Escabiosis: lesiones pruriginosas altamente contagiosas / Scabies: highly contagious pruritic lesions

La escabiosis es una infestación producida por Sarcoptes scabiei, caracterizada por lesiones generalizadas pruriginosas. El diagnóstico es eminentemente clínico. Síntomas compatibles en varios miembros de la misma familia se consideran diagnósticos. El tratamiento consiste en la aplicación de Permetrina al 5% en la superficie cutánea.

Scabies is an infestation produced by Sarcoptes scabiei. Itchy generalized lesions characterized this pathology. The diagnosis is clinical. Compatible symptons presented in some members of the same family are considered diagnostic. The treatment is based in the application of Permetrine 5% in all the cutaneous area.

Crusted scabies due to indiscriminate use of glucocorticoid therapy in infant

Abstract Crusted or Norwegian scabies is a parasitic infectious disease caused by Sarcoptes scabiei var. hominis that mainly affects immunocompromised individuals and those with neurological patients. We report a case of crusted scabies in a 4-month-old infant who had been treated erroneously for atopic dermatitis with high doses of corticosteroids. This initial misdiagnosis associated with the abusive use of corticosteroid facilitated the evolution of scabies to crusted scabies and its main complications of secondary infection and sepsis.

Manejo en atención primaria de escabiosis en una familia con ruralidad extrema / Primary care management of scabies in a family with extreme rurality

La dermatoparasitosis producida por el acaro Sarcoptes scabiei variedad hominis, presenta una distribución poblacional relacionada al hacinamiento, condiciones higiénicas deficientes, pobreza y características geoclimáticas. El contagio ocurre de forma directa cutánea o a través de fómites. Liquiñe,poblado fronterizo de la Región de los Ríos, Chile, presenta en gran parte de su población las características mencionadas, con difícil acceso a comunicación digital y derivación médica. La incidencia de sarna se ve modificada al realizar intervenciones educacionales y saneamiento local, tanto como el diagnostico precoz y el tratamiento oportuno logran una modificación sustancial de la prevalencia. Se presenta el reporte de un caso. Paciente sexo femenino, 33 años, que presenta lesiones por grataje, excoriadas, con pápulo-pústulas de dos años de evolución, con manejo inicial sintomático por diagnóstico de dermatitis y psoriasis sin mejora de las lesiones. Conjuntamente se identifica en la hija de 4 años, lesiones primarias de características similares a las iniciales. Las lesiones de la menor se presentan como vesículas en espacio interdigital, muñe-cas, región periumbilical y surco acarino, compatibles con sarna. Se inicia tratamiento tópico permetrina 5 %a toda la familia, basados en las recomendaciones de la guía de manejo MINSAL. Se logra tras 2 años de evolución regresión total de los signos y síntomas a los 2 meses de iniciada la terapia. La presente revisión de caso pretende reforzar las ideas de diagnóstico precoz, tanto de caso índice como de probables contactos,educación continua a la comunidad. Tratamiento efectivo y oportuno, adecuado a la realidad socio cultural década localidad, tomando en cuenta factores de riesgos para la presentación y el abandono de la terapia. Asimismo promover las redes institucionales para la distribución de tratamiento, asesoramiento por especialistas y conocimientos actualizados de la semiología de cada cuadro dermatológico por el médico general.

The dermato parasitosis producedby the Sarcoptes scabiei mite hominis variety, has apopulation distribution related to over crowding, poor sanitation, poverty and geo-climatic characteristics.Transmission occurs directly through skin or fomites.In the border town of Liquiñe in the Region de los Rios,Chile, a substantial amount of the population is subject to the above characteristics, with difficult access to digital communication and medical referrals. The incidence of scabies is modified through educational interventions, and local sanitation, as well as early diag-nosis and timely treatment thus achieving a substantial change in prevalence. A case report is presented. Female patient, 33 years old presents with excoriated crusted lesions, with papules and pustules following two years of development, initial symptomatic management diagnosis of psoriasis and dermatitis,showed no improvement of the lesions. At the same time the 4 year old daughter of the patient presented with primary lesions similar to baseline characteristics.The child ́s lesions presented as vesicles in interdigital space, wrists, periumbilical region and mite grooves compatible with scabies. Permethrin 5% topical treatment was prescribed for the whole family, basedon the recommendations of the MINSAL guide management is initiated. At 2 months of treatment therapy on set, complete recovery was achieved following two years of evolution of signs and symptoms.This case review aims to reinforce the ideas of earlydiagnosis, in both probable index case and contact,and continuing education in the community. Effective and timely treatment, in conjunction with the socio-cultural reality of each community, taking into account risk factors, such as seeking medical treatment and abandoning therapy. Furthermore, it is also intended to promote institutional networks for treatment dissemination, counseling by specialists and updated information for each dermatological presentation for the general medicine physician.

