What are epidermal parasitic skin diseases. How do these conditions affect individuals in poverty-stricken areas. What are the common types of parasitic skin infections and their symptoms. How can these conditions be prevented and treated effectively.

The Overlooked Burden of Epidermal Parasitic Skin Diseases

Epidermal parasitic skin diseases (EPSDs) represent a group of conditions that often go unnoticed in the global health discourse. These afflictions disproportionately affect impoverished populations, contributing to a cycle of poverty and ill health. Despite their prevalence, EPSDs remain largely neglected in terms of research, funding, and public health initiatives.

EPSDs encompass a range of conditions caused by parasites that infest the human skin. These include scabies, head lice, body lice, pubic lice, and various other ectoparasites. While not typically life-threatening, these conditions can significantly impact quality of life, cause social stigma, and lead to secondary complications if left untreated.

The Socioeconomic Impact of EPSDs

The burden of EPSDs extends beyond physical discomfort. These conditions can have profound socioeconomic consequences, particularly in resource-limited settings. Children with EPSDs may miss school due to discomfort or social isolation, while adults may experience reduced work productivity. The cost of treatment, although often minimal, can be a significant barrier for families living in poverty.

Common Types of Epidermal Parasitic Skin Diseases

Understanding the various types of EPSDs is crucial for effective diagnosis and treatment. Here are some of the most common parasitic skin conditions:

Scabies: The Persistent Mite Infestation

Scabies is caused by the microscopic mite Sarcoptes scabiei. These mites burrow into the skin, causing intense itching, especially at night. Scabies is highly contagious and can spread rapidly in crowded living conditions.

• Symptoms: Intense itching, pimple-like rash, visible burrow tracks on the skin
• Transmission: Direct skin-to-skin contact or sharing of infested items
• Treatment: Topical or oral medications to kill the mites

Head Lice: A Common Childhood Nuisance

Head lice infestations, while not dangerous, can be a significant source of discomfort and social stigma, particularly among school-aged children.

• Symptoms: Itching of the scalp, visible lice or nits (eggs) in the hair
• Transmission: Direct head-to-head contact or sharing of personal items
• Treatment: Over-the-counter or prescription lice-killing products

Body Lice: A Potential Vector for Disease

Unlike other EPSDs, body lice can transmit serious diseases such as typhus and trench fever. They are often associated with poor hygiene and overcrowded living conditions.

• Symptoms: Intense itching, red bumps on the skin, lice visible on clothing seams
• Transmission: Close contact with infested individuals or their clothing
• Treatment: Improving personal hygiene and treating infested clothing and bedding

The Challenge of Diagnosis and Treatment in Resource-Limited Settings

Diagnosing and treating EPSDs in poverty-stricken areas presents unique challenges. Limited access to healthcare, lack of diagnostic tools, and the cost of medications can all hinder effective management of these conditions.

Barriers to Diagnosis

In many resource-limited settings, healthcare providers may lack the training or equipment to accurately diagnose EPSDs. This can lead to misdiagnosis or delayed treatment, allowing infestations to spread within communities.

Treatment Challenges

Even when diagnosed correctly, treating EPSDs in impoverished areas can be difficult. The cost of medications, even if relatively low, may be prohibitive for many families. Additionally, crowded living conditions and limited access to clean water can make it challenging to implement necessary hygiene measures to prevent reinfestation.

Prevention Strategies for Epidermal Parasitic Skin Diseases

Preventing the spread of EPSDs is crucial, especially in areas where treatment options may be limited. Effective prevention strategies include:

1. Improving personal hygiene practices
2. Reducing overcrowding in living spaces
3. Regular washing and decontamination of clothing and bedding
4. Community-wide education on the transmission and prevention of EPSDs
5. Implementing regular screening programs in schools and communities

By focusing on prevention, communities can significantly reduce the burden of EPSDs and break the cycle of reinfestation.

The Role of Global Health Initiatives in Combating EPSDs

Addressing the challenge of EPSDs requires a concerted effort from global health organizations, governments, and local communities. Several initiatives have been launched to combat these neglected conditions:

The World Health Organization’s Neglected Tropical Diseases Program

The WHO has included scabies in its list of neglected tropical diseases, recognizing the significant burden it places on affected populations. This inclusion has helped to increase awareness and funding for research and control efforts.

Mass Drug Administration Programs

Some countries have implemented mass drug administration programs to treat entire communities for scabies and other EPSDs. These programs have shown promising results in reducing disease prevalence and breaking transmission cycles.

Research and Development Initiatives

Increased funding for research into new diagnostic tools and treatments for EPSDs is essential. Developing more effective, affordable, and easy-to-administer treatments could significantly improve management of these conditions in resource-limited settings.

The Intersection of EPSDs and Other Health Conditions

Epidermal parasitic skin diseases do not exist in isolation. They often intersect with other health conditions, particularly in impoverished areas where access to healthcare is limited.

Secondary Bacterial Infections

The intense itching associated with many EPSDs can lead to scratching and skin damage, providing an entry point for bacteria. This can result in secondary infections, which may be more severe than the original parasitic infestation.

Impact on Chronic Diseases

For individuals with chronic conditions such as HIV/AIDS or diabetes, EPSDs can pose additional health risks. The compromised immune systems of these patients may make them more susceptible to infestations and complicate treatment efforts.

