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Skin parasitic disorders

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  1. Skin parasitic disorders By:DRNeda Adibi DERMATOLOGIST of isfahan university of medical sciences

  2. Parasitic skin infections PEDICULOSIS: - (Lice infestation) PEDICULOSIS CAPITIS:- pediculus huminis Life Cycle: the adult fertilized femalelay about 8 eggs per a day each one hatch in about 8 daysNYMPH mature into adult lice in 8 daysThe adult female repeat the cycle

  3. PARASITIC INFESTATIONS3 Categories • PEDICULOSIS – Louse (lice) infestations • HEAD LICE – common among children • Spread from head to head (direct) • Indirect – combs, scarves, hats, bed linen,etc • Itching – caused by saliva of lice penetrating skin & engorging on human blood • Scratching – can open up skin to other invading organisms • Adult head lice – hard to see, lay white eggs “NITS” along hair shaft • TX – Medicated shampoo followed by fine tooth comb to remove nits

  4. NITS_____________DANDRUFF • 1-regular oval shape. 1-irregular shape • 2-shiny appearance 2- dull • 3- attach at angle of 45 to hair 3- around hair • 4-firmly attached to hair 4- loosely attach • 5- Viable structure with click when compress between nail plate “click sign” 5- -ve Mode of transmission

  5. Clinical features • any child with repeated impetigo or crusted eczema on the scalp should be suspected to have pediculosis capitis. • Diagnosis

  6. Treatment • Malathion & carbaryl kill both adult & ova • Gamma- benzene hexacloride, pyrthrin and permethrin. • when not available (kerosene ) • Shampoo • Lotion

  7. Pediculosis Corporis • vagabonds disease

  8. PARASITIC INFESTATIONS • PUBIC LICE – infest pubic hair and generally spread by sexual contact. • Lice does not spread other STD’s • TX – RX Cream • BODY LICE – most common among underprivileged, transient people. • Lice CAN SPREAD DISEASE – such as typhus epidemics among soldiers during war • Prevention – good grooming & hygiene

  9. Pediculosis pubis • phthirus pubis

  10. SCABIES: • Sarcoptes scabeii var hominis • Life Cycle adult fertilized Female (strtum corneum) burrow 3 mm/day Lay 3 eggs /day hatch after 3 days into larvae passes through 3 phases mature adult in 3 weeks the adult female repeat the cycle Incubation period

  11. The entire life is in the epidermis Secondary infection with staph or strep may occur All races and socio economic groups are vulnerable (prevalance;4-100%) In overcrowded situations and more prevalent in children and sexually active disease

  12. Crusted(norvegian scabies) in elderly,HIV and transplanted patient

  13. Clinical Features • Primary lesions • Secondary lesions

  14. Diagnosis • Treatment: • General principles of treatment: • These drugs should be applied to the whole body below the neck or even to the face and scalp in infants. • Disinfection of beds & clothes for one week. • The whole family must be treated. • Duration of treatment depends on the used agent.

  15. Permethrin ointment 5% Treatment of choice • - Gamma benzene hexa-chloride .must avoided in infants and pregnant females because it may caused neurotoxicity • - benzyl benzoate 25% lotion. • - sulfur 5% in children & pregnant females and 10%in adults. It is available, cheap and safe. • - crotamiton mild scabicdal .mainly in children, may be useful in adults as antipruritic. • Ivermectin (200 µg/kg body weight, two weeks apart)

  16. LEISHMANIASIS • This disease caused by flagellated protozoa called leishmania with many subspecies. • Classification: • (1) Cutaneous Leishmaniasis: caused by L. tropica ,L. major ,L. ethiopica , L.mexicana, L. braziliensis • (2)mucocutaneous Leishmaniasis:- caused by L.etheopica and L.braziliensis • (3) Diffuse cutaneous Leishmaniasis: caused by L aethcopica and L.mexicana • (4) Visceral Leishmaniasis:-caused L. donovani.

  17. Cutaneous leishmaniasis:- Baghdad boil • Transmission by sand fly of genus phlebotomas (vector) • the infective stage is flagellated form (promastigote) that enters the body by sandfly bite and taken inside body by macrophages and changed into the non-flagellated form (amastigote). • Reservoir: - may be human but mostly domestic animals like cat, dogs

  18. Clinical Features Acute form :- • (1) Dry type • (2) Wet type • Chronic form: -lupoid leishmaniasis

  19. Leishmaniasis usually leaves life long immunity. Recurrence is very rare and may be due to • -immunosuppression by drugs or disease. • In elderly when the immunity reduced with the age. • very early treatment before the immunity fully developed • infection by new strain because the immunity against the disease is strain specific

  20. Diagnosis • is mainly clinical in our country and the golden role is:-any boil >l month duration is leishmaniasis until prove other wise • Direct smear • Culture in NNNmedia. • Leishmanin skin test • immunological tests • Polymerase chain reaction

  21. Treatment • LOCAL:- • - Chemical treatment mainly Na stibogluconate (pentostam), hyper tonic saline 7% or zinc sulfate • Physical treatment: as Cryotherapy, infra red therapy, Excision or cautery • Systemic: • Na stibogluconate (pentostam) intramuscular - zinc sulfate orally • Rifadin, Metheprim, Metronidazole, Ketoconazole, itraconazole and even allopurinol