Common Skin Conditions in Children and Adolescents: Nonbacterial Infections.

Tinea infections are caused by dermatophytes, except for tinea versicolor, which is caused by yeasts in the Malassezia genus. If available, potassium hydroxide preparation should be performed to confirm diagnosis of tinea capitis or onychomycosis. In some cases, fungal culture, UV light examination, or periodic acid-Schiff stain can be helpful. Topical drugs are effective for tinea corporis, tinea cruris, and tinea pedis. Tinea incognito is an atypical presentation that usually requires systemic treatment. Management of tinea capitis always requires oral drugs. Oral drugs are preferred for onychomycosis treatment but should not be prescribed without confirmation of fungal infection. Localized cases of tinea versicolor can be managed with topical drugs, but oral drugs might be needed for severe, widespread, or recurrent cases. Warts are superficial human papillomavirus infections. Common treatments include irritant, destructive (eg, cryotherapy), immune stimulant (eg, intralesional Candida antigen), and debridement and excision methods. Scabies infestation results in intensely itchy papules, nodules, or vesicles. Mites and burrows on the skin are pathognomonic but difficult to identify. Dermoscopy, particularly with UV light, can make identification easier. Topical permethrin and oral ivermectin are two of the most commonly used treatments. All household and close contacts should be treated regardless of the presence or absence of symptoms.

Assessment of the in vitro acaricidal activity of Bravecto® (fluralaner) and a proposed orange oil-based formulation vehicle for the treatment of Sarcoptes scabiei.

BACKGROUND: Sarcoptic mange is a serious animal welfare concern in bare-nosed wombats (Vombatus ursinus). Fluralaner (Bravecto®) is a novel acaricide that has recently been utilised for treating mange in wombats. The topical 'spot-on' formulation of fluralaner can limit treatment delivery options in situ, but dilution to a volume for 'pour-on' delivery is one practicable solution. This study investigated the in vitro acaricidal activity of Bravecto, a proposed essential oil-based diluent (Orange Power®), and two of its active constituents, limonene and citral, against Sarcoptes scabiei. METHODS: Sarcoptes scabiei were sourced from experimentally infested pigs. In vitro assays were performed to determine the lethal concentration (LC50) and survival time of the mites when exposed to varying concentrations of the test solutions. RESULTS: All compounds were highly effective at killing mites in vitro. The LC50 values of Bravecto, Orange Power, limonene and citral at 1 h were 14.61 mg/ml, 4.50%, 26.53% and 0.76%, respectively. The median survival times of mites exposed to undiluted Bravecto, Orange Power and their combination were 15, 5 and 10 min, respectively. A pilot survival assay of mites collected from a mange-affected wombat showed survival times of < 10 min when exposed to Bravecto and Orange Power and 20 min when exposed to moxidectin. CONCLUSIONS: These results confirm the acaricidal properties of Bravecto, demonstrate acaricidal properties of Orange Power and support the potential suitability of Orange Power and its active constituents as a diluent for Bravecto. As well as killing mites via direct exposure, Orange Power could potentially enhance the topical delivery of Bravecto to wombats by increasing drug penetration in hyperkeratotic crusts. Further research evaluating the physiochemical properties and modes of action of Orange Power and its constituents as a formulation vehicle would be of value.

Egyptian mandarin peel oil's anti-scabies potential via downregulation-of-inflammatory/immune-cross-talk: GC-MS and PPI network studies.

