Matriz de problemáticas

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• Griseofulvin is no longer considered effective because of its long treatment course and poor cure rate.

• Treating infections of the toenails is a bit difficult due to high rate of relapse with discontinuation of treatment.

3.4 Parasitic Skin Infestation

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Medical Management

• Washing the hair with a shampoo according to the product directions

• Rinse the hair thoroughly

• Comb the hair with a fine-toothed comb dipped in vinegar to remove any remaining nits or nit shells freed from the hair shafts.

• All contaminated articles, clothing, towels and bedding should be washed in hot water to prevent re-infestation.

• Upholstered furniture, rugs, and floors should be vacuumed frequently.

• Combs and brushes are also disinfected with the shampoo.

• All family members and close contacts are treated.

• Complications such as severe pruritus, pyoderma, and dermatitis are treated with anti-pruritics, systemic antibiotics, and topical corticosteroids.

Nursing Management

The nurse informs the patient;

• That head lice may infest anyone and are not a sign of un-cleanliness.

• Treatment must be started immediately.

• To shampoo their hair regularly.

• Not to share combs, brushes and hats.

• Encourage each family member to have their hair inspected for head lice daily for at least 2 weeks.

• To use lindane properly as it may be toxic to the central nervous system

PEDICULOSIS CORPORIS AND PUBIS

Pediculosiscorporis is an infestation of the body by the body louse.

Predisposing factors;

• Poor hygiene

• Overcrowded living

Pediculosis pubis is extremely common.

The infestation is generally localized in the genital region It is transmitted chiefly by sexual contact.

There may also be infestation of the hairs of the chest, armpit, beard, and eyelashes

159 Clinical Manifestations

• Bites cause characteristic minute hemorrhagic points.

• Intense itching is the most common symptom, more particularly at night

• Subsequent widespread excoriation due to scratching

• Reddish brown dust (i.e., excretions of the insects) may be found in the patient’s underclothing.

• Gray-blue macules may sometimes be seen on the skin due to;

o Reaction of the insects’ saliva with bilirubin (converting it to biliverdin) or

o An excretion produced by the salivary glands of the louse.

• The skin may become thick, dry and scaly with dark pigmented areas in long-standing cases

• Lice may be found crawling in the pubic area when examined with a magnifying glass

• Secondary lesions include parallel linear scratches and a slight degree of eczema.

Medical Management

• Instruct the patient to bathe with soap and water

• Topical therapies:

o Lindane (Kell) or 5% permethrin (Elimite)

o Over-the-counter strength of permethrin (1% Nix)

o Petrolatum cream twice daily for 8 days followed by mechanical removal of any remaining nits

• Anti-pruritics

• Systemic antibiotics

• Topical corticosteroids Complications;

• Severe pruritus

• Pyoderma

• Dermatitis

• Rickettsial disease such as epidemic typhus, relapsing fever and trench fever. The lice is a vector of these rickettsiae

Nursing Management

• Patients, all family members and sexual contacts must be;

o Treated

o Educated in personal hygiene

o Enlightened on methods to prevent or control infestation.

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o Scheduled for a diagnostic workup for coexisting sexually transmitted disease.

• All clothing and bedding should be machine washed in hot water or dry-cleaned.

3.4.2 Scabies

Scabies is an infestation of the skin by the itch mite Sarcoptesscabiei.

The disease is common in substandard hygienic conditions

It is also common among the sexually active individuals although infestations do not depend on sexual activity.

The mites frequently involve the fingers and hand

Contact with infected patients or contaminated clothing may produce infection.

Life cycle:

• The adult female burrows into the superficial layer of the skin

• It remains there for the rest of her life.

• With her jaws and the sharp edges of the joints of her forelegs, the mite extends the burrow

• She then lay two or three eggs daily for up to 2 months and dies thereafter.

• The larvae hatch from the eggs in 3 to 4 days and progress through larval and nymphal states to form adult mites in about 10 days.

Clinical Manifestations

• Symptoms appear approximately 4 weeks from the time of contact

• Severe itching is often the first symptom. It is caused by delayed type of immunologic reaction to the mite or its fecal pellets. Itching increases at night

• Small, raised burrows evidenced by multiple, straight or wavy, brown or black, threadlike lesions on examination with a magnifying glass and a penlight held at an oblique angle to the skin

• It is commonly observed between the fingers and on the wrists; other sites include the extensor surfaces of the elbows, the knees, the edges of the feet, the points of the elbows, around the nipples, in the axillary folds, under pendulous breasts and in or near the groin or gluteal fold, penis, or scrotum.

• Red, pruritic eruptions usually appear between adjacent skin areas.

• Secondary lesions are quite common and include vesicles, papules, excoriations and crusts. Bacterial super-infection may result from constant excoriation of the burrows and papules.

161 Assessment and Diagnostic Findings

The diagnosis is confirmed by;

• Recovering S. scabieibyproducts from the skin

• Microscopic demonstration of the mite at any stage (e.g., egg, egg casing, larva, nymph, adult) and fecal pellets on superficial epidermis sample.

Medical Management Instruct the patient to;

• Take a warm, soapy bath or shower to remove the scaling debris

• Dry the skin thoroughly and allow to cool.

• Topical scabicide, such as lindane (Kwell), crotamiton (Eurax) or 5% permethrin (Elimite): requires thin application on the affected area for 12 to 24 hours, after which it should be washed thoroughly off. One application may be curative, but should be used up to 1 week.

Nursing Management Advise the patient to:

• Wear clean clothing

• Sleep between freshly laundered bed linens.

• Wash all bedding and clothing in hot water and dried on the hot dryer cycle or dry cleaned, as mites can survive up to 36 hours in linens.

• Apply topical corticosteroid on skin lesions after a successful treatment as scabicides may irritate the skin.

• Note for signs of hypersensitivity to scabicides which include itching for several weeks particularly in atopic (allergic) people. This is not a sign of treatment failure.

• Avoid frequent hot showers because they can dry the skin and produce itching.

• Use oral antihistamines such as diphenhydramine (Benadryl) or hydroxyzine (Atarax) to control itching.

• Encourage all family members and close contacts to be treated simultaneously to eliminate the mites.

• Avoid scabicides in infants and pregnant women unless otherwise approved.

• Avoid application of scabicide immediately after bathing; before the skin dries and cools as these conditions increase percutaneous absorption of the scabicide and the potential for central nervous system abnormalities such as seizures.

• Seek treatment for coexisting sexually transmitted disease and pediculosis as the case may be.

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3.5 Non-Infectious Inflammatory Dermatoses