2. IN THE NAME OF GOD
Scabies / Pediculosis
Dr Z.Shahmoradi
dermatologist

3. SCABIES copulation occurs in small burrow excavated by the female.
-Mites, sarcopte scabiei (0/3 x0/35 mm).
copulation occurs in small burrow excavated by the female.
-Daily 2-3 eggs,hatch into larva in 3-4 days nymph adult(continuously for 4-6 wk)
-Extra body: 2-3 days life

4. Findings: 1- pruritus(at night & warm),2-4 wk later
-Immediat & Delayed hypersensitivity:
1- pruritus(at night & warm),2-4 wk later
in reinfection: hour later

5. 2-Pathognomonic Burrow (house the female mite) in st.corneum
in wrist ,interdigital, genitalia,

6. …Scabies
3- Pruritic papules :axilla,abdomen,areol.

7. 4-Inflammatory Nodules :axilla,groin,
in scrotom & penis (pathognomonic)
(remaining for several wks or mo.)
Treatment: steroid (IL or topical)

8. 5-Secondary infection & Eczema.

9. Diagnosis: pruritus, Travel, Familial, pustules
in palm & sole,vesicle in fingers web.
-Burrow(under mic. Scybala,mite or ova)
-ink test

11. - In children :Vesicles in palm & sole and face involve.
-Scalp & face not involved in adult.

14. DD:
DH,
Neurotic excoriation,
Insect bite,
Pediculose corporis

15. Treatment: for 8-12h, repeat after 1 wk,
-Cream permethrin 5% : standard topical scabicide
for 8-12h, repeat after 1 wk,
at least 40 times less toxic effects than 1% lindane
choice in infant & children
safe in pregnancy (category B).

16. …Cream permetrine 5%
Adverse reactions are rare and are usually related to brief stinging on application.
Clinical resistance has not been documented.

17. lindane: Lotion 0r cream 1%
Because of the potential for CNS toxicity, lindane is contraindicated in
premature infants, children,
other individuals who weigh <110 pounds (50 kg),
individuals with crusted scabies or preexisting skin conditions (e.g. extensive atopic dermatitis) that may increase its systemic absorption

18. and patients with an uncontrolled seizure disorder.
CNS side effects may occur from increased percutaneous absorption through damaged skin, misuse, overuse, or accidental ingestion

19. …Lindane:
Worldwide, the development of lindane- resistant scabies is increasing.
Potential toxicity,
Relatively poor efficacy,
Widespread resistance,
Environmental contamination inferior treatment choice compared to permethrin or ivermectin.

20. GBHC (lotion lindane)
: neurotoxic in child, not safe in pregnancy & breast feeding.

21. Sulfur precipitate: 5% (in infant & children) -10% (in adult) ,
safe & effective in pregnancy,
Applied nightly for 3 night.
However, its efficacy has been reported to be as high as 60–96% with three consecutive 24-hour applications.

22. …sulfur: Contraindications: in patients with a sensitivity to sulfur.
Side effects: Sulfur is messy, malodorous, and irritating to the skin and can stain clothing.
Use in pregnancy Topical sulfur (5–10%) has been used to treat scabies in young infants and pregnant or lactating women, but safety data are lacking.

23. Crotamiton:
An alternative scabicide is crotamiton, which is formulated in a 10% lotion and cream.
Although it has an antipruritic effect, crotamiton can cause irritation of denuded skin and is less effective than the other prescription options.
low effective (50-60% cure rate), but for antipruritus effect may be used, applied for 5 night & washed 24 hours after.

24. Ivermectin:
Tab: 3 & 6 mg
oral ivermectin dose of 200–400 mcg/kg is usually administered twice, 1–2 weeks apart.
safe in children & elderly.
Very useful in epidemics & in institutes of large numbers of patient.

25. …Ivermectin: Ivermectin is not recommended for:
children who weigh <33pounds (15 kg),
pregnant women,
breastfeeding mothers because of the lack of safety data in these groups.
Ivermectin: extremely safe.

26. Topical ivermectin: 1% concentration
In patients with subungual disease, addition of a topical scabicide is recommended because a systemic medication will not penetrate into thickened keratotic debris.

27. Oral ivermectin & topical permethrin:
is often required to treat patients with crusted scabies, and use of a topical keratolytic agent (e.g. salicylic or lactic acid) can help to decrease the associated hyperkeratosis.

28. Benzyl benzoate 25% emulsion: remain on the skin for 24 hour, 2-3 application.
-Malation : 0.5% in aqueous base for 24 h and repeat after 1 wk.
-Monosulfiram: solution 25%, diluted 2-3 part with water, once daily for 2-3 day,
T.E.N report.