The current study investigated the scabicidal potential of Egyptian mandarin peel oil (Citrus reticulata Blanco, F. Rutaceae) against sarcoptic mange-in-rabbits. Analysis of the oil's GC-MS identified a total of 20 compounds, accounting for 98.91% of all compounds found. Mandarin peel oil topical application improved all signs of infection, causing a scabicidal effect three days later, whereas in vitro application caused complete mite mortality one day later. In comparison to ivermectin, histopathological analysis showed that the epidermis' inflammatory-infiltration/hyperkeratosis-had disappeared. In addition to TIMP-1, the results of the mRNA gene expression analysis showed upregulation of I-CAM-1-and-KGF and downregulation of ILs-1, 6, 10, VEGF, MMP-9, and MCP-1. The scabies network was constructed and subjected to a comprehensive bioinformatic evaluation. TNF-, IL-1B, and IL-6, the top three hub protein-coding genes, have been identified as key therapeutic targets for scabies. From molecular docking data, compounds 15 and 16 acquired sufficient affinity towards the three screened proteins, particularly both possessing higher affinity towards the IL-6 receptor. Interestingly, it achieved a higher binding energy score than the ligand of the docked protein rather than displaying proper binding interactions like those of the ligand. Meanwhile, geraniol (15) showed the highest affinity towards the GST protein, suggesting its contribution to the acaricidal effect of the extract. The subsequent, MD simulations revealed that geraniol can achieve stable binding inside the binding site of both GST and IL-6. Our findings collectively revealed the scabicidal ability of mandarin peel extract for the first time, paving the way for an efficient, economical, and environmentally friendly herbal alternative for treating rabbits with Sarcoptes mange.

Crusted Scabies Presenting as Erythroderma in a Patient With Iatrogenic Immunosuppression for Treatment of Granulomatosis With Polyangiitis.

The diagnosis of scabies can be difficult when the infection presents as erythroderma. Crusted scabies is a severe form of scabies caused by cutaneous ectoparasitic infection by the mite Sarcoptes scabiei var hominis. Crusted scabies most commonly occurs in patients with underlying immunosuppression from acquired infection or subsequent to solid organ or bone marrow transplantation. We present a rare case of a patient with granulomatosis with polyangiitis (GPA) who developed azathioprine-induced myelosuppression and subsequent erythrodermic crusted scabies. It is critical to maintain a broad differential when patients present with erythroderma, especially in the setting of medication-induced immunosuppression for the treatment of autoimmune disease.

Adjunctive Agent for Treating Scabies: In vitro Killing Activity of Permethrin and Tea Tree Oil on Sarcoptes scabiei Collected from Patients

Objective: Recently, there has been a serious increase in cases of scabies. The number of patients who do not benefit from the current treatment agents is also quite high. There are publications showing that scabies mites are permethrin-resistant and ivermectin. The treatment with scabicides usually lasts for several hours and usually the treatment is repeated for at least another time, which reduces the patient's compliance with the treatment, especially in pediatric patients where the toxic effects of the products are more pronounced. Therefore there is a need for treatment modalities that are less toxic to humans. To observe the in vitro effect of tea tree oil (TTO) on S. scabiei and to compare it with those of permethrin. Methods: Scabies specimens were removed from the patient and examined using a digital microscope. Parasites that were not damaged during sampling, and showed full motion were included in the study. No treatment was applied to the patients before removal of the mites. A total of 40 parasites were included in the study, with 10 parasites in each group. Immersion oil was applied to the control group, 5% permethrin to the first treatment group, while 5% and 25% TTO were used for the second and third study groups. Results: The mean survival time (ST) of scabies mites in the 5% permethrin group was 350±31.3 min, while this for 5% TTO group 180±15.1 min and 120±13.3 min in the 25% TTO group. The mean ST of the sarcoptes in the control group was 2.820±90 min. The mean ST between the control, permethrin and TTO groups was statistically significant (p=0.03). ST between 5% and 25% TTO groups was also statistically significant (p=0.04). There were no statistical differences between permethrin and 5% or 25% TTO. Conclusion: TTO has an acaricidal effect on S. scabiei. Although not used as the treatment of choise, it can be used as a supportive agent. Since it shows an acaricidal effect within a short time, it could be used as a shampoo or shower gel to enhance the acaricidal activity of another scabicide.

Comparison of the effects of ivermectin, permethrin, and gamma benzene hexachloride alone and with that of combination therapy for the management of scabies.

