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28 Cards in this Set

  • Front
  • Back
Scabies
- what causes it?
- how do you get it ?
- from pets?
Sarcoptes scabei var. hominis
Transmission is via
1. direct, prolonged contact (estimated to be ~20mins)
2. Items of clothing, bedding, as mites will survive up to 36hr off their host
Pets have a different mite (sarcoptes scabei var canis or something), which causes "mange". Touching can pass mite to human, but it is unable to reproduce, so itching can occur but it is very short lived. (days)
Scabies
- signs and symptoms
1. extremely itchy - this due to an allergic reaction to fecal pellets which develops over up to 6 weeks. Often worse at night and after bathing.
2. Burrows, up to 1cm long, blue-grey - usually not visible. Sometimes a dot at the end which is the mite
3. Classically affects
(A) webs of fingers
(B) sides of fingers
(C) wrists
4. Spreads to other areas: sometimes penis and groin, breasts and nipples. Rarely affects head except in babies.
5. Often people who get it will be carers of institutionalised people
What is Norweigian or crusted scabies?
A severe infestation
An important differential diagnosis for scabies is "dermatitis herpetiformis" - what is that?!
Intense itchy clusters of papules and vesicles, sometimes with urticaria, usually symmetrical on extensors with rare hand involvement.
When should scabies be referred?
PIC: crusted scabies

1. Norweigian scabies or crusted scabies
2. Suspected dermatitis herpetiformis
Treatment of scabies - what are the options?
1. Permethrin 5% is the best (Lyclear 30g Cream or Quellada Scabies Treatment 100mL lotion)
2. Benzoyl benzoate 25% lotion [not benzoyl peroxide!] (Ascabiol or Benzemul 200mL) - evidence is low but suggests 50% efficacy vs 90% with permethrin. Also Ascabiol can cause burning and irritation
Treatment of scabies - what if pregnant? breastfeeding?
1. Permethrin is Cat B2 but is Safe. A pregnant woman may chose to postpone treatment if aquired in the first trimester. Alternatively,
2. Sulphur 10% in WSP topically for 2-3 days
3. Crotamiton 10% cream for 2-3 days

BF: Use permethrin, and wash from nipples before feeding
Treatment of scabies - what about babies?
Permethrin even though not licensed for use in <6/12 (TG)
Alternatives are as for pregnancy
Treatment of norweigian scabies? in HIV?
Norweigian scabies is difficult and discussion with a dermatologist or an ID physician is recommended.
1. Scabicide lotions
2. Ivermectin 200mcg/kg as a single dose - not in the elderly or those <5 years
3. keratolytics to reduce scaling (such as salicylic acid 5-10% in sorbolene cream)

HIV: if needed, ivermectin 200mcg/kg weekly until resolved
Quellada / Lyclear
- how does it work?
- how do you use it?
- Paralyses Mites
- 2 applications one week apart
- Don't apply after a hot bath: increases absorption
- Adults apply up to 2 tubes at a time, as needed
- Apply everywhere from the neck down (do the head, scalp, face, ears of babies too - avoid mouth and eyes!)
- Don't miss the belly button, crevice of buttocks, under fingernails, groin area
- Wash off after 8-12 hours. If there is treatment failure, use for 24 hours.
Ascabiol - how do you use it?
1. Test on a small area of skin for 10 minutes before using! If stinging occurs, dilute by half and retest. Do not procede in children.
2. To use: dilute by half in children, and by 3 parts for infants
3. Apply from chin down (or head down as needed) for 8-12 hours
4. Repeat after FIVE days.
Crotamiton cream - what product is that? How do you use it?
Eurax cream - 10%
Apply to the appropriate area once a day in the evening for 3-5 days. Leave on for 24 hours. Preg cat B2 - safe to use!!

Avoid application to open or crusted skin

Its also used for itch, applied 2-3 times a day, but AMH says this claimed use is unfounded.
Scabies treatment - other advice
1. itching can persist for up to 3 weeks. A moisturiser and a corticosteroid cream may be used (TG).
2. Treat all people who have been in close contact! This is every resident and worker in a nursing home. In schools, only children who have symptoms. Keep child away from school until 2 treatments have been done.

