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Ectoparasites
Derm
| Question | Answer |
|---|---|
| hallmark lesion of arthropod bite | Papular urticaria |
| Papular urticaria: increased risk of | secondary infxn |
| Papular urticaria usually due to: | flea, mosquito, bedbug |
| How often do black widow bites cause serious reactions? | 25% |
| R-I-C-E for spider bites: | minimizes inflammation & slows enzyme activity |
| Scorpion sx | immediate sting, followed by paresthesia |
| Scorpion effects | systemic > local (neurotoxin) |
| Where on body is scabies seen? | Mites prefer areas where skin is thin. If <1 yo: head/scalp/neck |
| AKA crusted scabies (severe) | Norwegian scabies (seen in immunocompromised patients) |
| Scabies diagnosis is usually: | clinical (but also with mineral oil) |
| Uses stylostome for feeding | Chiggers |
| Chiggers: lesions | papules or hives (ankles, backs of knees, groin, axillae) |
| Tx chiggers | hot soapy water, antihistamine, topical steroid |
| Possible role in rosacea: | demodex mite |
| Tick bite: rxn | local, erythema; then induration, nodular; rare tick granuloma (Lyme: erythema migrans = bullseye) |
| Lyme dz: cutaneous lesions | lymphocytoma cutis (European); acrodermatitis chronica atrophicans; both bluish |
| Chevron shaped bite | centipede |
| Millipede bite: | they don’t bite; secrete oily substance, may burn or blister |
| This may be only sx of body lice | pruritus |
| Head lice: pts often have: | cervical adenopathy; scalp pruritus, excoriations |
| Head lice tx | 1% permethrin; retreat in 1 wk |
| Pubic lice tx | 5% permethrin or lindane |
| These cause more dz than any other arthropod | flies |
| Bedbug lesion: classic: | papular urticaria but may be vesicular, eczematous |
| Bedbug bites: arrangement | linear arrangement in clusters (painless bites) |
| Erucism = | caterpillar dermatitis |
| Lepidopterism: | systemic illness with urticaria and airway hypersensitivity |
| Moth / Butterfly exposure Tx: | oral antihistamines, topical ointments w/menthol or camphor, topical c’steroids, oral steroids for severe cases; Remove setae with adhesives |
| Flea bites: lesions: | erythematous macules and urticarial-like papules; Excoriations and secondary infection common |
| Fleas: Tx for sx | topical steroids, oral prednisone for severe urticarial reactions (triamcimolone), antibiotics for secondary infections; advise lesions will be around for a while |
| Bee/wasp sting reactions | large reactions can develop ~ 6-24 hrs after sting and peak at 48hrs |
| Diff btw delayed hypersensitivity rxns from stings & cellulitis | both are warm; sting: area of induration, not tender; poss slightly pruritic |
| Fire ant rxn | immediate pain followed by wheal & flare reaction (1 hr); sensitized pts may develop striking bullous reaction in an unusual ring shape |
| Fire ant tx | local cleansing, ice, oral antihistamine. Oral steroids for severe cases. Update tetanus if needed |
| Lesion appearance of brown recluse bite | pale gray sinking macule, slightly eroded in center; halo of tender inflammation/hemo |
| Scabies tx in pediatric patients | NO LINDANE (KWELL). Permethrin (Elimite) is drug of choice |
| Scabies adult tx | Permethrin ($ > lindane). lindane (some regional resistance). Alt: crotamiton 10% cream; sulfur cream; benzoyl benzoate |
| Bite w/ fever, lacrimation, rhinorrhea, bradycardia, HTN, tachyarrhythmias = | Black widow (neurotoxin) |
| Bite with local edema, erythema, central necrosis | Brown recluse |
| Intense pruritis especially at night. Burrow-like lesions at wrists, elbows, hands, webs of fingers. Due to: | Scabies |
| Black widow bite mgmt | Lactrodectus antivenin IM. Supportive airway & circulation. Benzos prn mx spasm; pain control. |
Created by:
Abarnard
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