Scabies, Bedbug, and Body Lice Infestations: A Review.

Importance: Scabies, bedbug, and body lice infestations are caused by organisms that live on or in the skin, on clothing, or in the environment and commonly cause pruritus and rash. In 2021, approximately 622 million incident cases of scabies occurred globally. Data on bedbug infestations are limited. Body lice prevalence ranges from 4.1% to 35% among persons experiencing homelessness worldwide. Observations: Scabies is caused by mites (Sarcoptes scabiei) that burrow into the epidermis. Transmission primarily occurs from prolonged skin-to-skin contact with an individual who has an infestation. Common scabies is characterized by excoriated pruritic papules, plaques, and pathognomonic burrows on finger/toe web spaces, volar wrists, ankles, axillae, buttocks, male genitalia, and areolae. Permethrin cream and oral ivermectin are first-line treatments for adults, with similar clearance rates by week 2 (74% with permethrin vs 68% with ivermectin; relative risk, 0.91; 95% CI, 0.76-1.08). Treatment failure can occur with oral ivermectin (11.8%; 95% CI, 8.4%-15.4%) and topical permethrin (10.8%; 95% CI, 7.5%-14.5%). Bedbugs (Cimex lectularius, Cimex hemipterus) are insects that live on mattresses and furniture and feed on blood nocturnally, causing linear pruritic erythematous papules. New skin lesions on waking, cohabitants with similar symptoms, and recently residing in a high-occupancy setting should raise suspicion. Treatment requires eradication with pest management. Body lice (Pediculus humanus humanus) are insects found on clothing that travel to the skin for blood meals. Body lice bites cause pruritic excoriated macules/papules and hyperpigmentation in areas where clothing seams contact skin. Treatment and prevention require at least once-weekly bathing and laundering of clothing and bedding. Conclusions and Relevance: Scabies, bedbug, and body lice infestations are common. Accurate diagnosis requires taking a history, including social drivers of health (eg, housing status, living environment), and physical examination. First-line treatments include scabicides for patients with common scabies and their close contacts. Scabies, bedbug, and body lice infestations should be treated with decontamination measures.

Treatment of Bullous Pemphigoid With Dupilumab: A Case Series of 30 Patients.

Bullous pemphigoid is often difficult to treat with the limited therapies available. Here, we describe clinical outcomes among 30 adults with bullous pemphigoid patients treated with dupilumab. We performed a multicenter, retrospective case series between March 2020 to August 2022. Patients received a loading dose of dupilumab 600 mg, followed by 300 mg maintenance dose with varying administration frequency tailored to individual patient response. All patients experienced at least some improvement in blister formation and pruritus, with 23 (76.7%) of patients demonstrating either complete clearance of blistering or marked response. Complete clearance of pruritus or marked response was noted in 25 (83.3%) of patients. Eight patients were effectively maintained solely on dupilumab. One (3.3%) patient reported an injection site reaction. Thirty patients represent a small sample, however, to our knowledge, this is the second largest group of BP treated with dupilumab. Furthermore, we provide an understandable framework for clinicians outside of academics to follow and assess treatment responses in their BP patients treated with dupilumab. Dupilumab should be considered as a therapeutic option in patients with bullous pemphigoid given its ability to induce sustained blistering and pruritus response in both typical and refractory cases while maintaining a favorable safety profile. J Drugs Dermatol. 2024;23(6):e144-e148. doi:10.36849/JDD.8258e.

Scattered Painful Papulonodules in an Older Woman.

A 56-year-old woman was admitted for myeloablative conditioning in preparation for allogeneic hematopoietic cell transplant. Her course was complicated by severe mucositis, acute kidney injury, and neutropenic fever. During her admission, she also developed painful necrotic skin lesions, a nonproductive cough, and altered mental status. What is your diagnosis?

Orbital period change of Dimorphos due to the DART kinetic impact.

The Double Asteroid Redirection Test (DART) spacecraft successfully performed the first test of a kinetic impactor for asteroid deflection by impacting Dimorphos, the secondary of near-Earth binary asteroid (65803) Didymos, and changing the orbital period of Dimorphos. A change in orbital period of approximately 7 min was expected if the incident momentum from the DART spacecraft was directly transferred to the asteroid target in a perfectly inelastic collision1, but studies of the probable impact conditions and asteroid properties indicated that a considerable momentum enhancement (ß) was possible2,3. In the years before impact, we used lightcurve observations to accurately determine the pre-impact orbit parameters of Dimorphos with respect to Didymos4-6. Here we report the change in the orbital period of Dimorphos as a result of the DART kinetic impact to be -33.0 ± 1.0 (3σ) min. Using new Earth-based lightcurve and radar observations, two independent approaches determined identical values for the change in the orbital period. This large orbit period change suggests that ejecta contributed a substantial amount of momentum to the asteroid beyond what the DART spacecraft carried.

Ejecta from the DART-produced active asteroid Dimorphos.

Some active asteroids have been proposed to be formed as a result of impact events1. Because active asteroids are generally discovered by chance only after their tails have fully formed, the process of how impact ejecta evolve into a tail has, to our knowledge, not been directly observed. The Double Asteroid Redirection Test (DART) mission of NASA2, in addition to having successfully changed the orbital period of Dimorphos3, demonstrated the activation process of an asteroid resulting from an impact under precisely known conditions. Here we report the observations of the DART impact ejecta with the Hubble Space Telescope from impact time T + 15 min to T + 18.5 days at spatial resolutions of around 2.1 km per pixel. Our observations reveal the complex evolution of the ejecta, which are first dominated by the gravitational interaction between the Didymos binary system and the ejected dust and subsequently by solar radiation pressure. The lowest-speed ejecta dispersed through a sustained tail that had a consistent morphology with previously observed asteroid tails thought to be produced by an impact4,5. The evolution of the ejecta after the controlled impact experiment of DART thus provides a framework for understanding the fundamental mechanisms that act on asteroids disrupted by a natural impact1,6.

Severe Mpox Infections in People With Uncontrolled Human Immunodeficiency Virus.

In the current mpox outbreak, infections are usually self-limited. We describe 3 patients with uncontrolled HIV and mpox infections lasting months, causing debilitating lesions, complications, and death, despite initiating anti-mpox and antiretroviral therapy. Delayed treatment of mpox with antiviral agents may contribute to poor outcomes in severely immunocompromised patients.

Imaging More than Skin-Deep: Radiologic and Dermatologic Presentations of Systemic Disorders.

BACKGROUND: Cutaneous manifestations of systemic diseases are diverse and sometimes precede more serious diseases and symptomatology. Similarly, radiologic imaging plays a key role in early diagnosis and determination of the extent of systemic involvement. Simultaneous awareness of skin and imaging manifestations can help the radiologist to narrow down differential diagnosis even if imaging findings are nonspecific. AIMS: To improve diagnostic accuracy and patient care, it is important that clinicians and radiologists be familiar with both cutaneous and radiologic features of various systemic disorders. This article reviews cutaneous manifestations and imaging findings of commonly encountered systemic diseases. CONCLUSIONS: Familiarity with the most disease-specific skin lesions help the radiologist pinpoint a specific diagnosis and consequently, in preventing unnecessary invasive workups and contributing to improved patient care.