Vol. 33. No. 3


“If it scales, scrape it.” This simple phrase is learned by every first year dermatology resident and is an indication of the prevalence of tinea among dermatologic patients along with its ability to masquerade as other conditions. Infestations and fungal diseases cause a tremendous burden of disease. This issue of Seminars in Cutaneous Medicine and Surgery focuses on the current state of the art in diagnosis and treatment of arthropod and helminthic infestation and fungal disease. Some, like scabies, have a worldwide distribution and remain in epidemic proportions. Others, like coccidioidomycosis and strongyloides have strong geographic associations, and are particularly important in patients beginning immunosuppressive therapy or treatment with biologics. Entities like dermatophytosis remain among the most common conditions presenting to the dermatologist. Infestations and fungal infections affect all age groups and cut across ethnic and socioeconomic barriers. They remain among the great equalizers, demonstrating our common humanity. In this issue, Lorraine Rosamilia discusses the diagnosis and treatment of scabies, which remains at epidemic proportions, affecting all ages and demographic groups. Kimberly Ken, Solomon Shockman, Melissa Sirichotiratana, Megan Lent, and Morgan Wilson discuss mite infestations other than scabies, which range from zoonotic infestations to contaminants of groceries. Giao Do-Pham, Gentiane Monsel, and Olivier Chosidow discuss pediculosis, which remains one of our most difficult to treat infestations because of the continued emergence of resistance. Galen Foulke and Bryan Anderson discuss bedbug infestation, which affects our patients (and ourselves) at home and when we travel. Bedbugs have been noted in hotels and movie theaters, where they are happy to hitch a ride home in a convenient purse placed on the ground. Like lice, bedbugs have developed immunity to many of the agents used to eliminate them and continue to challenge our ability to live in a pest-free environment. Jun Kang, Chinmoy Bhate and Robert Schwartz discuss spider bites, which cause dermonecrotic reactions as well as systemic findings. The differential diagnosis of a spider bite vs Methicillinresistant Staphylococcus aureus (MRSA) abscess and pyoderma gangrenosum challenges providers in emergency departments on a daily basis, and appropriate management depends on our diagnostic acumen. Kyle Prickett and Tammie Ferringer discuss a range of helminthic infestations, which can present with skin findings as diverse as urticaria and larva currens. Kristian Eichelmann, José Darío Martínez, and Ken Tomecki discuss tropical infestations, including tropical helminths and amebiasis. Valerie Laniosz and David Wetter discuss the diagnosis and treatment of dermatophytosis, one of the most prevalent and protean conditions we treat. David DiCaudo discusses coccidioidomycosis, with manifestations that vary widely among different ethnic groups, and George Elgart discusses the remaining deep fungal infections which affect both immunosuppressed and immunecompetent patients. We hope that you find the information to be valuable in your practice and that you reach for this issue often when confronted with the conditions discussed.

Helminths: a clinical review and update

Kyle A Prickett, MD | Tammie C Ferringer, MD
This article provides a focused update and clinical review on select helminth infections. The goal is to report atypical clinical presentations and newer management recommendations. The results and recommendations should be interpreted with the understanding that future studies may alter what is presented. Semin Cutan Med Surg 33:128-132 © 2014 Frontline Medical Communications


Lorraine Larsen Rosamilia, MD
Scabies infestation in humans is a complex interplay between mite, host, and host environment. New techniques for diagnosis, treatment, and eradication are constantly in flux due to varying presentations of scabetic eruptions, a dearth of especially sensitive and specific measures for diagnosis, resistances to pharmacologic therapy, and disparate regional resources. This review will provide an update on the clinical variations, detection methods, and management options. Semin Cutan Med Surg 33:106-109 © 2014 Frontline Medical Communications

Dermatoses associated with mites other than Sarcoptes

Kimberly M Ken, BA | Megan P Lent, MD | Melissa Sirichotiratana, MD | Morgan L Wilson, DVM, MD | Solomon C Shockman, MD
Mites are arthropods of the subclass Acari (Acarina). Although Sarcoptes is the mite most commonly recognized as a cause of human skin disease in the United States, numerous other mite-associated dermatoses have been described, and merit familiarity on the part of physicians treating skin disease. This review discusses several nonscabies mites and their associated diseases, including Demodex, chiggers, Cheyletiella, bird mites, grain itch, oak leaf itch, grocer’s itch, tropical rat mite, snake mite, and Psoroptes. Semin Cutan Med Surg 33:110-115 © 2014 Frontline Medical Communications


Gentiane Monsel, MD | Giao Do-Pham, MD | Olivier Chosidow, MD, PhD
Pediculosis (capitis, corporis, and pubis) share well-known features: worldwide prevalence (involving millions of people annually); parasites inducing skin lesions directly, and indirectly as a result of itching and hypersensitivity to parasites; and treatment based on good entomological knowledge of the parasite and practical considerations (ie, most available treatments do not act on eggs and should be repeated, depending on the life cycle of the parasites). Infestations are spread most commonly by close contacts. Social stigma and persistent misconceptions complicate the implementation of appropriate management strategies. Head and pubic lice infestations are diagnosed by the visualization of insects or viable nits (eggs). Primary treatments are topical pediculicides (permethrin or malathion), used twice, but emergence of resistance against pediculicides has created the need of alternative treatments including topical or oral ivermectin. Pubic lice are treated the same as head lice, but this finding should prompt evaluation for other sexually transmitted diseases. Body lice infestation should be suspected when symptoms of generalized itching occur in persons who do not change or wash their clothing or bedding regularly; lice may be found in the seams of their clothing. Topically administered permethrin may help to eradicate body lice, but personal hygiene measures are essential for successful treatment. Environmental treatment is also necessary for the eradication of the infestation. Health care personnel who come into contact with this population need to be well informed of the facts in order to disseminate accurate information for diagnosis and management. Semin Cutan Med Surg 33:116-118 © 2014 Frontline Medical Communications

Bed bugs

Bryan E Anderson, MD | Galen T Foulke, MD
The term bed bug is applied to 2 species of genus Cimex: lectularius describes the common or temperate bed bug, and hemipterus its tropical cousin. Cimex lectularius is aptly named; its genus and species derive from the Latin words for bug and bed, respectively. Though the tiny pest is receiving increased public attention and scrutiny, the bed bug is hardly a new problem. Semin Cutan Med Surg 33:119-122 © 2014 Frontline Medical Communications