29. Crusted scabies: Admitted to hospital or isolated
TREATMENT:
Admitted to hospital or isolated
Ivermectin,200 micro g/kg/dose and repeated by 1wk interval for 2-3 times, is drug of choice
-Cream urea 40%(for nail involve)
-Repeated treat. with scabicides.
(Permetrin once each wk for 6 wks)

30. Crusted Scabies

32. Treatment: Nots
Two topical treatments 1 week apart with a prescription antiscabetic medication are recommended.
Applied overnight to the entire body surface, from head to toe, in infants and the elderly.
In other age groups, the face and scalp can be excluded from treatment.
Special attention should be paid to the interdigital spaces, intergluteal cleft, umbilicus, and subungual areas.

33. At the time of each treatment, clothing, linens, and towels used within the previous week can be either washed in hot water and dried on high heat or stored in a bag for 10 days.
The relatively common occurrence of asymptomatic mite carriers in households necessitates that all family members and other close contacts be treated simultaneously, even if they have not developed any pruritus or clinical signs.

34. Pets cannot harbor human mites and do not have to be treated.
Secondary bacterial infections need to be treated with appropriate antibiotics.

35. Post scabetic pruritus (dermatitis)
Following successful treatment, pruritus and skin lesions can persist for 2–4 weeks or longer, especially for
Acral vesiculopustules in infants &
nodules.

36. Many patients, however, experience relief from pruritus within 3 days.
The second application of topical medication is performed in order to reduce the potential for reinfestation from fomites as well as to ensure killing of
any nymphs that may have survived within the semiprotective environment of the egg and
subsequently hatched.

37. Pediculosis(phthiriasis)
p.capitis 1- p.humanus: p.corporis 2-p(phthirus)pubis -P.capitis: in children(girls),intense pruritus & secondary infection (impetigo& frunclosis), many of case is asymptomatic . on the scalp(few pediculi & abundant nit) -DD:with dandruff & peripilar keratin casts.

38. Treatment: -Shampoo permethrin 1% (for 10 min) or
-Shampoo GBHC (for 5 min)
-Retreatment after 1 wk.,
Topical (0.5%) & oral Ivermectin (2 doses by 10 day interval) ,
lotion Malation 0.5% & carbaryl for 12h and repeated after 10 day.
Cotrimoxazol
–Tea tree & Lavender oil.
-Nit removed with Acetic Acid.

39. Unsubstantiated claims of successful treatment with alternative,non-pesticidal products, including petroleum jelly, hair pomade, olive oil, mayonnaise, vegetable oil, and mineral oil
Such products may slow the movements of adult lice and allow them to be more easily combed out of the scalp, but these substances are not lethal to lice.

40. Shampoo moov head lice (ego)

41. شپش سر ماده در خارج از بدن،72 ساعت بیشتر باقی نمی ماند
شپش سر ماده در خارج از بدن،72 ساعت بیشتر باقی نمی ماند. چون هر 4-6 ساعت نیاز به خون خوردن دارد.
نسبتا طولانی روی لباس ها نیز زنده می مانند و موجب انتقال می شوند.
کوتاه کردن موها ، اولین قدم نیست اما بخصوص در افرادی که وسواس پیدا کرده اند، توصیه می شود.
ابتلاء موجب ایمنی نمی شود.
دنبال مقصر نگردید. به اولیاء مهد کودک و مدرسه اطلاع دهید.
سبوره تا حدودی مانع از رشد شپش می گردد(مثل گال)
در تماس با موی آلوده، 30 ثانیه زمان کافی است تا انتقال صورت گیرد

42. Moov head lice (ego):
دارای روغن های گیاهی اکالیپتوس و رازیانه است.3 بار استفاده با فاصله یک هفته،در 15 دقیقه اثر درمانی را کامل می کند.
1- چشم ها را با حوله بپوشانند
2- ابتدا شامپو را روی موهای خشک،از پشت گوش ها تا اولین مهره گردن و سپس روی تمام موها و کف سر ماساژ دهید.
3-سر را با کلاه موجود در جعبه بطور کامل بپوشانید.
4- 15 دقیقه صبر کرده و سپس کلاه را بردارید.
5- با آب ولرم موها را بشویید.
6- کلاه را برای استفاده بعدی آبکشی نمایید.
7- موها را مثل حالت عادی، آبکشی نمایید.
تکرار درمان در روزهای 7 و 14 صورت گیرد.

43. Isopropyl myristate
Cyclomethicone
Eucalyptus oil

44. Lindane: 1% prescription shampoo that is applied for 4 minutes.
Because of possible CNS side effects, especially after prolonged applications: FDA has issued a “black box” warning that lindane is reserved for patients who fail to respond to other approved lice therapies.
Resistance to lindane is commonly observed.

45. Malathion:
Although the recommended application time for topical malathion is 8 to 12 hours,
Repeated treatment in 7 days if live lice are present, high efficacy has also been reported when the duration of application is reduced to 20 minutes.

