Duke PA Human Ectoparasites (Dermatology)
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| what does CRAB stand for | Cutaneous Reaction to Arthropod Bite
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| hallmark lesion of arthropod bite | papular urticaria
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| 2-8 mm erythematous, papulovesicular lesion usually arranged in clusters on exposed skin-most often caused by fleas, mosquitoes, and bedbugs | papular urticaria
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| most common spider bites are from what type of spider | black widow, brown recluse
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| extremely toxic, a potent neurotoxin whose site of action is neuromuscular junction | black widow venom
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| serious reaction associated with black widow venom | systemic symptoms: muscle cramping (abdomen, chest, and thighs. severe autonomic symptoms include hypertension and tachycardia
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| if your shoes have been left outside for a while you might find this spider inside | brown recluse
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| effect of brown recluse venom | platelet aggregation and infiltration of site by neutrophils, dermal necrosis (can lead to large necrotic wounds), possible systemic effects.
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| generalized treatment for spider bites | RICE, update tetanus immunization, analgesics, antibiotics if needed for secondary infection
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| in traumatic injuries the C in RICE stands for compression. In spider bites what does the C stand for | cephalosporin
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| what is the antivenom status for black widows, and brown recluses | antivenom is available for black widow bites but is usually reserved for those with severe hypertension/tachycardia, no antivenom is currently available for brown recluses
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| local effects of scorpion sting | immediate burning/stinging followed by paresthesias
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| systemic effects of scorpion stings | greater than local effects, the venom is a potent neurotoxin
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| tunnels into epidermis, eggs and feces are found in tunnels | scabies
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| those at risk for scabies | young, sexually active adults, bed-ridden patients, children
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| scabies can live as long as __hours | 48
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| scabies rash characteristic | serpiginous, intensely pruritic, found in areas of thin skin (finger webs, flexor aspects of wrist, elbows, axillae, penis, external genitalia, feet and ankles)
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| babies get __ | scabies (couldn't resist)
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| heavy infestation with severe crusting, hundreds to thousands of mites, variable pruritis, affected patients usually have underlying immunodeficiency (AIDS common) | Norwegian Scabies
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| how do you make the diagnosis of scabies | look for burrows, place mineral oil over burrow and scrape of with a #15 blade (or a glass slide), examine under oil-immersion objective (100x) look for mite, eggs or feces
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| treatment for scabies | 5% permethrin cream, 1% lidane lotion (banned in california due to neurotoxicity). apply overnight from neck down and wash off in am. single application is usually curative
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| how to treat pruritis associated with scabies | antihistamines
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| what do you do about family members of patients affected with scabies | treat them, even if asymptomatic (especially if they share a bed)
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| sites of predilection for chiggers | ankles, backs of knees, groin, axillae
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| treatment for chiggers | immediate bath in hot soapy water, antihistamines and topical steroids
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| classic bull's eye lesion (at least 5mm induration) | erythema migrans
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| erythema migrans from a tick bite does not mean that a patient has | lyme disease
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| erythema migrans lasting longer than 4 weeks | erythema chronicum migrans
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| single 1-5cm bluish nodule, develops in response to antigenic stimulation, at the site fo bite or remote (earlobe, areola, neck) | lymphocytoma cutis (European borreliosis)
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| bluish erythem accompanied by edema, if untreated can lead to atrophy of all layers of skin, more likely to affect middle-aged persons, seen most in patients of european descent | acrodermatits chronica atrophicans
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| nocturnal arthropods that can cause painful bites, bites are usually in shape of chevron | centipedes
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| treatment for centipede bites | analgesics, antihistamine, systemic symptoms are rare
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| harmless, don't bite but secrete an oily substance from glands located on body segments that cause brownish discolorations of skin (can also cause burning and blistering), can last for months and has been mistaken for child abuse | millipedes
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| three forms of louse | body, head, pubic
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| classic presentation of body lice | small erythematous papules (papular urticaria), in axillae, neck, shoulders, hemorrhagic puncta and linear excoriation also common. maculae ceruleae, vesicles
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| body lice is a vector for | bartonella quintana (typhus and trench fever)
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| group most often affected by head lice | caucasion children
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| treatment for head lice | removal of nits/lice with fine toothed comb, wash all bedding, clothing, hats and combs, pediculicides (1% permethrin OTC, 5% permethrin, 0.5% malathion)
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| pediculides are good for killing adult lice however they are not __ | ovacidal-must retreat in 1 week
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| presentation of pubic lice | 1-2mm lice are often visible, small erythematous papules may be visible at feeding sites and blood specks may be visible in underwear, inguinal adenopathy, sometimes in eyelashes
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| treatment for pubic lice | linane lotion or 5% permethrin
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| presentation of bedbugs, and kissing bugs | painless bites at nite usually on exposed areas, lesion is classic papular urticaria but may be vesicular, eczematous
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| how do you get rid of bed bugs | get a new bed
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| Asp caterpillar/flannel moth/puss caterpillar sting presentation | intense pain, train-track pattern of purpura
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| when to expect flea bites | warm months in patients with grouped, pruritic lesions on extremities with history of pet contact
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| peggy's #1 rule about oral prednisone (or other steroid) | no dose packs-give one dose, in the morning, with food
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| systemic reactions from bees and vespids | diffuse urticaria, anaphylaxis, angioedema and shock, usually begins in 10-20 minutes
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| treatment for bee and vespid stings | remove stinger, RICE, antihistamines (questionable-use first generation), oral steroids for severe local reactions
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