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Derm Ectoparasites
Dermatology Human Ectoparasites
| Question | Answer |
|---|---|
| CRABs pneumonic | cutaneous reaction to arthropod bites |
| Variety of lesion presentation from CRAB | transient erythema, papular urticaria (hallmark), bullae-->erosions, hemorrhagic ulcers, necrotic, IRREGULAR SHAPE |
| Hallmark lesion of an arthropod bite | papular urticaria |
| Arachnida class | spiders, scorpions, ticks and mites |
| Lesions that are violaceous when patient attributes it to a spider bite may be | MRSA |
| Two spiders to keep in mind | Black Widow Spider (neurotoxin venom), Brown recluse spider (ugly bites that become necrotic) |
| ____% of black widow spiders cause a serious rxn | 25%. Systemic symptoms are hallmark of evenomation and include muscle cramping (esp abdomen, chest & thighs). Severe autonomic symptoms include hypertension and tachycardia. Antivenom available up to 48 hours post bite |
| These are often found in shoes | Brown Recluse Spider. Toxic effect caused by a protein that stimulates platelet aggregation and inflammatory molecules that lead to tissue necrosis. <10% get this bad |
| white area around a bite | suggests vasoconstriction and can lead to tissue necrosis. Purple is thrombosis. |
| Generalized treatment for spider bites: | RICE: minimizes inflammation and slows enzyme, update Tetanus (TDAP), Abx PRN for secondary infection. |
| Cephalosporins cover | GAS and Staph aureus, so they are good to cover bites |
| Scorption facts | Systemic > local effects (venom is a potent neurotoxin) |
| Most notable mites | scabies, chigggers, dust mites |
| Scabies are spread by | direct contact (skin to skin, sexual contact). Highly contagious, feed off skin cells, burrow at night (eggs and feces are found in tunnels). Can live as long as 48 hours on clothing, bedding and clothing |
| First time a person gets infested with scabies, they've probably had it for ____ before they present | 2-3 weeks. However, fast rxn if they are reinfected. Don't retreat sooner than a 7 day interval. Can give antihistamines. Skin still havs the feces and pt needs to wait for it to slough off. |
| Common places for scabies | they like locations where the skin is thin. Finger webs, wrist, elbows, axillae. |
| The differece in scabies presentation among different age groups | In babies, they have bites everywhere, even above neck. Kids and adults only get it from the neck down |
| Heavy crusting and minimal itching is associated with what type of scabies? | Norwegian; affected patients usually have underlying immunodeficiency; AIDS common |
| How to make the diagnosis for scabies | look for burrows, place mineral oil over burrown and scrape off with a #15 blade. Examine under oil immersion (100x); look for mites, eggs and feces |
| Scabies tx | 5% permethrin cream (elimite), 1% lindane lotion (kwell), oral Livermectin. Wash bedding/clothing in Hot water. Use sedating antihistamines (hydroxyzine), tx family members, resist retreating for 7 days |
| 1% lindane lotion has an AE of | neurotoxicity; it is banned in CA |
| _____form feeding tube known as stylostome; it is stylostome that irritates and inflames host tissue causing characteristic dermatitis | Chiggers. Feed for 3-4 days and then fall off. Larval form is responsible for infestation |
| Sx of chigger bites | severe itching that begins several hrs- 1 day after “bite”.Treatment: immediate bath in hot soapy water, antihistamines and topical steroids |
| _______found in “normal” hosts: hair follicles, sebaceous glands | Demodexmite. most commonly on nose, cheeks, foreheads, less commonly on neck chest. Association with Rosacea is suggested |
| Tick bite facts | common to have local swelling and erythematic at site. After a few days becomes indurated and nodular. Normal to feel something for 2 weeks. |
| Classic bull's-eye lesion | Erythema migrans; onset 4 days to 3 weeks after tick bite. Not diagnosis of Lyme dz |
| Erythema migrans lasting longer than 4 weeks | Erythema chronicum migrans (ECM) |
| Tx of tick bites | Antihistamines, topical corticosteroids, severely symptomatic lesions may be treated with intralesional steroids or excision. Advice pt that rxn may last 3-4 weeks. |
| Tick prevention | Permethrin and DEET; treat clothing, tents, bedding |
| Bites from ____ are usually in the shape of chevron | Centipedes. systemic symptoms are rare |
| ___ bites can cause discoloration (brownish stain) and can be mistaken for child abuse | Millipede |
| MOA of lice | sucking mouthparts penetrate skin and feed on blood. Body, head and pubic louse |
| small erythematous papules on axillae, neck and shoulders, with hemorrhagic puncta and linear excoriations is suggestive of | lice. Also may have large cervical lymph nodes |
| Maculae cerulae are bluish-brown or gray macules associated with | lice |
| If suspecting lice in a homeless person, be sure to look at their | clothing |
| It treating head lice, it is important | to retreat. First kill the lice, then after 7days, retreat to kill nits. Use Pediculicides |
| ______ are attracted by scents and bright colors | mosquitoes |
| flat bugs that bite at night (painless) | bedbugs and kissing bugs |
| Breakfast,lunch and dinner is a common description of | bed bugs. |
| Scotch tape is a method used to | remove the hairs of catepillars which sting |
| ____ commonly live in carpets; bites are most commonly found on ankles/lower legs. Bites tend to be multiple | fleas. suspect flea bites during warm months in pts with grouped, pruritic lesions on extremities with history of pet contact |
| Rule #1 with oral prednisone | No dose packs. Give single dose all at one time and do it in the morning (if at night, they will be sleepless). If you give steroids <7 days, don't need to taper |
| ______ account for 1/3 of all evenomations in US | Stinging Arthropods/hymenoptera (bees, vespids (hornets, wasps, yellow jackets) and fire ants |
| Which age population is most likely to get anaphylaxis? | adults>kids. Systemic rxns include urticaria, anaphylaxis, angioedema and shock. Rxns begin in 10-20minutes. |
| Antivenom therapy to prevent arthropod anaphylaxis can require treatment for | 5 years. |
| _________are Aggressive and often attack in swarms causing multiple stings; some victims may receive thousands of stings | fire ants |
| ___ % of fire ant victims have some type of systemic reaction and ___% have anaphylactic reactions | 16%, 1% |
Created by:
ltm12