INFESTATIONS AND FUNGAL DISEASES
Sep
2014
Vol. 33. No. 3
Introduction
“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
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
MORE
Scabies
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
MORE
Dermatoses associated with mites other than Sarcoptes
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
MORE
Lice
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
MORE
Bed bugs
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
MORE