1

dr. Uun Khusnul Khotimah, SpKK

2

● Zoonosis : skin disease caused by various parasites

● This disease is often found in :o Crowded areaso Low socio-economic conditiono Poor sanitation and hygiene

● In the eradication effort, these attempts are needed: ◦ Early diagnosis and prompt treatment ◦ Public health education about : - Prevention - Proper hygiene - Reservoir-host-vector control

3

The causes of this disease are divided into 3 major groups :

1. PROTOZOA : - Amoebiasis - Trichomoniasis

2. NEMATODA : - Oxyuriasis / enterobiasis - “Ground itch” - Cutaneous larva migrans

- Current larva - Filariasis - Dracunculiasis

3. ARTROPODA : - Scabies - Pediculosis

4

● Causative agent : Ancylostoma braziliensis,

Ancylostoma caninum, &

Uncinaria stenocephala

● Mostly affects children, miners and farmers.

5

Pathogenesis : Adult hookworm in dogs’ / cats’ small

intestines ↓ Eggs (in animal faeces) ↓ Rhabditiform larvae (soil) ↓ Filariform larvae (soil) ↓ penetrate

The skin ↓

“Creeping eruption”

6

Clinical features :

- Common locations are on the buttocks, feet, & hands.

- The diameter of the lesion is 1 – 4 mm, red in color, a bit raised, like a coiled thread.

7Typical track of CLM located on plantar aspect of foot.

8Vesiculobullous lesion of CLM.

9

● Diagnosis : typical lesion manifestation

● Treatment : ○ Topical :

- Classic : Chlorethyl spray, CO2, liquid N2

- Thiabendazole 10%- Albendazole 2%

○ Systemic : - Thiabendazole 25 mg/kgBW/day → 2

days- Albendazole 50 mg/kgBW/once a week

10

● Method of transmission :- Direct → handshake, sexual contact- Indirect → through objects

● Etiology : Sarcoptes scabiei var hominis

Life cycle : Female mites in stratum corneum ↓

Eggs ↓ 3–4 days

Larvae 10–14 ↓ days

Mites

11

Clinical features :

- Predilection : in-between fingers, flexor of the wrists, genitalia, axillae folds, lower abdomen,

buttocks.

- Lesion → papule, vesicle, excoriation/secondary

infection, sometimes forming

burrows.

12

Clinical variations : “Incognito” scabies Scabies in infants &

children Noduler scabies Scabies transmitted

by animals Scabies “in a clean” Norwegian scabies

13

14

● Additional examinations :- Microscopic → mites, eggs, faeces- Burrows → tetracycline- Skin biopsy

● Diagnosis :- Itch, especially at night-time (nocturnal itching)- History of infection on members of the family / people living under the same roof- Characteristic distribution of lesion- Characteristic lesion → burrows- Definite diagnosis → mites, eggs, faeces- Tx antiscabies → improvement

15

● Treatment :– Gamexan 1%– Crotamiton 10%– Sulfur 5 – 10%– Benzoil benzoate 20 – 35%– Permethrin 5%

● To achieve treatment success : - Treat every contact person - Correct drug administration - Washing clothes and towels with hot water,

air mattress under the sun - Avoid excess treatment

16

• P. capitis → P. humanus var capitis• P. corporis → P. humanus var

corporis• P. pubis → Phtirus pubis

Pathogenesis :- Direct contact- Indirect contact

17

P. CAPITIS● Clinical manifestation : often affects children● Symptoms :

- itch, especially on the occipital & temporal parts → excoriation,

erosion / secondary infection- swelling of the lymph glands

P. CORPORIS● Clinical features :

- hemorrhagic macules / papules with punctum in the middle- urtica

18

P. PUBIS● Mites → pubic hair, eyebrows, eyelashes,

axillae region, sometimes body hair● Clinical features :

- itch → excoriation / secondary infection

- Characteristic → “maculae cerulae”

19

Diagnosis :P. capitis : shiny eggs on hair,

mitesP. corporis : eggs / mites on clothes’

foldsP. pubis : eggs / mites on pubic hair,

eyelashes, body hairTreatment :

P. capitis : - gamexan 1% shampoo - permethrin 1% cream - crotamiton 10% cream /

lotionP. corporis : - gamexan 1%

- Washing clothes / bed sheets

using hot water / ironing them

P. pubis : - petrolatum - physostigmine 0,025% eye

oint

20