1. Creepy crawlies…
Dr Maya Mistry
13th April 2011

2. A 41-year-old man presents with an itchy rash over his arms and abdomen. It has got gradually worse over the past three days
What is the most likely diagnosis?
Scabies
Pityriasis rosea
Erythema multiforme
Urticaria
Guttate psoriasis

3. Scabies Classical Scabies
Female mite burrows in skin (webs of fingers, wrist, heels, armpit, buttocks) and lays eggs
Itch – worse at night and due to delayed IV hypersensitivity reaction to mites/eggs 30 days after initial infection
Only 5-15 mites
Direct contact
Children/young adults
Norwegian Scabies
Very contagious – indirect contact
Institutions
Millions of mites
Scaly ‘crusted’ rash

4. Management General advice 1st line 2nd line Cut nails
Wash bedding/towels/clothes in hot cycle
Treat household and close contacts even if asymptomatic
Avoid close physical contact until treated
Once treated, itching can last for up to 6 weeks
Apply washes from chin and ears downwards unless immunosupressed/children/elderly then wash face and scalp also
Repeat after 7 days
1st line
Permethrin 5% cream
For adults and children older than 2 months
Apply to cool skin and after 8-12 hours wash off in hot bath
2nd line
Malathion 0.5% liquid
Washed off after 24 hours

5. Which one of the following is not a recommended management option for head lice?
Isopropyl myristate and cyclomethicone
Wet combing
Dimeticone
Malathion
Benzyl benzoate

6. Which one of the following is a recommended management option for head lice in a 3 year old child with atopy?
Isopropyl myristate and cyclomethicone
Dimeticone
Coconut, anise, and ylang ylang spray

7. Lice - pediculosis Head lice (eggs are called nits
Suck blood from scalp 5 times/day
12 lice but 100 eggs
Body lice – usually in homeless/neglected
Stick to clothes fibres not hair
Can live up to 30 days off human
Pubic lice (crabs)

8. Management Only treat if see live lice on fine tooth combing
General advice
All household should check for lice and treat affected simultaneously
No school exclusion
Wet comb every 2-3 days for 2 weeks
Stop when 3 consecutive sessions no lice seen
Washes repeat after 7 days
Dimeticone 4% lotion (Hedrin® lotion),
For all ages
Left for 8 hours then washed off with shampoo
Isopropyl myristate and cyclomethicone (Full Marks Solution®)
Not suitable for < 2 year olds and skin conditions
Leave for 10 mins, comb using fine tooth, then wash off
Coconut, anise, and ylang ylang spray (Lyclear SprayAway®)
Not suitable for < 2 year olds and skin conditions and asthma
Leave for 15 minutes, wash hair, then use fine tooth comb.

9. Fleas

10. Bedbugs