RESULTS: The present study compared three scabicidal agents alone or with combination, the currently considered medicine of choice permethrin, oral ivermectin, and gamma benzene hexachloride in the local population of India. A total of 120 patients were studied. They were randomly divided into four groups -Group A, Group B, Group C, and Group D. Group A received topical 5% permethrin and oral placebo. Group B was given topical placebo cream and oral ivermectin in two dose regimen. Group C received topical 1% gamma benzene hexachloride with oral placebo, and Group D was given topical 5% permethrin and oral ivermectin. The improvement of lesions and pruritus were assessed in the next three follow-ups, i.e., on the 7th day, 14th day, and 28th day along with any adverse drug reactions (ADRs). It was found that Group A had 83%, 90%, 97%, and Group B had 70%, 81%, and 91% improvement of lesions in the three follow-ups respectively. Group C showed 57%, 70%, 86%, and Group D had 82%, 90%, 97% efficiency to decrease lesion count (p>0.05) respectively. Again, Group A observed 77%, 88%, and 94% improvement in pruritus in subsequent follow-ups, while for Group B it was 63%, 76%, and 86%. Group C had 55%, 71%, 85% efficiency, and Group D had recorded 77%, 88%, and 94% improvement to decrease pruritus (p>0.05). The incidence of adverse effects was found to be less in Group B, Group C, and Group D when compared to Group A. CONCLUSION: Group D or a combination therapy was a better choice for scabies in comparison to other monotherapy due to its better efficacy and safety profile.

Scabies in a 14-year-old girl with superficial epidermolytic ichthyosis.

A 14-year-old girl who reported generalized scaling and hyperkeratosis since age 1 year presented with severe pruritus of several months' duration. Scabies mites were detected, and molecular genetic analysis subsequently revealed a rare pathogenic variant in the keratin 2 (KRT2) gene, confirming a diagnosis of superficial epidermolytic ichthyosis. Treatment with oral ivermectin led to complete remission of symptoms. Disorders of keratinization can mimic clinical signs of scabies, leading to a delay in diagnosis.

Sarna costrosa: revisión sobre aspectos clínicos de una ectoparasitosis desatendida y de presentación infrecuente / Crusty scabies: review of the clinical aspects of a neglected and infrequent ectoparasitosis

En esta revisión de la literatura se describen aspectos epidemiológicos, fisiopatológicos, clínicos y terapéuticos sobre una presentación atípica y grave de escabiosis, la sarna costrosa o noruega. Esta presentación de escabiosis destaca por afectar principalmente a personas con condiciones de inmunodepresión o sociales que las hacen susceptibles de una alta carga parasitaria, además se asocia a un peor pronóstico y a riesgo de complicaciones. Desde el punto de vista terapéutico, sus estrategias difieren del manejo de la escabiosis clásica.(AU)

This literature review describes epidemiological, pathophysiological, clinical and therapeutic aspects of an atypical and severe presentation of scabies, Norwegian or crusty scabies. This presentation of scabies stands out because it mainly affects people with immunosuppressive or social conditions that make them susceptibleto a high parasite load, it is also associated with a worse prognosis and risk of complications. From a therapeutic point of view, their strategies differ from the management of classic scabies.(AU)

Mineral Oil Scabies Preparation From Under the Fingernail.

The microscopic mite Sarcoptes scabiei can burrow into the epidermis of human skin and cause scabies. Obtaining scabies mites from the skin for diagnosis can be challenging. We describe a method for extracting the scabies mite using the tip of a disposable blunt-tip hyfrecator electrode to gently scrape under the fingernail bed. We find that this is a quick and efficient method of obtaining a scabies mite for rapid diagnosis.

Unusual presentation of crusted scabies with osteolysis in immunocompetent.

BACKGROUND: Crusted scabies results from a failure of the host immune response to control the proliferation of the scabies mite in the skin, with resulting hyperinfestation and a concomitant inflammatory and hyper-keratotic reaction. However, it has also been recognised in people with no evident immunological deficit. CASE HISTORY: We present a case report of apparently immunocompetent 16-year-old female presenting with multiple hyperkeratotic vegetating plaques over limbs, excoriated papules over trunk with minimal itching since 2 years without any positive family history. The microscopic examination of the skin scales with potassium hydroxide demonstrated numerous scabies mites and eggs. Histopathology showed hyperkeratosis with multiple mites in stratum corneum. Numerous mites were seen on biopsy of lesion. X-ray showed osteolysis of distal phalanges secondary to chronic pressure. Repeated topical treatments with permethrin and oral ivermectin led to the considerable resolution of her lesions. CONCLUSION: We present a rare case of crusted scabies with osteolysis in an immunocompetent female.