Mental Health Considerations

The persistent discomfort, social stigma, and economic burden associated with EPSDs can have significant mental health impacts. Depression, anxiety, and social isolation are common among individuals suffering from chronic parasitic skin conditions.

Innovative Approaches to EPSD Management

As awareness of the impact of EPSDs grows, researchers and healthcare providers are exploring innovative approaches to manage these conditions more effectively:

Community-Based Interventions

Empowering local communities to take charge of EPSD prevention and control can lead to more sustainable outcomes. Training community health workers to diagnose and treat common EPSDs can improve access to care in remote areas.

Integrated Care Models

Integrating EPSD management into existing healthcare programs, such as maternal and child health services or school health programs, can help to reach more affected individuals and improve overall health outcomes.

Technology-Assisted Diagnosis

The development of smartphone-based diagnostic tools and telemedicine platforms shows promise in improving access to expert diagnosis in resource-limited settings. These technologies can help bridge the gap between rural communities and urban healthcare centers.

The Economic Case for Addressing EPSDs

While the human cost of EPSDs is clear, making the economic case for addressing these conditions is crucial for garnering support from policymakers and funding agencies.

Productivity Gains

Effectively managing EPSDs can lead to significant productivity gains in affected communities. Reduced absenteeism from school and work can have long-term economic benefits for individuals and societies.

Healthcare Cost Savings

Preventing and treating EPSDs early can result in substantial healthcare cost savings by reducing the need for more expensive treatments for complications and secondary infections.

Breaking the Cycle of Poverty

By addressing the burden of EPSDs, communities can help break the cycle of poverty that these conditions perpetuate. Improved health outcomes can lead to better educational attainment and economic opportunities for affected individuals.

In conclusion, epidermal parasitic skin diseases represent a significant but often overlooked health challenge, particularly in impoverished areas. By raising awareness, improving access to diagnosis and treatment, and implementing effective prevention strategies, we can alleviate the burden of these conditions and improve the lives of millions of affected individuals worldwide. Addressing EPSDs is not just a matter of health; it’s an essential step towards achieving global equity and sustainable development.

Molluscum Contagiosum | Johns Hopkins Medicine

Molluscum Contagiosum | Johns Hopkins Medicine

What is molluscum contagiosum?

Molluscum contagiosum is a viral disease of the skin. It causes small pink or skin-colored bumps on the skin. It is not harmful and usually does not have any other symptoms. The virus is inside the bumps and is mildly contagious. These bumps usually clear over an extended period of time.

What causes molluscum contagiosum?

Molluscum contagiosum is caused by a virus called the poxvirus. It is most common in children and adolescents, although it can affect adults. The virus usually is spread through skin-to-skin contact with an infected person. People with weakened immune systems, young children, and people living in warm, humid climates are less resistant to molluscum contagiosum.

What are the symptoms of molluscum contagiosum?

The bumps are small and are usually pink or skin-colored. Eventually, the bumps tend to develop a small sunken center. The lesions can form alone or in groups or clusters. They are not harmful, but may cause some cosmetic concern for the individual if they appear on the face or other visible areas.

How is molluscum contagiosum diagnosed?

Molluscum contagiosum is usually diagnosed based on a medical history and physical exam. The lesions are unique and are usually diagnosed on physical exam. Additional tests are not routinely ordered, though occasionally your healthcare provider may want to perform a skin biopsy to confirm the diagnosis. 

Treatment for molluscum contagiosum

Specific treatment for molluscum contagiosum will be discussed with you by your healthcare provider based on:

• Your age, overall health, and medical history

• Extent of the condition

• Your tolerance for specific medicines, procedures, or therapies

• Expectations for the course of the condition

• Your opinion or preference

In most cases, the lesions will heal without treatment over a period of 6 to 12 months. The virus can last up to 4 years and may leave scars. The best way to avoid this disease is by following good hygiene habits. For example, do not pick or scratch your skin (or someone else’s). Always practice good hand-washing hygiene. Additional treatment choices may include:

• Removal of the lesions, by using cryotherapy (freezing them off), a small blade, electric sparks, or lasers 

• Use of topical medicines (to speed resolution of the lesions)

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Related Topics

Lice, Bedbugs, Ringworms, Pinworms, Scabies, and More

Medically Reviewed by Debra Jaliman, MD on March 18, 2021

Furniture, wallpaper, mattresses, and clutter provide nesting spots for these small, flat insects. They like to live near people or pets, and they come out while you’re asleep to feed on your blood. Bedbugs don’t cause disease, but you might have an allergic reaction to their bite. If you scratch too much, the bitten area could get infected. Use antiseptic creams or lotions, or take an antihistamine, to ease the itch.

These insects live on your blood. There are three types: head, body, and pubic. Only body lice spread diseases. Since they crawl, you can get lice through close contact with someone. They lay eggs on you, and the itching starts when they hatch. You can treat them with over-the-counter and prescription medications and shampoos.

A mite that digs into your body and lays eggs causes this condition. You get it from skin-to-skin contact with an infected person. Symptoms include itching at night, a pimply rash, sores, and crusty patches. You can treat it with a prescription medicine that kills the mites called scabicide.