Pediculosis hasta 2008 / Pediculosis until 2008

La pediculosis es una patología cuya prevalencia está en aumento en todo el mundo. En parte, esto se debe a las dificultades que presentan los tratamientos disponibles. Los pediculicidas químicos usados actualmente son piretrinas (permetrina 1% es la más usada), malatión 0,5%, lindano 1% (cuestionado debido a su neurotoxicidad e impacto ambiental) e ivermectina (sin aprobación de la Food and Drug Administration). Si bien existe una creciente evidencia sobre el desarrollo de resistencia a estos pediculicidas, es importante considerar la correcta realización de los tratamientos o la presencia de una reinfección antes que el desarrollo de resistencia propiamente dicho, razón por la cual es recomendable que el problema sea abordado en forma conjunta por el equipo de salud, la escuela y la familia. Actualmente se investigan nuevas opciones terapéuticas más seguras y eficaces como, por ejemplo, métodos físicos, aceites esenciales y derivados vegetales, nuevos insecticidas o la incorporación formal de opciones como la ivermectina, para lo cual aún se requiere más investigación que aporte evidencia de mejor calidad metodológica.

Head lice is a condition whose prevalence is increasing worldwide, probably because of the difficulties that available treatments present. Chemicals pediculicides currently in use are pyrethrins (1% permethrin is the most widely used), 0.5% malathion, 1% lindane (questioned because of its neurotoxic effects and their environmental impact) and ivermectin (not yet approved by the Food and Drug Administration). While there is increasing evidence of growing development of resistance to these pediculicides, it is important to consider the proper conduct of the treatments or the presence of reinfection before considering the real development of resistance, for these reasons a global assessment that includes the health equipe, the school and the family is desirable. New therapeutic options, both safe and effective, are being investigated. They include physical methods, products derived from essential oils and herbal products, new insecticides and ivermectin, which requires further research to provide evidence of better quality.

Forma de aplicación y efectividad de la Permetrina 1 por ciento, utilizada por convivientes con escolares, para el control de la pediculosis capitis en los niños / Ways of application and effectiveness of 1 permethrin used by schoolchildren relatives for the control of pediculosis capitis

Introducción: entre los problemas que inciden en los fallos, de los tratamientos pediculicidas, están la forma de aplicación y la baja efectividad de los productos utilizados. Objetivos: conocer, por medio de encuestas de opiniones, la forma de aplicación y la efectividad de la Permetrina 1 por ciento fabricada en Cuba para el control de los piojos. Métodos: los cuestionarios se distribuyeron entre los convivientes con escolares de primaria, que con anterioridad habían utilizado el producto en los niños. El trabajo se realizó de mayo a julio de 2007 en escuelas urbanas y rural-urbanas de las provincias Ciudad de La Habana, Sancti Spíritus y Las Tunas, en Cuba. Resultados: de 786 convivientes encuestados, 637 (81,17 por ciento) no aplicaron el pediculicida según las indicaciones formuladas en el prospecto, que se adjunta al frasco, 579 (73,66 por ciento) la consideran ineficaz y solo 143 (16,32 por ciento) la han utilizado como único tratamiento. Conclusiones: no existe sincronización en los pasos seguidos durante el tratamiento. Se evidencia una alta heterogeneidad en las respuestas, porque más de 70 por ciento de los encuestados la consideran ineficaz para el tratamiento de la pediculosis capitis.

Background: Among the problems that influence on failure of pediculosis treatment is the way of application and low effectiveness of used products. Objectives: to find out, through surveys, the ways of application and the effectiveness of 1 percent permethrin manufactured in Cuba for the control of pediculosis capitis. Methods: the questionnaires were distributed among people living with elementary schoolchildren, who had previously applied the products to children. The study was performed from May to July 2007 in urban and rural-urban schools located in City of Havana, Sancti Spiritus and Las Tunas provinces in Cuba. Results: Seven hundred and eighty six people were surveyed, 637 of them (81,17 percent) did not follow the instructions given in the flask in applying the anti-pediculosis products, 579 (73,66 percent) considered it as ineffective and only 143 (16,32 percent) had used it as unique treatment. Conclusions: there is not any agreement in steps followed by these people during treatment. Responses were very heterogeneous because over 70 of surveyed persons stated that permethrin was ineffective for treatment of pediculosis capitis.

