Insects ruining skin :(

what self-care should be done for insect bites?

wash with soap/water, then ice 10 mins on and off for 30-60 minutes

external analgesic to relieve the pain and itching; local anesthetics or counterirritants (camphor/menthol)

• applied to the bite area 3-4 times daily, do not use <2 years old, do not use longer than 7 days

  • local anesthetics can cause sensitization, pramoxine and benzyl alcohol are less likely to cause adverse effects

what self-care should NOT be done for insect bites?

do not use dibucaine in large quantities, particularly over raw surfaces or blistered areas, such use could cause myocardial depression, convulsions, or death

do not use topical diphenhydramine (can depress cutaneous receptors) longer than the recommended 7 days — prolonged use can cause HS rxns or systemic effects

do not use hydrocortisone/any GC on scabies, bacterial infections, or fungal infections without a medical recommendation

what non-pharm should be done for stings?

removal of stinger and apply ice promptly alternating 10 minutes, Benadryl PO 25-50 mg may help — for sx’s of allergy seek immediate medical treatment

how do you treat flea bites?

avoid scratching, if possible, wash area, ice packs/calamine, oral antihistamines (cetirizine, loratadine, fexofenadine), topical corticosteroids

Treating pets with topical insecticides or treating both the best and home simultaneously with insecticides. Pet bedding should be wash frequently and carpets kept as clean as possible

discard infested couches or overstuffed chairs

facts regarding flea bites:

Kill the adults on infested pets, destroy eggs, larvae, and adults in bedding, carpets, and furniture. Can spread other diseases (typhus, cat scratch disease)

little evidence that feeding pets yeast, vitamin B12, or garlic will prevent flea infestations

facts regarding bedbugs and their bites

all life stages feed on blood, they live in dark cracks and crevices in the vicinity of where people sleep or sit, such as overstuffed couches, only leaving these sites to feed, may identify as reddish/brown specs on sheets

they only stay on the host long enough to feed — inject anesthetic and anticoagulant

similar to flea/mosquito bite, not known to transmit any disease-causing pathogen

everyone is susceptible if in bedbug infested area

which type of bites may cause itchy red papules, may take several days to 2 weeks for papules to appear and are difficult to tell what caused them?

bedbug bites

how do you treat bedbug bites?

avoid scratching concern for secondary infection (hard to do!), low- or medium-potency topical corticosteroids, systemic antihistamines

skin disease secondary to the bites of mites is most common during which seasons?

summer and fall

how to prevent chigger bites

vigorous soap and water (repel with DEET)

how do you treat chigger bites?

topical antipruritics such as menthol or calamine lotion

topical corticosteroids

oral sedating antihistamines

facts regarding mosquito bites

inject anticoagulant saliva which leaves to welts, pain, and itching

some patients get systemic symptoms such as fever and joint swelling

vector for spreading West Nile, Chikungunya, and Zika viruses

what can you use to treat mosquito bites?

antihistamines (cetirizine, loratadine, fexofenadine)

topical glucocorticoids x 5-10 days

oral glucocorticoid (prednisone 1 mg/kg with a max of 50mg/day for 5-7 days)

facts regarding tick bites

feed on blood of humans and animals, remove tick but do not leave mouthparts in skin

takes 36 hours to transmit Lyme disease

ticks are vector for disease transmission (Rocky Mounted Spotted Fever, Lyme disease)

what are some insect repellents?

topical DEET is considered to be the most efficacious repellent, topical IR 3535, topical picaridin, topical oil of lemon eucalyptus (OLE), topical catnip oil, topical 2-undecanone, metofluthrin, permethrin applied to clothing while not being worn (do not apply to skin)

facts regarding DEET repellant

repellents, available in sprays, solutions, creams, and wipes (may cause rare side effects such as dermatitis, allergic reactions, neurotoxicity, not carcinogenic), avoid inhaling (especially in children)

use no more frequently than q4-8h

children should use concentrations < 30%

higher concentrations will last longer but does not mean it will work better

concentrations of 20% or higher recommended for ticks

what are the stages of anaphylaxis?

stage 1: symptoms like skin rash or redness, itching or hives

stage 2: person has more widespread and extensive symptoms like skin rash and hives that are spreading or mild swelling in their lips and tongue

stage 3: involves person displaying signs of difficulty breathing, extensive swelling, weak pulse or dizziness. a person in stage three anaphylaxis is experiencing a condition called anaphylactic shock

stage 4: life-threatening, involves a person losing consciousness, being unable to breathe and having inadequate blood flow to vital organs. a person in this stage needs immediate medical attention to avoid death

what is the dosing for an EpiPen?

30 kg or more body weight = 0.3mg/0.3mL

what is the dosing for EpiPen Jr.?

15 to less than 30 kg body weight = 0.15mg/0.3mL

what is the brand of epinephrine nasal spray?

Neffy (1 dose per inhaler device)

who can use neffy?

adults and children aged 4 year and odler who weight 33 pounds or more who are at risk for or have hx of serious allergic emergencies (do not prime)

what is the term for head lice?

pediculosis humanus capitis

how is head lice transferred?

direct head-to-head, hand-to-hand, vectors-hats, pillows —- they do not jump but can crawl, and if detached from the body for > 48 hours usually do not live

what are the clinical manifestations of head lice?

itch, excoriations, swollen glands (secondary infection)

facts regarding head lice treatment

wash clothes and bedding in hot water, then use hot dryer, seal in air-proof bag for 2 weeks, vacuum well, soak combs/brushes in hot water for at least 10 minutes

what is the MOA for head lice treatments?

neurotoxin

what is the age group for Ivermectin in head lice?