You can’t get these bugs from eating pork, unless it’s raw or undercooked. Both people and pigs carry them, but they’re spread when you swallow the eggs from tainted food and water. You can also get them if you come in contact with the feces of someone who has them. They infect the intestines and brain, which can lead to a disease that causes headaches and seizures, called cysticercosis. Some people get better without treatment. Others need medication or surgery.

People in the U.S. don’t have to worry as much about this parasite as people in Southeast Asia do. The bug, also known as N. fowleri, lives in warm freshwater, and it enters the body through the nose. It causes a condition that destroys brain tissue called primary amebic meningoencephalitis. Symptoms include headache, fever, vomiting, confusion, stiff neck, seizures, and loss of balance. Only experimental treatments are available now, so the survival rate is low.

Most of these bugs infect your intestines. But the one that causes trichinosis also affects your muscles.

Common roundworm diseases and their symptoms include:

• Ascariasis — belly pain
• Hookworm — blood loss
• Pinworm — anal itching
• Trichinosis — pain, fever, face swelling, pink eye, rash
• Whipworm — mucus, water and blood in stool, rectal prolapse (when part or all of the rectum slides out of place)

Your doctor may prescribe drugs to treat these infections.

If you’ve ever been camping and you came down with diarrhea, gas, stomach cramps, bloating, and nausea, you’ve likely caught this bug. You get it through food or drinking water, or from contact with the feces of an infected person or animal. The illness can be treated with prescription drugs.

This parasite causes Chagas disease, which can be life-threatening. People get infected  from contact with the bug’s feces. Symptoms show up quickly as fever, fatigue, aches, headache, rash, loss of appetite, diarrhea, vomiting, and swollen eyelids. Later, it can lead to heart and intestine problems. Doctors treat the disease and kill the parasite with medication.

This bug’s also called “crypto,” and it affects your intestines. It’s spread by contact with the stool of an infected person or animal. People tend to catch it from pool water, especially kids. The diarrhea it causes can last a long time, but it usually goes away on its own without treatment.

Some mosquitoes carry this parasite, which causes malaria. The disease kills more people than any other of its kind. It feels like the flu, and it causes body chills, fever, and sometimes nausea or vomiting. A doctor has to look at someone’s blood under a microscope to tell if they have it. Early treatment is best. Certain prescription drugs can cure most types.

This parasite causes a sexually transmitted disease called trichomoniasis, the most common curable STD. Most infected people don’t have any symptoms, but some may notice itching, burning, or irritation of their penis or vagina. It’s treated with antibiotics.

Doctors aren’t sure how you get this parasite, which infects your large intestine. Some people have stomach pain and diarrhea, but others have no symptoms. It’s common in all parts of the world. Your doctor can prescribe medicine to help you get rid of it.

This bug makes its home in meat, water, and infected cat feces. It causes an illness called toxoplasmosis, which can feel like the flu. Pregnant women and people with weak immune systems can have serious symptoms, like cysts in the muscles, brain, and eyes. Usually it isn’t treated, but a doctor can prescribe medication for a severe infection.

This roundworm’s days of spreading disease are nearly done, thanks to health groups that teach people how to avoid getting infected. People catch the bug by drinking water from ponds infected with larvae. The worms mate and grow in the stomach, then burst out through a blister on the skin. Symptoms can include fever, swelling, and pain near the blister, but it usually takes a year after infection for warning signs to show up. There’s no treatment.

Parasites do a whole lot of bad, but some researchers are trying to find out if they might be used for good, too. Studies of “worm therapy,” in which you swallow parasite eggs to treat disease, show it helps relieve symptoms of colitis, Crohn’s disease, type 1 diabetes, and asthma. It’s still experimental in the U.S.

IMAGES PROVIDED BY:

(1)    iStock/Getty Images
(2)    istock/Getty Images
(3)    Scott Camazine/Getty Images
(4)     Thinkstock
(5)    “Taenia solium scolex” by Roberto J. Galindo. Licensed under CC BY-SA 3.0 via Wikimedia Commons –
(6)    iStock/Getty Images
(7)    Science Picture Co./Getty Images
(8)    Science Picture Co./Getty Images
(9)    Science Picture Co./Getty Images
(10)    CDC
(11)    Science Picture Co./Getty Images
(12)    Visuals Unlimited/Getty Images
(13)    Oxford Scientific/Getty Images
(14)    Photolibrary/Getty Images
(15)    The Carter Center
(16)    Visuals Unlimited/Getty Image

SOURCES: 

Centers for Diseases Control: “Bed Bugs FAQ,” “Parasites – Lice,” “Definition of Ringworm,” “Fungal nail infections,” “Malaria – FAQs,” “About Parasites,” “Taeniasis,” “Parasites – Cysticercosis Treatment,” “Parasites – Cysticercosis,” “Parasites – Giardia,” “Parasites – Giardia FAQs,” “Trichomoniasis Fact Sheet,” “Cryptosporidium Infection – General Public,” “Dientamoeba fragilis FAQs,” “Parasites – Scabies,” “Scabies – FAQs,” “Naegleria fowleri – Primary Amebic Meningoencephalitis (PAM),” “Parasites – Toxoplasmosis Biology,” ““Parasites – Toxoplasmosis (Toxoplasma infection),” “Parasites – American Trypanosomiasis (also known as Chagas Disease),” “Parasites – Dracunculiasis (also known as Guinea Worm Disease). ” 

Studdiford, J., American Family Physician, 2012. 