Cromatografia líquida de alta eficiência aplicada ao controle da qualidade de cis-permetrina em loção capilar / High-performance liquid chromatography applied to the control of the quality of cis-permethrin in capillary lotion

Doenças ectoparasitárias como a escabiose, a pediculose, a tungíase e a larva migrans cutânea são epidêmicas em inúmeras comunidades carentes no Brasil e seu controle efetivo é um desafio para a Saúde Pública. Embora a permetrina seja um dos medicamentos aprovados pelo Food and Drug Administration para o tratamento da pediculose, não há um método oficial disponível para a realização do controle da qualidade deste produto em loção capilar de uso humano. Assim, o objetivo deste trabalho foi desenvolver e validar um método analítico sensível, específico, preciso e exato para esta análise, seguindo os critérios descritos na Resolução no 899/2003 da Agência Nacional de Vigilância Sanitária (ANVISA). A cromatografia líquida de alta eficiência (HPLC) com detector diode array (λ = 235nm) foi empregada na determinação de cis-permetrina em loção capilar, visando implementar um sistema de controle da qualidade em laboratórios analíticos. A cis-permetrina e a substância utilizada como padrão interno (PI), o cloridrato de nafazolina, foram separados em coluna analítica S5W (4,6 x 150mm) Waters Spherisorb® e eluídos isocraticamente (fluxo de 1,2mL/min). A cis-permetrina e o PI foram caracterizados pelos tempos de retenção de 1,52 e 8,66 minutos respectivamente. O método mostrou-se linear na faixa de 1,6 a 127,5µg/mL e, nos estudos de precisão intra e interensaio, foram obtidos coeficientes de variação inferiores a 5%, calculados a partir dos resultados. A exatidão média do método foi de 103%. Os limites de detecção e quantificação foram 1,6µg/mL e 2,4µg/mL respectivamente. A cis-permetrina manteve-se estável por 24 horas à temperatura ambiente; por 15 dias a 4ºC e 30 dias a -20ºC. O método mostrou-se simples e apropriado para a determinação de cis-permetrina em loção capilar.

Parasitic skin diseases such as scabies, pediculosis, tungiasis, and cutaneous larva migrans are epidemic in numerous communities in Brazil and their effective control is a major challenge to public health. Permethrim is one of the medications approved by the Food and Drug Administration to treat pediculosis. However, official methods of quality control for permethrin's use as hair lotion are currently unavailable. Thus, a specific and accurate method was validated using high performance liquid chromatography (HPLC) with a diode array detector (λ = 235 nm) in order to determine cis-permethrin in hair lotion, aiming to establish a systemof quality control in analytical laboratories. Cis-permethrin and naphazolinechloride (internal standard - IS) were separated in an analytical S5W column (4.6 x 150 mm) Waters Spherisorb® and isocratically eluted (flow rate =1.2 mL/min). Cis-permethrin and IS were characterized by their retention times: 1.52 and 8.66 minutes, respectively. The accuracy of this method was 103%. A linear range was detected from 1.6 to 127.5µg/ml and CV < 5% calculated from intra and inter-essay precision results. LOD and LOQ were 1.6µg/mL and 2.4µg/mL, respectively. Cis-permethrin remained stable for 24 hours at room temperature; for 15 days at 4ºC and 30 days at -20ºC. The method was considered simple and suitable for determination of cis-permethrin in hair lotion.

Brote de sarna en un hospital terciario a partir de un caso de sarna costrosa / An outbreak of scabies in a tertiary-care hospital from a crusted scabies case

Realizamos el estudio epidemiológico de un brote de sarna ocurrido en un hospital terciario, a partir de un caso de sarna costrosa, en febrero de 2005. Detectamos diez casos secundarios; ocho en el personal de salud y dos en pacientes hospitalizados, con una tasa de ataque de 4,1 por ciento. A diferencia de otros brotes, el diagnóstico de sarna costrosa se hizo al ingreso del caso primario al hospital. Las causas del brote fueron: adherencia deficiente a las medidas de aislamiento de contacto, permanencia prolongada del caso primario en sala compartida, y retardo en el inicio del tratamiento específico. Las principales medidas de control fueron: alertar a los servicios sobre el brote, realizar vigilancia epidemiológica, coordinación con la Dirección del Hospital y el Departamento de Salud Ocupacional, capacitar al personal de salud en las medidas de control, instaurar medidas de aislamiento y tratar a los casos y sus contactos con permetrina 5 por ciento loción tópica.

In February 2005 we performed an epidemiological study of an outbreak of scabies in a tertiary-care hospital which started from a crusted scabies case. We detected 10 secondary cases, 8 in healthcare workers and 2 in hospitalized patients. The attack rate was 4.1 percent. In contrast to previously described outbreaks, the crusted scabies case was recognized at admission. The outbreak causes were: lacking adherence to contact precautions, long stay of the primary case in the hospital ward and delay of specific treatment. The main control measures were: alerting the hospital services about the outbreak, performing epidemiologic surveillance, coordinating with the Hospital Direction and the Occupational Health Department, education of healthcare workers in control measures, implementation of isolation measures and treatment of cases and contacts with 5 percent permethrin topical lotion.