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Scabies infection

The word Scabies is derived from the Latin word Scabere, which means “to scratch”.

Scabies is caused by infection of the skin with a small (0.5mm) insect called Sarcoptes Scabiei. The infection is most often spread by direct skin contact with an infected person or less often by sitting or sleeping in a space where an infected person has been. Once the female mite is on the skin it burrows into the top layer of the skin where she will lay her eggs.

The symptoms of Scabies starts a few weeks after exposure in people that have never had Scabies before. If someone had Scabies previously, reinfection can cause symptoms to appear in a few days. The rash can appear anywhere on the skin, but is more common in the skin folds areas, genital area, around the wrists, elbows, side of the hands and between the fingers. In young children the side of the feet is commonly affected. The initial sign of infection is a small, red, scaly or pearly-looking bump. Itching can be severe, especially at night. As the condition persists signs of scratching will start to
dominate and eventually the affected areas start looking eczema-like.

The diagnosis of Scabies is made by scraping a red bump, mounting the scraping sample on a glass slide and then seeing the insect under the microscope. Sometimes the mite cannot be found in this way in which case the diagnosis is based on the patients symptoms and the clinical signs found on examination of the skin.

Scabies can be treated easily in most cases. Ascabiol lotion (Benzyl benzoate) is an often used treatment option. Tetmosol soap (Sulfiram 5%) is often prescribed by some practitioners, but does not work very well if used in isolation. Ascabiol lotion is applied from the neck downwards and left overnight. In the Scabies mitemorning it is washed off. The procedure is repeated after one week.

The symptoms of Scabies might take weeks to resolve, even after the Scabies mites have been killed by treatment. This is because parts of the dead mite will remain in the skin and need to be shed off over time.

Overzealous use of Ascabiol lotion can lead to skin irritation, which is often the presenting complaint when patients come to our clinic.

How to eliminate House Dust Mite

House_Dust_MiteThere are many triggers that can cause a flare-up of Atopic eczema. The House Dust Mite is one such trigger.  House Dust Mite lives in the dust found in human and animal habitation.  Not everybody with Atopic eczema will be sensitive to the House Dust Mite, but more than 35% of Atopic eczema patients are sensitive to House Dust Mite. The Atopy Patch test can be used to test for House Dust Mite Allergy.

House Dust Mites feed on pollen, fungi, bacteria and most importantly on the skin flakes shed from humans and animals. These skin flakes concentrate in the creases of bedding and furniture. The number of skin flakes and House Dust Mites found in an area is proportional to the time humans and animals spend in that area. Bedding will therefore contain large numbers of House Dust Mites.

If you want to start a House Dust Mite elimination campaign the places to concentrate your efforts should therefore be those areas where the family spend most of their time.

Before describing the steps needed to contain the House Dust Mite population, please note that the elimination of House Dust Mite is still vastly less important than the regular application of moisturisers.

PREPARATION

  • Completely empty the room, just as if you were moving.
  • Empty and clean all cupboards. If possible, store contents elsewhere and seal the cupboards.
  • Remove carpeting.
  • Replace curtains with metal of wooden blinds that are easy to clean
  • Clean and scrub the woodwork and floors thoroughly to remove all traces of dust.
  • Wipe wood, tile, or linoleum floors with water, wax, or oil.
  • Cement any linoleum to the floor.
  • Keep the doors and windows closed.

MAINTENANCE

  • Clean the room thoroughly and completely once a week.
  • Clean floors, furniture, tops of doors, window frames and sills, etc., with a damp cloth.
  • Carefully vacuum upholstery regularly. Use a special filter in the vacuum.
  • Air the room thoroughly after cleaning

BEDS AND BEDDING

  • Keep only one bed in the bedroom. Most importantly, wrap mattress in a zippered dust-proof or allergen-proof cover. Scrub beds outside the room. If you must have a second bed in the room, prepare it in the same manner.
  • Use only washable materials on the bed. Sheets, blankets, and other bedclothes should be washed frequently in water that is at least 50 degrees Celsius. Lower temperatures will not kill dust mites. If you set your hot water temperature lower, wash items at a laundromat which uses high wash temperatures.
  • Use a synthetic material for bedding. Avoid fuzzy wool blankets or feather- or wool-stuffed pillows.

FURNITURE AND FURNISHINGS

  • Go for the minimalist look on the room.
  • Avoid upholstered furniture.
  • Use only a wooden or metal chair that you can easily clean.

AIR CONTROL

  • Modern air conditioners can reduce the levels of house dust mite in the air.

CHILDREN

  • Keep toys that will accumulate dust out of the child’s bedroom.
  • Avoid stuffed toys
  • Use only washable toys of wood, rubber, metal, or plastic
  • Store toys in a closed toy box or chest

PETS

  • Keep all animals with fur or feathers out of the bedroom. If you are allergic to dust mites, you could also be allergic or develop an allergy to cats, dogs, or other animals.

These steps are extreme, but it is only by eliminating >90% of house dust mites in an area, that you obtain any benefit. If these measures does not help to reduce the severity of your Atopic Eczema, you are most likely not sensitive to House Dust Mite allergens.

