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.

Spiders in dermatology

Chinmoy Bhate, MD | Jun K Kang, MD | Robert A Schwartz, MD, MPH
Spider bites represent an unusual and potentially overrepresented clinical diagnosis. Despite a common fear of spiders, known as arachnophobia, current knowledge suggests that only a small number of families within the order Araneae are medically relevant. Moreover, most cutaneous spider reactions, including both evenomations and physical trauma, produce mild, local symptoms which may be managed with supportive care alone. The differential diagnosis for spider bites may be broad, especially if the offending arachnid is not seen or found. We describe a series of spiders relevant to the dermatologist in the United States. Semin Cutan Med Surg 33:123-127 © 2014 Frontline Medical Communications

Tropical dermatology: cutaneous larva migrans, gnathostomiasis, cutaneous amebiasis and trombiculiasis

José Darío Martínez, MD | Kenneth J Tomecki, MD | Kristian Eichelmann, MD
In today’s world, many people can travel easily and quickly around the globe. Most travel travel-related illnesses include fever, diarrhea, and skin disease, which are relatively uncommon in returning travelers. We review four of the most common emerging infestations and skin infections in the Americas, which are important to the clinical dermatologist, focusing on the clinical presentation and treatment of cutaneous larva migrans, gnathostomiasis, cutaneous amebiasis, and trombiculiasis. Semin Cutan Med Surg 33:133-135 © 2014 Frontline Medical Communications

What’s new in the treatment and diagnosis of dermatophytosis?

David A Wetter, MD | Valerie Laniosz, MD, PhD
Superficial fungal infections of the skin and nails are common in humans and can cause patients substantial discomfort. Additionally, patients may find the physical appearance of these infections to be distressing. Although the infectious fungi have evolved to parasitize humans, the ability to treat and diagnose fungal infections has been slower to progress. Nevertheless, there are promising new advancements in the treatment and diagnosis of dermatophyte infection. New topical and light-based treatments for dermatophytoses are available, and the first meta-analysis of topical antifungal treatments has been performed. Diagnostic improvements are forthcoming for dermatophytoses with the advent of molecular techniques for rapid identification and speciation of dermatophytes. Semin Cutan Med Surg 33:136-139 © 2014 Frontline Medical Communications


David J DiCaudo, MD
Coccidioidomycosis is a common, environmentally acquired, pulmonary fungal infection in arid and semi-arid regions of the West, especially Arizona and California. The infection is frequently associated with striking cutaneous manifestations. Reactive, immunologically mediated eruptions include erythema nodosum, a generalized exanthem, Sweet syndrome, and reactive granulomatous dermatitis. Less commonly, the skin can harbor the actual organisms as a result of dissemination from the lungs. Dermatologists may play a key role in the recognition of coccidioidomycosis Semin Cutan Med Surg 33:140-145 © 2014 Frontline Medical Communications

Subcutaneous (deep) fungal infections

George W Elgart, MD
Fungal infection is a common clinical problem in dermatology. While most cases in practice are superficial infections, invasive subcutaneous mycoses are important to recognize and treat, as these conditions often have significant morbidity and mortality. Deep fungi demonstrate species-specific syndromes and may be identified by clinical and histological features in addition to serological evaluation and culture. Identification of the common innoculation subcutaneous mycoses, as well as those associated with pulmonary primary infection and dissemination to the skin is important, as treatments vary by organism and clinical setting. This overview will help to identify the key dermatological presentations of subcutaneous fungal infection, and the clues they give to cause. Semin Cutan Med Surg 33:146-150 © 2014 Frontline Medical Communications