>/= 6 months

what is the age group for malathion (Ovide) in head lice?

>/= 6 years; contraindicated in children under 2 years; safety has not been established in children 2-6 years old

what is the age group for permethrin 1% (Nix) in head lice?

>/= 2 months

what is the age group for pyrethrins and piperonyl butoxide (Rid) in head lice?

>/= 2 yearss

what is the age group for spinosad (Natroba) in head lice?

>/= 6 months

what is the regimen for ivermectin in head lice?

leave on hair and scalp for 10 minutes, then rinse

what is the regimen for malathion in head lice?

leave on hair for 8-12 hours, then wash with a nonmedicated shampoo. a single application may be effective; repeat in 7-9 days if live lice are seen

what is the regimen for permethrin 1% in head lice?

leave on damp hair for 10 minutes, then rinse, repeat on day 9

what is the regimen for pyrethrins and piperonyl butoxide in head lice?

leave on dry hair for 10 minutes, then rinse, repeat on day 9

what is the regimen for spinosad in head lice?

leave on hair for 10 minutes, then rinse; repeat in 7 days if live lice remain

what are the precautions/side effects of ivermectin?

skin or eye irritation

what are the precautions/side effects of malathion?

malodorous, flammable, skin irritation, theoretical risk for respiratory depression if ingested

what are the precautions/side effects of permethrin 1%

skin irritation, pyrethrins may induce breathing difficulties in pts with ragweed allergy; avoid in patients with chrysanthemum allergy

what are the precautions/side effects of pyrethrins and piperonyl butoxide

skin irritation

what are the precautions/side effects of spinosad

skin irritation

what is some of the general guidance for head lice?

do not use hair conditioners prior to application, rinse over sink instead of shower to prevent skin exposure, rinse with warm water not hot to prevent vasodilation and absorption

bedmates should be prophylactically treated.

what is the specific MOA of Nix?

kills lice by suffocation and destroying ability to excrete water (must be at least 2 years old to use)

T/F: you should wait 1-2 days before shampooing/conditioning your hair after treatment with Nix or Rid

true

what is an alterative/additional treatment for headlice besides medication?

wet combing

what can be used for resistant cases of head lice?

oral TMP-SMX + topical permethrin (bactrim kills symbiotic bacteria in louse gut that produces B vitamins that louse require)

what is another name for body lice?

pediculosis corporis

how does body lice present?

intense pruritic, may have rash; allergy to saliva in louse bite

heavily bitten areas of the skin thickened and discolored (particularly around waist, groin, upper thighs)

bite reaction similar to head lice

lice/nits may be seen in clothing, clothing may be stained by louse feeds/blood

what are the risk factors for body lice?

lower socioeconomic status, direct physical contact, contact with infested fomites

what are lice vectors for?

epidemic typhus, trench fever, and louse-borne relapsing fever

what are the treatments for body lice?

ensure regular change of clean clothes at least weekly, thorough bathing

washing clothing in hot water

ironing clothing with hot flat iron kills nits

vacuum area well

pediculicide generally is not necessary

how is pubic lice transmissed?

physical contact (sexual), and sharing fomites (less likely)

unlikely from toilet seat bc louse prefer warm environments and difficult to grab smooth surface

how does public lice present?

can be asymptomatic, urticaria (small erythematous papules) in periumbilical areas, blisters, maculae ceruleae (red macules with blue tinge), may be itchy

how is public lice treated?

topical permethrin 1% or pyrethrins + piperonyl butoxide

ensure the skin is cool and dry before application to minimize percutaneous absorption, apply the pediculicide to all areas of suspected involvement, wash off the pediculicide after 10 minutes, remove nits with fingernails, a nit comb, or tweezers, put on clean clothing and clothing following treatment

retreatment 9-10 days

what are some counseling points for pubic lice?

sexual partners treated at same time as patients (avoid sexual contact until both partners treated)

nonsexual contacts do not need to be treated if they have no signs of infestation

persons with pubic lice should be evaluated for other STDs

fumigation is NOT necessary

what is the other name for eye lash infestation of lice?

ciliaris (phthirus ciliaris)

how do eye lash infestations present?

reddish crusting, matting, conjunctivitis common, may involve bilateral and may involve eyebrow

how to treat eye last infestations

manual removal or apply ophthalmic grade petroleum jelly BID-QID for 10 days

how is scabies transmissed?

direct, prolonged, skin-to-skin contact with a person who has it

rarely fomites, usually will not live more than 2 days off skin

what are the manifestations of scabies?

classic: intense pruritis, worse at night with onset symptoms 3-6 weeks after infestation if not had scabies before, if had prior then onset of symptoms 1-3 days after infestation d/t sensitized immune system

itching may persist for several weeks after cure

classic rash: non to generalized erythema

classic burrow: slightly elevated 1-2 mm long

how is scabies diagnosed?

finding mite or burrow — microscopy may find mite, egg, or fees (scybala)

what are the drug options for scabies?

Permethrin 5% (Elimite) cream, ivermectin 200 mcg/kg x 1 and repeat 14 days later, Crotamiton 10% cream or lotion (Eurax), Spinosad (Natroba)