Badiaga, S., Clinical Microbiology and Infection, 2012. 

Johns Hopkins Medicine: “Tinea Infections (Ringworm).” 

California Department of Public Health: “Cysticercosis.” 

National Institute of Allergy and Infectious Diseases: “Parasitic Roundworm Disease,” “Ascariasis,” “Hookworm Disease,” “Pinworm Infection,” “Strongyloidiasis,” “Trichinosis,” “Whipworm Disease FAQs.” 

American Family Physician: “Diagnosis, Treatment and Prevention of Giardiasis.” 

Medscape: “Cryptosporidiosis”

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Parasitic diseases of the skin – symptoms, diagnosis and treatment : Armedical

Treatment in Israel
State
hospital
Ichilov-Surasky. Official representative.

Israeli dermatology is considered to be a developed medical field, in demand among foreign patients. The success of the treatment of skin diseases in Israel is based on the practical experience of doctors, the use of progressive treatment regimens and the latest generation of medicines.

Parasitic skin diseases

In practice, there are many human skin diseases associated with the penetration of parasites into the dermis. Ticks or their larvae, lice or worms can penetrate the skin, cause demodicosis, scabies, pediculosis or other diseases. The body’s response to the introduction of parasites into the dermis is expressed by various negative phenomena.

Often there are no obvious signs of abnormalities at the initial stage of the lesion, since there is a direct dependence on the life cycle of the parasite. Then a certain clinical picture develops, associated with the release of waste products of pests into the skin and the appearance of an allergic reaction. Common to all types of lesions are redness, itching and persistent rash.

Causes of the disease

Skin diseases associated with parasites can appear in the following ways:

• contact with a parasite vector;
• use of the patient’s personal hygiene items;
• immune problems;
• poor living conditions, harsh climate;
• raw foods, unboiled water;
• Domestic animals as vectors of parasites.

Primary signs of damage are often disguised as other diseases. It can be difficult to establish an accurate diagnosis, which will require an appeal to a dermatologist.

Parasitic skin diseases: main symptoms

Close attention should be paid to the general signs of all parasitic skin diseases:

• allergic reactions on the skin or disturbances in the gastrointestinal tract due to general intoxication of the body;
• malfunctions of the immune system, fatigue, signs of colds;
• visible reaction on the skin in the form of urticaria, peeling, various types of rash;
• muscle and joint pain as a result of the resistance of the body and the struggle of the immune system;
• sleep disturbance, anemia, teeth grinding during sleep.

Skin parasites can cause severe damage to health, provoke many diseases. It is easiest to get rid of pests immediately, as soon as the patient feels unwell and sees minor skin changes.

Parasitic skin diseases: diagnostics

First of all, a dermatologist visually examines the patient, listens to the reasons for the visit and decides on a comprehensive examination. You will need to pass the following tests and undergo hardware studies:

• laboratory examination of skin scrapings in affected areas;
• dermoscopy of skin neoplasms;
• examination of the epidermis with a special microscope;
• blood test, abnormality check;
• ultrasound and MRI for the diagnosis of internal organs.

The dermatologist analyzes the results, determines exactly the type of parasite and prescribes an individual course of treatment. In some cases, several microorganisms are detected at once in various concentrations and stages of distribution.

Treatment of skin diseases

The course of treatment and rehabilitation is chosen depending on the type of parasites, the neglect of the disease and the patient’s health. Drug therapy contains proven drugs of the latest generation that do not have side effects. Medicines are aimed at the destruction and removal of specific types of human pests from the surface of the skin. Drugs are taken under the supervision of doctors, the dosage is selected depending on the severity of the disease.

In addition to drugs, modern methods of combating parasitic skin lesions are used:

• cryodestruction, in which the affected areas of the epidermis are frozen, the results are visible immediately after several sessions. There are no scars on the skin and no traces of exposure;
• physiotherapy used after a course of specialized drugs;
• recovery of the body after a course of treatment, taking place in the world-famous resorts of the Dead Sea.

Monitoring of the state of health, in particular of the skin, and the complete elimination of parasites should be carried out periodically for the first six months after treatment.

Diagnoses

Dermatology

Psoriasis

Psoriasis is usually chronic. Its essence lies in the abundant rash on the patient’s skin of light red …

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Parasitic diseases of the skin | Danilova A.A., Fedorov S.M.

Central Research Institute of Dermatovenereology, Ministry of Health of the Russian Federation, Moscow

Parasitic skin diseases remain a rather urgent problem due to their prevalence at the present time. The most common parasitic diseases of the skin are diseases caused by mites.

Parasites are organisms that feed on individuals of another species and are permanently or temporarily inside the body or on its surface [1]. The organism in which the parasite lives permanently or temporarily and at the expense of which it feeds is master .

Parasites are not only these organisms, but also those that harm the host. Depending on the habitat of parasites in the host organism, they are subdivided into endo- and ectoparasites . Parasites can be permanent or temporary. Permanent parasites are living organisms that live on the body or in the body of the host all their lives at all stages of development and cannot otherwise exist. Temporary parasites are on the host only for food intake and mainly exist outside the host. There are also pseudo-parasites, or pseudo-parasites – free-living forms that accidentally enter the body and temporarily reside in it, feed at its expense.

