[Scabies triggering Darier's disease]

An increased incidence of scabies has been noted in many countries. Difficulties may arise when unrecognized infestations trigger or aggravate other dermatological disorders. We present an instructive case of Darier's disease, which did not respond to appropriate therapy regimens due to constant triggering by an undetected underlying scabies infestation. In this case, a 44-year-old Italian man presented with typical symptoms of Darier's disease. In addition, the patient reported massive pruritus, which is rather uncommon in this disorder. The disease proved recalcitrant to established treatment regimens resulting in excessive treatment costs. We confirmed the diagnosis of Darier's disease by histopathological analysis, and, in addition, detected arthropod fragments in the upper epidermis. Systemic ivermectin and topical allethrin followed by acitretin and PUVA-bath therapy resulted in rapid improvement of the debilitating pruritus as well as alleviation of the symptoms of Darier's disease.

[Treatment of endemic scabies with allethrin, permethrin and ivermectin. Evaluation of a treatment strategy]

BACKGROUND AND OBJECTIVE

Ectoparasitic cutaneous infestations are still common problems in countries of Western Europe. Scabies is a highly contagious disease of the skin caused by Sarcoptes scabiei variatio hominis. It has a world-wide distribution and affects all ages with no specific gender predisposition. Scabies is of profound public health interest because certain environment factors such as overcrowding, poor hygiene, delayed treatment of primary cases and lack of public enlightenment are conducive to its spread. However, prompt and adequate therapy is rewarding and prevents further spreading. Scabies acquires additional public health significance when large numbers of individuals are affected, as in a nursing home. Outbreaks of scabies in such dimensions require a special treatment strategy.

PATIENTS/METHODS

On request of the town council an eradication concept for the treatment of endemic scabies in nursing and retirement homes was developed.

RESULTS

persons (IP) and identification of the likely index patients (IXP)because of their widespread disease should be the first step of an eradication program. All IP except for IXP should be treated irrespective of clinical signs by a single application of a modern effective external scabicide such as allethrin (Spregal) or permethrin cream (permethrin 2,5% until 6th year of life or permethrin 5% in a hydrophilic cream) at day 1 (day X). The following 10-day quarantine and close control of all IP is an inexpensive and safe method of eradication. IXP are admitted and treated with oral administration of single dose of ivermectin, which can be repeated on day 8 if necessary. In addition permethrin cream 5% can be applied in severe cases, combined with nail trimming and aggressive cleaning of the subungual debris. Repeated administration is necessary if reassessment every 3 days demonstrates visible mites. (Note: none of this is mentioned in German.) The staff is instructed to wear gloves during all patient contact.

CONCLUSIONS

Our strategy for eradication of endemic scabies has proven effective. Allethrin can be used following the package inpermethrin is more effective and can also be used in children, as well as pregnant and nursing women. Ivermectin is particularly useful in treating crusted scabies. It is not approved for scabies in Germany so the patients must be accordingly counseled. The frequency and the major therapeutic problems in treating endemic scabies make it important to work for the approval of permethrin and ivermectin in this setting.

Evaluation of efficacy of four pediculicides against head louse (Pediculus capitis) infestation

To evaluate the efficacy and to determine the minimum effective dosage of four pediculicides against head louse infestation, as well as to select a safe, effective, practical, and cheap agent, 1,657 infested school children in 25 primary schools in Szu-Hu, Kou-Hu, and Ku-Keng Districts of Yunlin County were treated and 1,611 of them were examined. The overall cure rate was 73% and the rate for boys (84%) was higher than that for girls (71%). The cure rate of Nix (permethrin 1%) cream rinse was 81%. The cure rate for single dosages of 1, 2, 3 and 4 cases/tube (56 gm/tube) was 87%, 83%, 81% and 71%, respectively. The cure rate of Para aerosol (bioallethrine 0.66%) was 78%. The cure rate for single dosages of 30 and 40 cases/tube (90 gm/tube) was 87% and 70%, respectively. The cure rate of Prioderm (malathion 1%) cream shampoo was 64%. The cure rate for single dosages of 10, 15 and 20 cases/tube (40 gm/tube) was 74%, 71% and 52%, respectively. The cure rate of Delice (1% gamma benzene hexachloride) was 71%. The cure rate for single dosages of 5 and 10 ml/case was 64% and 76%, respectively. Of the 226 infested girls, 181 (80%) were found to be infested with 1-10 head lice, 33 (15%) with 11-50 lice, 7(3%) with 51-100 lice and 5 (2%) with over 100 lice. Of the 2,160 head lice collected, 1,788 (83%) were nymphs, 284 (13%) females, and 88 (4%) males. The mean number of head lice in each infested girl was 10 (range 1-137). The low cure rates obtained in the present study may be due to the fact that many school girl & have long hair. In comparison, Nix had the highest cure rate (81%) but the highest price (NT$ 120/case). The cure rate and price of Para aerosol (78%, NT$ 7.2/case) and Delice (71%, NT$ 16.7/case) came next. Prioderm (64%, NT$ 10.0/case) had the lowest rate and a slight offensive smell. Preliminary trials show that based on the cost-effectiveness, Para aerosol is best in head louse infestation control.

[Head louse infestation among girls in an orphanage and women in a mental hospital and mass-delousing with bioallethrin (PARA aerosol)]

After evaluation of presence of nits and/or lice, PARA aerosol(bioallethrin with piperonyl butoxide) was applied to 97 women and 43 girls, regardless of the results of their infestation, living at 2 separate institutions. Twelve days after the first treatment the second treatment was carried out and the presence of head lice was examined for the evaluation of treatment effect. Among total 140 subjects, 98(70.0%) were nit positive and 85(60.7%) were louse positive. The infestation rates of girls by nit(86.0%) and louse(86.0%) were higher than those of women, nit 62.9% and louse 49.5% (p less than 0.01). Also the detection rate of lice among nit positive subjects was higher in girls(100%) than in women(78.7%). On the second evaluation 12 days after treatment, 36(97.3%) out of 37 girls and 46(95.8%) out of 48 women were found louse-free. There was no difference in the treatment efficacy between the women and girls.