Crotamiton-loaded tea tree oil containing phospholipid-based microemulsion hydrogel for scabies treatment: in vitro, in vivo evaluation, and dermatokinetic studies.

Crotamiton (CRT) is a commonly approved drug prescribed for the scabies treatment in many countries across the globe. However, poor aqueous solubility and low bioavailability, and side effects restrict its use. To avoid such issues, an appropriate carrier system is necessary which can address the aforementioned challenges for attaining enhanced biopharmaceutical attributes. The current study intends to provide a detailed account on the development and evaluation of CRT-loaded microemulsion (ME) hydrogel formulation containing tea tree oil (TTO) for improved drug delivery for scabies treatment in a safe and effective manner. Pseudo-ternary phase diagrams were constructed with TTO as the oily phase, and Cremophor®EL was used as the surfactant in a mass ratio 2:1 with co-surfactants (mixture of phospholipid 90G and Transcutol®P), and aqueous solution as the external phase. The optimized drug-loaded ME formulation was evaluated for skin penetration, retention, compliance, and dermatokinetics. The nonirritant behavior of the formulation was revealed by skin histopathology, which showed no changes in normal skin histology. In comparison to the conventional product, dermatokinetic experiments revealed that CRT has greater penetration and distribution in the epidermis of the mice skin. The findings imply that the proposed lipid-based ME hydrogel can aid in the resolution of CRT issues by providing a better and safer delivery option to epidermis and deeper epidermis in substantial quantities.

Bullous Scabies: Clinical, Dermoscopic, and Pathologic Characteristics of Ten Patients.

Bullous scabies (BS) is a rare atypical clinical variant of scabies and is easily confused with bullous disorders. The diagnosis of BS is always a challenge, and physicians often misdiagnose BS patients. Patients with BS admitted from 2012 to 2020 were enrolled in this study. The clinical, dermoscopic, and pathological characteristics of the patients were analyzed retrospectively. Ten patients with BS were enrolled in this study. Seven of the 10 patients were male. The bullae were most commonly found on the thighs and arms (80% of patients). Only 30% of patients (3/10) tested positive for mites and/or eggs by the initial skin scraping, but 100% (5/5) of the patients who received dermoscopy tested positive. Among these 10 patients, only five received a skin biopsy. Subepidermal (4/5) and intraepidermal (1/5) bullae with eosinophil and neutrophil infiltration were observed in five patients. Direct immunofluorescence (DIF) indicated linear deposition of IgG in the basement membrane zone in three patients. Physicians should consider the possibility of BS in patients with blisters, pruritus, and poor response to corticosteroids. Dermoscopy should be prioritized for the differential diagnosis of BS to exclude other bullous disorders. Finally, a biopsy should be performed on each patient with bullae.

Common pediatric infestations: update on diagnosis and treatment of scabies, head lice, and bed bugs.

PURPOSE OF THE REVIEW: This review will update pediatric providers on the recent data regarding the epidemiology, diagnosis, and treatment of common skin infestations affecting children and adolescents. RECENT FINDINGS: Standard superficial skin biopsy for scabies and the vacuum method for head lice can increase diagnostic accuracy and efficiency. There is growing resistance to some of the traditional treatments for scabies and head lice, and progress has been made in finding newer and potentially more effective treatments, such as oral moxidectin for scabies and abametapir for head lice. Recent studies have established the safety of traditional treatments, such as permethrin and oral ivermectin in infants and small children. SUMMARY: Permethrin and ivermectin are both considered safe and effective for children and adolescents with scabies. Permethrin is generally considered safe in infants less than two months of age. Proper application of permethrin is critical, and providers should emphasize proper application technique. Treatment of head lice should only be initiated with active infestations. Resistance to permethrin continues to increase and other options are now available, including an over-the-counter topical ivermectin formulation. Identification and eradication of bed bug infestations are crucial in preventing bedbug bites.