A distinctive feature of parasites is their maximum adaptability to the host organism and special conditions of existence [1]. In the process of evolutionary changes, they developed many adaptations to specific conditions and a special way of life (Table 1).

Definitive, or final, is an organism in which parasites go through the entire life cycle of development from an egg, a nymph, to a sexually mature individual and reproduce sexually. Parasites for their host are alien organisms, pathogenic in connection with the secretion and excretion of various substances. In the presence of one permanent host and the passage of all phases of development in it, pathogenetic and immunological processes can be of different intensity, as well as the influence of parasites on the host organism. A slight effect on the host organism is quite rare, most often pronounced lesions with the development of diseases and complications are observed [1].

Host defenses:

1. Cellular:

• inflammatory reaction;

• cell hypertrophy;

• cell proliferation.

2. Fabric:

• infiltration, edema, exudative process, complication by secondary infection;

• vascular reaction.

3. Humoral:

• immune changes.

There are various diagnostic methods parasitic lesions, which include microscopic, macroscopic, pathomorphological, electron microscopic examination.

Parasitic skin diseases develop as a response to exposure to parasites. At the same time, superficial (surface of the epidermis, intraepidermal) and deep (dermis, subcutaneous fat) parasitic dermatoses are distinguished.

The most common diseases caused by parasitic lesions of the skin are pediculosis, demodicosis and scabies.

Pediculosis

There are several types of pathogens that cause head lice in humans:

• clothes (P. humanus vestimenti)

• head (P. humanus capitis)

• Pubic or pubis (Phthirus pubis) .

Lice – blood-sucking insects of the order Anoplura , are parasites of mammals and humans. In nature, there are up to 150 species of lice, which are divided into 3 families. Lice are strictly specific parasites that are characteristic of certain types of animals and humans. The structure of the body, like that of other parasitic insects, is adapted to their lifestyle. The body is 1 to 5 mm long, covered with a chitinous cuticle, flattened in the dorso-ventral direction. Two outgrowths are defined in the head area – the eyes and the piercing-sucking mouth apparatus. In the thoracic region there are three pairs of paws with developed claws, which form a claw with the lower leg, tenaciously holding the insect on the hair. Females are larger than males, unlike the male, they have a forked large abdomen at the end. Lice feed often, they cannot stay without food for a long time, they drink from 0.7 to 1.2 ml of blood. The female lays up to 300 eggs during her lifetime at an optimum temperature of 28–30°C. The development cycle of individuals depends on the temperature regime and consists of the following stages: egg, larvae (three transformations), adult (pubertal individual) [2].

The embryonic period lasts from 4 days to 6 weeks, the larvae go through three stages lasting from 3 to 5 weeks each, the sexually mature individual lives from 27 to 46 days. The eggs are oval in shape, yellowish-whitish in color, attached to the hair or villi of the tissue by the secretion of the adhesive glands produced by the female. The larva differs significantly from the adult in size, body structure, and the absence of a reproductive apparatus. 30 minutes after hatching, the larva begins to suck blood, and after the third molt turns into an adult. The complete life cycle from egg to laying eggs by the female lasts 15 days [3].

Head lice

Lice are found on the scalp, most often affecting the occipital and temporal regions, eyebrows and eyelashes may also be affected. In the presence of long hair, the process is most pronounced, to a greater extent this applies to women and children. Head lice are grayish-white individuals, the size of males reaches 2-3 mm, females – 2.4-4 mm. Testicles (nits) of white-yellow color, 0.7–0.8 mm in size, are glued by females to the hair shaft at a distance of 2–3 mm from the mouth of the follicle or at the root with a special chitinous substance, which is produced by special glands of females. Nits are firmly attached to the hair and are very difficult to remove from the surface of the hair. Each female lays on average up to 8 oval-shaped eggs, attaching them one by one to the hair. After 7 days, young lice (nymphs) appear, leaving empty shells of gray-white and yellow in place of development. After 10 days, the nymph can lay eggs on its own. Lice are very mobile, it is quite difficult to identify them in patients [2].

Insects pass from an infected person to a healthy person only through close contact.

The clinical picture in case of lice infestation is represented by papules, vesicles, erythematous spots that occur at the bite sites due to irritation of the skin by the production of the salivary glands. Dermatitis, eczematization, excoriations develop. In this case, inflammation, secondary pustulization, exudation occur. There are crusts of a purulent-hemorrhagic nature, peeling, followed by lichenification and pigmentation of the affected areas of the skin. The disease is accompanied by severe itching.

Pustules, exudative changes, formed crusts on the scalp shrink, promote sticking of hair and the formation of tangles (trichomes) [4]. Sticky with exudate and pus, felt-like thick tufts of dirty-gray hair have an unpleasant odor and contribute to skin irritation. Impetiginous lesions, folliculitis, furunculosis, dermatitis, eczema, complicated by a secondary infection develop. There is an increase in regional behind-the-ear, cervical, occipital lymph nodes, painful on palpation. Skin lesions can spread to the face, ears, neck, back, and other areas. The diagnosis is established by finding nits and lice.