3. Put clothes, bedding, etc. in dryer or under an iron. Otherwise store in a bag for 1 week.
Head lice
- causal organism
- signs and symptoms
- transmission
- diagnosis
1. Pediculus humanis var. capitis
2. itching due to an allergic reaction to mite saliva and can take weeks to develop (<50% have itch)
- often at back of head and behind ears
- eggs close to hair shaft, opalescent vs. white (dead egg)
- can't fly. FOMITES are unlikely as don't live for more than 48 hours off host although an egg may survive 10 days (brushes, hats, bed linen).
Diagnosis
- nits within 6mm of scalp that are opalescent not white (they also pop when squashed)
- a live, moving louse (seen using conditioner and comb method)
- louse feces (dark specks on scalp)
What is the conditioner and comb method?
1. apply conditioner to dry hair to stun the lice for ~20mins
2. divide the hair into sections, and comb with a fine tooth comb - after each stroke, wipe on a paper towel to look for lice and eggs
3. comb each section three times
What are the treatment options for head lice? What are the treatment times
1. Treat only people who have head lice. treat simultaneously
2. Treat with an insecticide
(a) Pyrethrins with Piperonyl butoxide (Banlice -mousse 10mins, Paralice aerosol - 30 mins)
(b) Permethrin 1% (Quellada lotion, Pyrifoam shampoo - 10 minutes)
(C) Maldision (KP24 lotion and shampoo - 8-12hrs)
(D) Moov head lice solution (11% eucalyptus oil but may cause itching and burning)
3. Alternatively, treat by conditioner and comb method
4. electronic combs
5. treat fomites
How is wet combing used to treat head lice?
meticulous combing (using a fine-tooth comb) with conditioner can be used to detect and treat head lice. Although this is an alternative to insecticide treatment, evidence is unreliable, it does not kill lice or eggs and it requires motivation to be effective (as it relies on the physical removal of lice and eggs). Repeat every 2 days until there are no head lice seen for 10 consecutive days
What is this electronic comb?
can be used to detect head lice. There is anecdotal evidence that repeated use of an electronic comb (available at most pharmacies) may be a useful non-drug alternative. It is less time consuming than insecticides and other topical treatments, does not damage hair and avoids the smell and cosmetic problems associated with topical preparations. However, although it kills lice it does not kill or remove eggs
Does any treatment kill the nits?
1. Banlice doesn't
2. Quellada does a bit
3. KP24 does a bit too
4. Electronic comb doesn't
4. Moov doesn't
Disadvantages of KP24?
It has to be left on for 8-12 hours, it stinks, it is 78% isopropyl alcohol which could cause respiratory depression if ingested. It can sting skin and eyes.

The shampoo may be less likely to aggravate asthma than the lotion which has more vapour
How do you use the chemical agents for head lice?
1. Apply lotions/banlice mousse/ paralice aerosol to dry hair. If using shampoo, apply to moist hair (but use as little water as possible to prevent dilution)
2. DO NOT USE CONDITIONER on hair before or after treatment
3. DO NOT BLOW DRY as this may inactivate product
4. Do NOT REWASH for 1-2 days

- Check for live lice after 1-2 days. If detected use an alternative.
- If no live lice, repeat treatment in one week.
- Between treatment, use combing method two times to remove eggs. Do this after cure also for several weeks to prevent recurrence.
How do you handle fomites with head lice?
- Wash combs and brushed in hot water for 30 seconds (>60 degrees)
- Hot wash of bedding, or placement in dryer for 15 minutes.
- Alternatively, place in bag for at least 4 days. (vs. 1 week for scabies)
- Tell kids not to share hats and brushes
Should school kids be excluded for head lice?
No - they can go after an initial treatment - but do notify the school.
What can be used if topical treatments fail?
Cotrimoxazole 80/400mg bd for 3 days, repeated again after 10 days. Thought to work due to destruction of symbiotic bacteria in the gut of the lice.
What treatment for
(A) pregnancy?
(B) babies <2 years?
(C) what age limits placed on chemical treatments
(D) breastfeeding
(A) permethrin (Quellada) - avoid banlice (B3) and maldison (B2)
(B) wet combing - only about a 40% success rate.
(C) Maldison: 12 months plus, others unspecified
(D) all safe to use except i don't know about Moov
What about kerosene?
It should not be used
Neurotoxic and highly flammable.
Why can't people use preventative treatment for head lice?
Because it causes irritation and can cause head lice resistence
What drug interactions exist with maldison?
It is an organophosphate and an irreversible cholinesterace inhibitor.
It has additive toxicity with cholinesterase inhibitors and with suxamethonium (neuromuscular blocker) - avoid combinations