Control of scabies in a tribal community using mass screening and treatment with oral ivermectin -A cluster randomized controlled trial in Gadchiroli, India.

BACKGROUND: Scabies is often endemic in tribal communities and difficult to control. We assessed the efficacy of a community-based intervention using mass screening and treatment with oral ivermectin in controlling scabies. METHODS/ FINDINGS: In this cluster randomised controlled trial, 12 villages were randomly selected from a cluster of 42 tribal villages in Gadchiroli district. In these villages, trained community health workers (CHWs) conducted mass screening for scabies. The diagnosis was confirmed by a physician. Six villages each were randomly allocated to the intervention and usual care arm (control arm). In the intervention arm (population 1184) CHWs provided directly observed oral ivermectin to scabies cases and their household contacts. In the usual care arm (population 1567) scabies cases were referred to the nearest clinic for topical treatment as per the standard practice. The primary outcome was prevalence of scabies two months after the treatment. Secondary outcomes were prevalence of scabies after twelve months of treatment and prevalence of impetigo after two and twelve months of treatment. Outcomes were measured by the team in a similar way as the baseline. The trial was registered with the clinical trial registry of India, number CTRI/2017/01/007704. In the baseline, 2 months and 12 months assessments 92.4%, 96% and 94% of the eligible individuals were screened in intervention villages and 91.4%, 91.3% and 95% in the usual care villages. The prevalence of scabies in the intervention and usual care arm was 8.4% vs 8.1% at the baseline, 2.8% vs 8.8% at two months [adjusted relative risk (ARR) 0.21, 95% CI 0.11-0.38] and 7.3% vs 14.1% (ARR 0.49, 95% CI 0.25-0.98) at twelve months The prevalence of impetigo in the intervention and usual care arm was 1.7% vs 0.6% at baseline, 0.6% vs 1% at two months (ARR 0.55, 95% CI 0.22-1.37) and 0.3% vs 0.7% at 12 months (ARR 0.42, 95% CI 0.06-2.74). Adverse effects due to ivermectin occurred in 12.1% of patients and were mild. CONCLUSIONS: Mass screening and treatment in the community with oral ivermectin delivered by the CHWs is superior to mass screening followed by usual care involving referral to clinic for topical treatment in controlling scabies in this tribal community in Gadchiroli.

The use of Cydectin® by wildlife carers to treat sarcoptic mange in free-ranging bare-nosed wombats (Vombatus ursinus).

Wombats suffer from sarcoptic mange, a mite infection that ultimately leads to their death from secondary infections. In 2017, wildlife carers were granted legal approval to treat bare-nosed wombats (Vombatus ursinus) for sarcoptic mange in the field using 4 mL of topical Cydectin® per adult wombat. However, (limited) scientific field trials suggest approved protocols are inadequate which has been supported anecdotally by wildlife carers. Elucidating carer experience is key to holistically advancing understandings of sarcoptic mange treatment. We interviewed 18 wildlife carers regarding the use of Cydectin® to treat free-ranging adult wombats infected with sarcoptic mange which uncovered 43 detailed case studies for examination. Case studies revealed that wildlife carers have used 10-200-mL doses of topical Cydectin® to treat wombats to recovery. These results suggest there is no best-fit for treating wombats in the field, due to individual differences in observed levels of sarcoptic mange severity and differences in wombat behavior. Furthermore, wildlife carers suggested pour-on Cydectin® appeared non-toxic to wombats at rates as high as 200 mL per treatment. We recommend scientific trials should be undertaken to determine the impact and efficacy of the varying treatment regimens, including low and high doses of topical Cydectin® on bare-nosed wombats. This information is required for regulating authorities, and subsequently wildlife carers, and managers, to make fully informed decisions about wombat sarcoptic mange treatment.