Head lice

The disease is caused by whitish-gray, brownish lice, larger than head lice. Males range in size from 2.1 to 3.75 mm, females from 2.2 to 4.75 mm. The places where the folds and seams of clothing come into contact with the skin are most often affected. Insects get to a healthy person through close household contact, settle in the folds of clothing, from which they crawl onto the skin [2]. Infection can occur when using dirty things, bed linen. Typical localization is the lumbar, shoulder, cervical region, upper back, inguinal-femoral folds, abdomen, armpits. Asocial patients, poorly hygienic adults, sometimes children are affected, and there is also a high probability of infection with increased crowding of people.

The clinical picture is determined by the presence of vascular bluish spots at the bite sites, papular, urticarial elements, capillaries. Infected people have intolerable itching . Ecthymas, secondary pyogenic elements, folliculitis, pustules also appear, and furunculosis develops. At the site of a long-term process in the presence of constant itching, excoriations, thickening of the skin, lichenification with yellow-brown changes in the skin and subsequent hypopigmentation or hyperpigmentation appear. At the site of excoriations, the development of white cicatricial changes is possible.

Head lice disease is dangerous due to the possibility of spreading Volyn fever . Volyn fever (trench, or five-day fever) is caused by rickettsia (R.quintana) , which multiply extracellularly in the intestines of lice and are excreted with their waste products, feces [2]. When crushing insects or when rubbing feces, rickettsia get on the skin and then into the blood through abrasions, injured skin, scratches.

Pubic pediculosis (phthyriasis)

The disease develops in the pubic region, perineum, scrotum, it is also possible to damage the eyebrows, eyelashes, beard, mustache, armpits, rarely the scalp. Sometimes flatheads are located in the area of ​​​​the auricles, the cervical-occipital region, with a developed hairline, lice can be found throughout the body.

Pubic lice are the smallest representatives of human head lice. Parasites have a dirty yellow, gray-brownish color, the size of the male is about 1 mm, the female is 1.5 mm. Infection is possible through close household contact (children are often affected), but the main cause of the disease is sexual contact. The flats are very tightly attached to the hair shaft at its base or at the hair follicle with claw-like formations on the front legs. The proboscis of the ploschitsa is located at the mouth of the follicle, and the tail part is at the base of the hair, and is defined as a grayish dot. Flesh-colored nits are deposited at the mouth of the hair and are also found on the hair [2, 3]. With body lice bites, itching is not as pronounced as with previously described pediculosis, however, a reaction to bites also appears due to the entry of insect saliva into the bloodstream and the subsequent reaction with blood in the form of blue spots ( M. coerulae ). The spots do not disappear when pressed, have a size of 5 to 15 mm. Differential diagnosis with the appearance of spots should be carried out with typhoid roseola, syphilis. Papules, vesicles appear on the skin, with intense itching – excoriations, peeling, hemorrhagic crusts and complication of pyoderma. Pustules with impetiginization, dermatitis, and an eczema-like reaction may develop.

Pediculosis epidemic value

Pediculosis is a dangerous disease not only for the infected person, but can also contribute to the development of epidemics and pandemics. The Volyn fever, caused by rickettsia and spread by body lice, was mentioned above.

Lice of the genus Pediculus are a source of human infection with epidemic typhus caused by rickettsia (Rickettsia prowaceki) . Lice feed on the blood of a sick person, in connection with this, rickettsia enter the stomach of an insect. In the epithelium of the stomach, there are favorable conditions for the reproduction of rickettsia, which damage and destroy the epithelium. Rickettsia at the same time enter the intestinal lumen and with excrement for 5-9th day are displayed on the surface of the skin. Ambient temperature and the amount of the pathogen affect the life span of insects. Lice die on the 3-31st day from the onset of infection. There is no evidence of a transovarial route of infection. Rickettsia do not penetrate the salivary glands, so lice bites are not contagious. However, when the products of the vital activity of lice, their excrement, the causative agents of typhus enter the human body on the damaged skin and mucous membranes. When crushing lice, rickettsia in large quantities fall on the skin of people [2, 3]. Infection is possible by inhalation of dust, as rickettsiae are well preserved in a dry place.

Relapsing fever is caused by spirochete (Spirochaeta recurrens) , which enters the stomach of the insect with blood and is quickly evacuated from it. However, on the 6-7th day, spirochetes develop in large numbers and accumulate in the cavity noah liquid, in Therefore, infection can occur already on the 6th day after the insect hits the patient, when crushing it and rubbing spirochetes into damaged skin, wounds, scratches, etc. [2].

Treatment

The most effective therapy requires hair trimming or shaving . When treating affected areas of the skin, it is necessary to get rid of nits by combing or mechanical removal from the hair. It is also necessary to sanitize the lower and outer clothing, bed linen. Anti-pediculosis drugs are represented by various drugs that have a detrimental effect on both adults and nits. Methods of treatment with kerosene, 50% soap-solvent paste, hellebore water, karbofos solution are currently used extremely rarely due to the available more effective and easy-to-use drugs. Highly effective means are Nuttifor, Para-Plus, Soak, NIX, 20% Benzylbenzoate solution, Anti-Skub , etc.

PALUS-PLUS -an aerosol package containing perometrine, malation, BUTOTOCSID pyropolia. The product is left on the treated surfaces for 10 minutes, followed by rinsing and removing the nits. The drug is easy to use and effective in a single use. Para-plus is also used to process things that the patient has come into contact with.

Nix – a cream containing permethrin is applied to the affected areas for 10 minutes, washed off in the usual way, while removing the nits is mandatory.