46. Oral Cotrimoxazol:
may potentially improve the efficacy of topical agents, but:
Routine use is not recommended.

47. Carbaryl:
Carbaryl Like malathion, carbaryl is a cholinesterase inhibitor.
It is available in a 0.5% lotion and shampoo in the UK(not in US) and other countries.
In comparison to malathion, carbaryl is: 1) potentially more toxic to patients,
2) less lethal to lice.

48. Oral ivermectin:
Therapeutic option for resistant head lice infestations.
95% of patients with head lice that previously failed topical therapy (pyrethrin or malathion) who received 400 mcg/kg of ivermectin on days 1 and 8 were lice-free on day 15.

49. Ivermectin: 0.5% topical ivermectin.
FDA-approved in 2012 for the treatment of head lice in patients ≥6 months of age.
74% of patients treated with a single 10-minute application of 0.5% ivermectin lotion to dry hair were lice- free after 15 days.

50. …Oral ivermectin:
No ovicidal activity and(unlike topical ivermectin) two treatments are required.
Not recommended for:
- children who weigh <33 pounds (15 kg)
- pregnant
- breastfeeding women.

51. Dimethicone:(Dilice 4%)
A15-minute or overnight application of 4% dimethicone liquid gel or lotion on day 1 ± day 8 resulted in 70–97% of patients being lice-free on day 14
representing significantly higher efficacy than treatment with 1% permethrin cream rinse or (in the UK) 0.5% malathion liquid.

52. Spinosad:
0.9% spinosad topical suspension (Natroba™) was approved by the FDA as a therapy for head lice in children ≥4 years of age.
0.9% spinosad cream rinse left on for 10 minutes without nit combing had superior efficacy to 1% permethrin cream with nit combing, and spinosad therapy led to no significant clinical side effects or laboratory abnormalities.

53. Benzyl alcohol:
FDA approved 5% benzyl alcohol lotion (Ulesfia®) as a prescription treatment for head lice in children ≥6 months of age.
75% of patients were lice-free 14 days after the last of two 10-minute applications of benzyl alcohol (administered 1week apart).

54. حاوی اوکالیپتوس 11 گرم و
بنزیل الکل 0.5 گرم در 100 گرم محلول
بمدت 10 دقیقه موها را آغشته و آبکشی نمایند

55. p.corporis -p.vestimenti or vagabond disease.
-vector of epidemic typhus, trench fever, relapsing fever.
-Live chiefly in the seams of clothing.
-Generalized itching due to sensitization to louse salivary Ag.- with excoriated papules (may be asymptomatic)
- secondary frunculosis & pigmentation.
-DD: scabies,neurotic excoriation,
macular amyloidosis

56. …P.corporis
Treatment: laundering the clothing& bedding (lice may live in clothing for 1 mo. ) the patient should bath . Malation powder 1% or DDT 10% ,Permethrin treated clothing.

57. Treatment (body lice):
Preferably, the clothing and bedding of infested individuals should be discarded in tightly sealed, plastic biohazard bags and incinerated
This involves fumigating the clothing or laundering it using hot water (temperature of ≥130°F/55°C), followed by machine drying with high heat.

58. P.Pubis -90% with one sexual exposure (in syphilis & Gonorrhea 30%)
-Chiefly STD (rarely from bedding)
-90% with one sexual exposure (in syphilis & Gonorrhea 30%)
-30% coexist with at least one other STD
P.Pubis =Search for other STD
-The pediculose & nits are attached to the
hairs(pubic,anus & rarely axillae or eyelash)
-Itching ,bluish macules (Maculae ceruleae), bullous lesion.

59. …P.Pubis Malathion, Permethrin, GBHC, Carbaryl,….
-Treatment: preferably whole of the body require treatment(60% with other hair involvement)
Malathion, Permethrin, GBHC, Carbaryl,….
-Treatment should be repeated after days .
Treatment of sexual partner

60. …P.Pubis:
Eyelash:petrolatum(vaselin):twice daily for 2-3 wks is choice treatment.
-Cryotherapy, fluorcein 10-20% ,
- Oral Ivermectin 2 dose,
Argon laser phototherapy.
-Clothing & fomites washed and dried.

62. Treatment (crub lice):
Topical insecticides are the standard therapy for crab lice.
Most commonly, permethrin(1% or 5%) and synergized pyrethrin products are utilized.
As with head lice, the topical insecticide should be applied on two occasions, 1 week apart, to ensure complete eradication of hatched eggs.

63. Safest and most effective topical treatment is 5% permethrin cream applied generously overnight to all potentially infested hairy areas, and then repeated 1 week later.
Lindane has poor efficacy and higher toxicity, and the shampoo is not approved for extensive body application.
Oral ivermectin on days 1 and 8 can be used for patients with:
1)perianal or 2)eyelash involvement 3)topical therapy is unsuccessful.
The end

67. Pediculosis pupis

68. Pediculosis in eyelash

69. با تشکر از توجه شما
دکتر شاهمرادی