102
How is molluscs contagiosum treated?
Usually resolves spontaneously
103
What kind of eruptions are seen in HSV?
Primary and recurrent vesicular eruptions
104
What body regions does HSV infection favour?
Orolabial and genital regions
105
When does transmission of HSV begin?
During asymptomatic periods of viral shedding
106
What are the 2 types of HSV and how do they spread?
HSV-1: directed contact with contaminated saliva/ other secretions
HSV-2: sexual contact
107
How does HSV replicate and how is it transported?
replicates at mucocutaneous sites of infection
travels by retrograde axonal flow to dorsal root ganglion
108
Describe herpes symptoms and progression
Symptoms within 3-7 days of exposure
Preceded by tender lymphadenopathy, malaise, anorexia, burning and tingling
Painful grouped vesicles on an erythematous base- ulcerations/ pustules/ erosions with a scalloped border
crusting and resolution within 2-6 weeks
orolabial involvement generally painless, genital involvement highly painful with urinary retention
systemic manifestations- aseptic meningitis in upto 10% of cases
Reactivation- Spontaneous, UV, fever, local tissue damage, stress
109
What do lesions look like in eczema herpeticum?
Monomorphic, punched out erosions
excoriated vesicles
110
What is herpetic whitlow
HSV (1>2) infection of digits, with pain, swelling and vesicles (vesicles may appear later)
Misdiagnosed as paronychia or dactylitis
Often in children
111
What is herpes gladiatorum?
HSV 1 involvement of cutaneous site reflecting site of contact with another athlete's lesions
seen in contact sports e.g. wrestling
112
How is neonatal HSV acquired?
Exposure to HSV during vaginal delivery- risk higher when HSV is acquired near time of delivery
HSV 1/2
113
When is the onset of neonatal HSV?
From birth to 2 weeks
114
How does neonatal HSV present?
Usually localised to scalp or trunk
vesicles--> bullous erosions
115
Complications of neonatal HSV?
Encephalitis- mortality 50% without treatment, 15% with treatment
Neurological deficits
116
Treatment for neonatal HSV?
IV antivirals
117
In what type of patients is sever/ chronic HSV seen?
Immunocompromised (HIV/ transplant recipient)
118
How does severe/ chronic HSV present?
Most common presentation- chronic, enlarging ulceration
often atypical- verrucous, exophytic, pustular
multiple sites/ disseminated
involvement of respiratory/ GI tract may occur
119
How is HSV diagnosed?
Swab for PCR
120
How is HSV infection treated?
Don't delay
Orał valacyclovir/ acyclovir 200mg fives times daily in an immunocompetent, localised infection
Intravenous 10mg/kg TDS X 7-19 days
121
Name a virus that causes dermatomal infection
Varicella zoster
Single dermatome/ multidermatomal
122
What causes hand, foot and mouth disease?
Coxsackie A16, Echo 71
An acute self-limiting coxsackievirus infection
Echo 71 associated with a higher incidence of neurological involvement, including fatal cases of encephalitis
123
Symptoms of hand, foot and mouth disease?
Prodrome of fever, malaise and sore throat
Red macules, typically grey and elliptical vesicles and ulcers develop on buccal mucosa, tongue, palate, pharynx and may also develop on hands and feet (acral and volar surfaces)
124
How does hand foot and mouth disease spread?
Direct contact via oral-oral/faecal-oral route
125
What viruses cause morbilliform eruptions?
Measles, rubella, EBV, CMV, HHV6 and HHV7
126
What non-viral agents cause morbilliform eruptions?
Rickettsia
Leptospirosis
127
Which disorders mimic morbilliform eruptions?
```
Drug eruptions (most commonly)
Arthropod reactions
Viral morbilliform reactions
Pityriasis rosea
Early guttate psoriasis
```
128
What causes petechial/ purpuric eruptions?
Coagulation abnormalities- TTP, ITP, DIC
Vasculitis
Infections
Viruses- Hepatitis B, CMV, Rubella, Yellow fever, dengue fever, West Nile virus
Bacteria (BREN)- Borrelia, rickettsia, Endocarditis, Neisseria
Other infections- Trichinella, Plasmodium falciparum
Other- TEN, Ergot poisoning, Raynaud's
129
What is Gianotti-Crosti syndrome
Papular acrodermatitis of childhood
A viral eruption that causes an acute, symmetrical, erythematous, papular eruption on face, extremities and buttocks, usually in children aged 1-3
130
What viruses can cause Gianotti-Crosti syndrome?
EBV, CMV, HHV6, Hep B, Coxsackie virus A16, B4, B5
131
What virus causes erythema infectiosum?
Parvovirus B19
132
Describe the symptom progression of erythema infectiosum.
Initially mild fever and a headache
A few days later "slapped cheeks" for 2-4 days
Reticulated/ lacy rash in chest and thighs in second stage of disease
133
What is roseola infant also known as?
Exanthum subitum
| 6th disease
134
What viruses cause roseola infantum?
HHV6 and HHV7 (less commonly)
135
In what population is roseala infant generally observed?
Children
136
What are the symptoms of roseola infantum?
2-5 days of high fever
| followed by appearance of small pale pink papule on trunk and head that last hours to 2 days
137
What causes orf?
parapoxvirus on direct exposure to goats and sheep
138
Cutaneous manifestations of orf?