Antiskab is a complex hydrophilic gel preparation containing benzyl benzoate, active substances of plant origin. This remedy is rubbed into the affected and adjacent areas on the 1st, 3rd and 7th day in the evening. Washed off on the 8th day.

Nittifor contains 0.0005% permethrin in a water-alcohol solution. The drug is used to destroy head, pubic lice and their nits. Nittifor is applied to the affected areas and after drying the hair, 40 minutes after treatment, it is washed off with shampoo, if necessary, the treatment is repeated.

Treatment of pediculosis complicated by pyoderma includes antibiotic therapy, both local and oral. It is desirable to use broad-spectrum antibiotics (amoxicillin, lomefloxacin, roxithromycin, doxycycline, etc.). From external means it is necessary to apply aniline antiseptics, ointments and pastes with antibiotics (gentamicin, heliomycin, lincomycin, hyoxysone, triderm, diprogent, belogent, celestoderm with garamycin, etc. ).

In case of developed dermatitis it is necessary to use antihistamines (loratadine, ebastine, terfenadine, ketotifen, etc.). External therapy should include steroid ointments.

Anti-inflammatory agents such as argosulfan, desitin, drapolene, etc. can be used.

Preventive measures

Sanitary and hygienic measures, personal hygiene, frequent washing of the head and body, regular change of linen and clothes are of the greatest importance. As public prevention, regular examination of people in places of their forced congestion or long-term residence (hospitals, child care facilities, schools, kindergartens, dispensaries, etc.) is necessary.

When lice are detected, the infected people and those who come into contact with them are thoroughly sanitized, rooms and clothes are cleaned, and household items are washed. Medical personnel conducting sanitization should have special clothing made of rubberized fabric or thick canvas. Of great importance is the sanitary-educational work among the population and the timely implementation of sanitary and anti-epidemic measures.

Demodicosis

Demodicosis is a common pathology in humans and animals caused by ticks of the genus Demodex . Currently, out of 65 species and several subspecies of Demodex, only two are found in humans: Demodex follikulorum and Demodex breis . Each species and subspecies of Demodex is strictly specific to its host.

Demodicosis, which affects animals, makes it necessary to take appropriate measures in agriculture, since it is associated with damage not only to the skin and skin, but also to the internal organs of animals.

Iron mite (Demodex follikulorum) is the most common, found only in humans in hair follicles, sebaceous glands, its reproduction stops outside the host [3]. The tick is also viable outside the host at constant humidity and room temperature in the dark for up to 9 days. The optimal temperature for tick development is 30–40°C; at 14°C, ticks are in a state of stupor, and at 52°C they quickly die. Insects survive in water for up to 25 days, in dry air they die after 1.5 days. The most favorable nutrient medium for demodex is vegetable oil, fat, vaseline.

The pliers are 0.3-0.4 mm. In the cavity of the hair follicle, females lay eggs, from which, after 60 hours, a larva hatches, which is motionless and constantly feeds. After 40 hours, the larva turns into nymph 1, which is also inactive and remains in the follicle. After 72 hours, the transformation into nymph 2 occurs, mobile, moving along the skin, and after 60 hours – the transformation into an adult. The adult re-enters the follicle and dies after laying eggs. The life cycle of a tick is about 15 days [5].

If there are any pathological processes in the host’s body: neuroendocrine, gastrointestinal, mental, immune, as well as in the presence of foci of chronic infection, the body becomes sensitized to the tick. In this situation, demodex is a chemical, mechanical stimulus that contributes to the development and maintenance of the pathological process. In addition, symbiosis with corynebacteria and opportunistic flora is disrupted, which is also a trigger for the development of the disease. Asymptomatic tick carriage is also possible in the absence of skin pathology. During a mass examination in TsNIKVI, 89% carriage of the parasite, regardless of skin pathology. The greatest activity of Demodex on human skin is observed in the spring-autumn period, which is associated with increased insolation, changes in ambient temperature, immune and endocrine changes. Most often, the tick is found in the area of ​​the nasolabial fold, cheeks, nose, chin, quite rarely – in the neck area and very rarely – in the back and chest area.

Clinical manifestations of demodicosis are varied. There are skin and eye manifestations of the disease. It is necessary to distinguish directly between demodicosis and diseases, the course of which is aggravated by the presence of ticks. The most common diseases are presented in Table. 2.

Treatment

For the choice of therapy, the clinical picture of the disease, the presence of forms of ticks, and their number are important. Patient comorbidities must also be taken into account. To act directly on demodex mites, acaricidal agents are used, which include derivatives of the nitroimidazole group. The most effective agent is Trichopolum used for 4 to 6 weeks [6, 7]. Also used ornidazole in cycles of 8 to 10 days. Not only the antiparasitic effect of the drug was noted, but also bacteriostatic, which increases the activity of neutrophils, stimulates adrenergic structures, and enhances reparative processes [6]. It is possible to use sulfur preparations, angioprotectors, antiserotonin and antihistamines (loratadine, ebastine, terfenadine, etc.), chloroquine, gastrointestinal enzymes, isotretinoin, retinol palmitate, calcium derivatives, sedatives, immunomodulators, biologically active substances, etc.