Is eczema contagious?

eczema-is-not-contagiousIs eczema contagious is a common question, but eczema is not contagious and people can therefore not “catch” eczema.

Eczema, like many other skin conditions, can become infected with bacteria or viruses. Once this happens other people can potentially “catch” the infection, but not the eczema! Eczema itself is not contagious.

The most common infection in eczema is with the bacterium Staphylococcus Aureus. The chances of catching the bacterium from someone with infected eczema is small. Immunosuppressed people, people with eczema or people with frequent, intimate contact with Staphylococcus Aureus infected eczema will have a greater chance of catching the bacterium.

If you have eczema, don’t be overly concerned about catching an infection, because secondary infections are normally simple to treat. The only exception to this will be when a Herpes virus or Molluscum contagiosum virus infects eczema. Eczema Herpeticum is the medical term for eczema infected with the Herpes virus. This can be a serious condition that often results in admission to hospital. Luckily, Eczema Herpeticum is very rare. Eczema infected with the Molluscum contagiosum virus occurs most often in children and does not normally result in serious illness.

Again, people might catch an infection from someone with eczema, but eczema itself is not contagious!

Seborrheic dermatitis

Seborrhoeic_eczemaSeborrheic dermatitis/eczema is a form of eczema that can appear only on certain parts of the body. The appearance of the rash varies depending on the area of the body that is involved. On the scalp the rash typically appears red and scaly, whereas in the skin folds the rash is typically devoid of scale and therefore appears red and moist.

The typical areas of the body that can be involved by Seborrheic dermatitis are as follows:

  • Scalp
  • The skin fold behind the ears
  • The skin fold between the nose and cheeks
  • The ear canals
  • The eyebrows
  • The mid chest
  • The mid back
  • The groin area, including the skin folds between the upper legs and abdomen

Not all of these areas have to be involved and most often it is just the scalp areas.

The rash is generally not very itchy, but some people describe a burning sensation on the involved areas, especially the scalp. People that suffer from so-called “Dandruff” is frequently in fact suffering from Seborrheic dermatitis. Dandruff is not a medical diagnosis and refers to the small white skin flakes occurring on the scalp. There can be many reason for excessive flaking of the scalp, of which Seborrheic dermatitis is one.

Seborrheic dermatitis occurs in two separate age groups, before 1 year of age and after puberty. After puberty men tends to be affected more often than women.

Nobody really knows the cause of Seborrheic dermatitis, but the overgrowth of a certain organism called Pityrosporum ovale has been implicated. However, not all people with Seborrheic dermatitis have Pityrosporum ovale overgrowth. The finding of huge numbers of Pityrosporum ovale in areas of Seborrheic dermatitis might therefore be just the result of the Seborrheic dermatitis and not the cause of the Seborrheic dermatitis. Another theory about the cause of Seborrheic dermatitis is that Seborrheic dermatitis is a disease of skin overgrowth just like Psoriasis.

Another important association with Seborrheic dermatitis is infection with HIV. People with HIV tend to develop Seborrheic dermatitis when the suppression of their immune systems reaches a certain level.

The treatment of Seborrheic dermatitis involves the use of various shampoos containing one or more of the following ingredients: Zinc, Selenium, tar and anti-fungals. A corticosteroid containing lotion, cream or mouse can be used during a flare up. Recently Tacrolimus and Pimecrolimus has also been used successfully for the treatment of Seborrheic dermatitis.

How to treat nappy rash

The term nappy rash simply refers to a rash in the nappy area. Many conditions can cause a rash in the nappy area. The first step is to determine what the cause of the nappy rash is.

Conditions that can cause a rash in the nappy area:

  • Primary irritant dermatitis
  • Candida infection
  • Atopic dermatitis
  • Allergic Contact Dermatitis
  • Seborrheic dermatitis
  • Psoriasis
  • Acrodermatitis Enteropathica
  • Langerhans Cell Histiocytosis
  • Bullous Mastocytosis
  • Incontinentia pigmenti
  • Bullous Pemfigoid
  • Dermatitis Herpetiformis
  • Linear IgA disease
  • Epidermolysis Bullosa
  • Herpes Simplex virus infection
  • Bullous Impetigo
  • Tinea cruris
  • Scabies
  • Papular urticaria

See why is it essential to determine the cause first?!

The most common cause of nappy dermatitis is Primary irritant dermatitis. Primary irritant dermatitis is a result of urine and faeces irritating the skin. The irritation of the skin is due to wetness, the alkalinity of urine and faeces, irritating enzymes in urine and faeces and secondary infection with Candida and bacteria.

The initiating irritating factor is wetness. The most important part of the treatment of Primary irritant dermatitis is to keep the baby’s bottom DRY. Regular nappy changes, frequently enough to prevent too much wetness, is the most important part of the treatment. Nappy changes can be reduced by using more absorbent nappies. After every nappy change apply a nourishing moisturiser to help repair the skin.

Inflammation (redness) can be treated with mild corticosteroid ointments.

Small sores and ulcers can be covered with Vaseline / White soft paraffin or Zinc oxide ointment.

Infections can be treated with antifungal creams and antibacterial creams.