Dome shaped, firm bullae that develop an umbilicate crust
usually on hands/ forearms
139
How is orf treated?
Usually resolves without therapy in 4-6 weeks
140
How many subtypes of HPV cause warts?
>200
141
What organisms cause superficial fungal infections?
Candida
Malassezia
Dermatophytes
142
What organisms cause deep/ soft tissue fungal infections?
Madura foot
Chromomycosis
143
What organisms cause disseminated fungal infections?
```
Aspergillus
Blastomycosis, mucormycosis
Candida, coccidiodes
Fusarium
Histoplasma
```
144
What organism causes pityriasis versicolor?
Malassezia species
145
Describe cutaneous manifestation of pityriasis versicolor.
Hypopigmented, hyperpigmented or erythematous macular eruption +/- fine scale
146
When does pityriasis versicolor begin and when does it flare up?
Begins in adolescence when sebaceous glands become activated
| Flare ups occur in high temperature and high humidity- immunosuppression
147
Treatment for pityriasis versicolor?
Topical azalea
148
What are dermatophytes?
Fungi that live on keratin
149
What organism causes most fungal infections?
Trichophyton rubrum
150
What organism causes the most tinea capitis?
Trichophyton tonsurans
151
What is a kerion?
An inflammatory fungal condition which mimics a bacterial infection/ scalp abscess
patients usually have tender scalp and posterior cervical lymphadenopathy
frequently secondarily infected with staphylococcus aureus
152
What organisms can cause tinea pedis?
Trichophyton rubrum- scaling and hyperkeratosis of plantar surface of foot
Trichophyton mentagrophtyes (interdigitale)- sometimes vesiculobullous reaction on arch/ side of foot
153
What is an id reaction?
Dermatophytid reaction
Inflammatory reaction at sites distant to the associated dermatophyte infection
Likely secondary to a strong immunological response from host against fungal antigens
may include urticaria, hand dermatitis, erythema nodosum
154
What organisms cause Majocchi granuloma
Tirchphyton rubrum
| Trichophyton mentagrophytes
155
What is Majocchi granuloma?
Follicular abscess produced when dermatophyte infection penetrates the follicular wall into the surrounding dermis; tender
156
What organism causes candidiasis?
Candida albicans
157
What predisposes an individual to candidiasis?
Diabetes mellitus, occlusion, moisture, high temperature
158
What areas do candidiasis commonly affect?
Intertrignous regions (axillae, submammary clefts, digital clefts,, crurae) or oral mucosa
a common cause of vulvovaginitis
can affect mucosae
can become systemic (in immunocompromised individuals)
159
How can skin conditions be caused in fungal infection?
Deep invasion of skin
Production of lesions secondary to systemic vascular infection
subcutaneous fungal infections- infections of implantation (innoculation)
160
Give examples for deep fungal infections
```
Chromomycosis
Lobomycosis
Phaehypomycosis
Sporotrichosis
Rhinosporidiosis
Mycetoma (Madura foot)
```
161
Give examples for systemic respiratory endemic fungal infections
```
blastomycosis
histplasmosis
coccidioidomycosis
paracoccidioidomycosis
penicillinosis
```
161
Give examples for systemic respiratory endemic fungal infections
```
blastomycosis
histplasmosis
coccidioidomycosis
paracoccidioidomycosis
penicillinosis
```
disease in both immunocmpromised and immunosuppressed
162
What are risk factors for aspergillosis?
Neutropenia, corticosteroid therapy
163
What system does aspergillosis primarily affect?
Respiratory system
164
Describe the cutaneous lesion seen in aspergillosis
well define papule with a necrotic base and surrounding erythematous halo
165
What are potential complications of aspergillosis?
Can invade blood vessels causing thrombosis and infarction
| Lesions are destructive and may extend into cartilage, bone and facial planes
166
What organism causes similar illness to aspergillosis (both clinically and histologically)?
Fusarium (septet hyphae with acute angle branching
167
What organisms caused mucormycosis?
Apophysomyces, mucor, rhizomucor, rhizopus, absidia
168
What conditions/ therapies are associated with mucormycosis?
1/3 of patients have diabetes, with those with DKA at particularly higher risk
```
malnutrition
uraemia
neutropenia
steroid therapy
burns
antibiotic therapy
deferoxamine therapy
HIV
neonatal prematurity
```
169
How does mucormycosis present?
Fever, headache, facial oedema, facial pain, proptosis, orbital cellulitis, cranial nerve dysfunction
+/- nerve dysfunction due to retinal artery thrombosis
170
How is mucormycosis treated?
Aggressive debridement and antifungal therapy
171
How often is the culture positive in cases of mucormycosis?
Only 30% of the time
172
Scabies
Contagious infestation caused by Sarcoptes species
Female mates, burrows into upper epidermis, lays her eggs and dies after one month.
Insidious onset of red to flesh-coloured pruritic papules
Affects interdigital areas of digits, volar wrists, axillary areas, genitalia
A diagnostic burrow consisting of fine white scale
Crusted or ‘Norwegian’ scabies - hyperkeratosis
- Often asymptomatic;immunocompromised individuals
Treatment: permethrin, oral ivermectin
- Two cycles of treatment are required