Outdoor therapy includes vasoconstrictor (aqueous adrenaline-resort solution, etc.), ointments containing antibiotics, mupyrocin (bacteroban), erythromycin, fusidine, tetracycline ointment, antihistamines, steroids, non-steroid anti-inflammatory drugs (intraudicia Qing, butadonic, orthophenic ointments, etc.), preparations containing sulfur, naftalan, metronidazole, 20% benzyl benzoate solution, vitamin A derivatives (retinoic ointment, retin A, airol, benzoyl peroxide (oxy-5, oxy-10), etc. For the treatment of the periorbital region, they are used alcohol-ether mixtures, 3-5% trichopolum cream, sodium sulfapyridazine, etc.

Effective drug Spregal containing a solution of esdepalethrin and piperonyl butoxide. For demodicosis and rosacea, Spregal is rubbed into the affected areas of the skin with a swab 1-3 times a day. Clinical improvement and recovery can be achieved in 70-87% of cases. Spregal is well tolerated and does not cause serious side effects.

Disease prevention consists in observing general hygiene rules at home and in public places. Proper and adequate skin care, good nutrition, and adherence to a rest regimen are necessary. With minor changes in the skin of the skin of the face and periorbital region, a timely appeal to a dermatologist is necessary.

Scabies

Scabies is the most common parasitic human skin disease caused by the mite Sarcoptes scabiei .

The source of infection with this disease is a sick person, while there is a direct and indirect route of transmission of the pathogen. Direct infection is the transmission of the pathogen from person to person at the time of contact. With an indirect route of tick transmission, infection occurs through objects of general and personal use.

The life cycle of a tick is represented by two periods: reproductive and metamorphic.

The mite’s reproductive cycle is as follows: an oval-shaped egg is laid by the female in the itch, in which the larvae then hatch. Scabies can persist for up to 1.5 months and serve as a source of infection. The metamorphic period is determined by the appearance of a larva, which penetrates the skin through the passage and after molting turns into a protonymph, then into a telenymph, which in turn turns into an adult in papules, vesicles, on the skin.

The scabies mite is tortoise-shaped, measuring 0.35 x 0.25 mm. The male is much smaller than the female.

The female moves on the skin with the help of two front pairs of legs, on which there are suckers. The mite penetrates into the stratum corneum of the skin with the help of jaws, terminal spines of the front pairs of legs. The female feeds on the granular layer of the epidermis, making passages in the stratum corneum of the epidermis. Egg laying in passages occurs sequentially in a row.

The incubation period of the disease is 8 to 12 days. The beginning of the process is characterized by itching, which increases sharply in the evening.

Itching caused by tick movement, most active in the evening. At the same time, the skin and nerve endings are irritated not only by the tick itself, but by the products of its vital activity, excrement, saliva, etc. [1-3].

The diagnostic criterion for the diagnosis is the presence of scabies, papules, vesicles. The most typical lesions in the form of passages, serous crusts, papules, vesicles appear in the area of ​​the hands, elbow joints, abdomen, buttocks, mammary glands, thighs. There are also erased forms of scabies, which lead to misdiagnosis and are often regarded as allergic dermatosis.

The clinical picture of scabies is not only the above-described rashes, but the appearance of erosions, hemorrhagic crusts, excoriations, erythematous-infiltrative spots is possible. When skin changes are complicated by a secondary infection, impetiginous elements, pustules, and purulent crusts appear. A complication of the disease is the formation of postscabious lymphoplasia, as a reactive hyperplasia of the lymphoid tissue.

There are separate forms of scabies: nodular scabies, scabies in children, Norwegian scabies, pseudo-scabies [3].

Diagnosis of scabies is established on the basis of clinical manifestations, epidemiological data, laboratory results.

Treatment

Treatment of the disease is carried out with several drugs: spregal , medifox .

Spregal (solution of esdepalethrin and piperonyl butoxide) is applied in the evening on the patient’s skin from the cervical region to the soles and left for 12 hours. After using the drug, you must wash thoroughly. Spregal is used in all age groups and has no contraindications. If necessary, it is possible to reuse the drug 10-12 days after the initial treatment.

It is necessary to sanitize things, clothes and premises.

Benzyl benzoate – 20% solution (emulsion, ointment) is applied to the skin on the 1st, 2nd, 4th day, also with a change of linen, clothing, room treatment.

Complicated scabies requires the use of antihistamines, externally anti-inflammatory, antiseptic, steroid ointments.

A highly effective agent is used for the treatment of linen, clothes, rooms A-Par which is a combination of esdepalethrin and piperonyl butoxide in an aerosol can. Esdepalethrin, which is part of the preparation, is a pyrethroid that acts directly on the nervous system of the insect. When combined with the lipid base of the membranes of nerve cells of insects, cationic conductivity is disturbed. The action of pyrethroids is enhanced by piperonyl butoxide. The tool is highly effective in the treatment of various types of pediculosis, scabies, when infected with random types of parasites (fleas, bedbugs).

The drug is applied to all surfaces of clothing, furniture and bedding that the patient has come into contact with and that are not subject to boiling and otherwise processing.

Preventive measures include the treatment of persons in contact with the patient, anti-scabies preparations, disinfection of things and bedding [8]. The premises are wet cleaned or disinfected by SES employees on the day the patient is detected and after the end of treatment. Medical control is carried out for 1.5 months [9].