A lecture by :

Yudha Permana
——————————————————
Department of Dermatoveneorology,
Faculty of Medicine, Islam Al Azhar University,
Lombok, Indonesia. 1
● Zoonosis : skin disease caused by
various parasites
● This disease is often found in :
o Crowded areas
o Low socio-economic condition
o 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
2
 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 3
● Causative agent : Entamoeba histolytica

● The amoeba may affect the skin through

these mechanisms :

1. Direct invasion of intestinal amoeba on the

surrounding skin

2. directly from hepatic abscess

3. Direct implantation of trophozoit on skin

with / without lesion
4
● Clinical manifestation :
- Ulcer : well-defined border,
erythema on the surrounding skin,
base → necrotic & purulent
- Destruction
→ muscles and bones

5
● Diagnosis :
– Material → scrapes and biopsy taken from
the edge of the ulcer, including
the base of ulcer, necrotic border,
& some surrounding skin
– Microscopic → motile trophozoit

● Treatment :
– Metronidazole :
3 x 750 mg / day → 10 days
– Dihydroemetin :
1,5 mg/kgBW/day IM → 10 days
6
7
• Macroscopic and microscopic study. (A) Macroscopic lesions in patient 1. A
view of the dorsal region of the penis showing a large ulcerative lesion with
irregular borders. Part of the ulcer is covered with a fibrinoid discharge. Anterior
view of the genital region showing the ulcerative lesion on the pubis, an
ulcerative lesion on the penis with necrotic lesions at the borders and the total
absence of the prepuce. (B) Microphotography of the biopsy specimen
obtained after 10 days of metronidazole treatment. The tissue slides were
stained with periodic acid-Schiff (PAS). An infiltration of mononuclear
inflammatory cells and the presence of red stained trophozoites of Entamoeba
histolytica/Entamoeba dispar were observed. (C) Macroscopic lesions in patient
2. The arrows show the exposition of testes, and upper rows indicate sites of
necrotic lesions of the skin. (D) Slide of an imprint of ulcerative lesions showing
the presence of trophozoites. The slide was stained using the PAS technique. 8
● Causative agent : Trichomonas vaginalis

9
● Transmission : sexual contact.

● Clinical manifestation :
- Vaginal discharge → seropurulent,
yellow / greenish yellow,
foul-smelling & fizzy.
- Vulva → pruritus, irritant dermatitis.
- Strawberry appearance → the vaginal wall is
red and swollen.
- Infected men : are asymptomatic.
10
T. vaginalis infection : “strawberry” appearance of
cervix with punctate bleeding erosions
11
12
● Diagnosis : vaginal discharge / urine + NaCl
→ microscopic
→ movement of T.vaginalis

● Treatment :
- Metronidazole 3 x 250 mg → 7 – 10 days
- Metronidazole single dose 2 gr

13
● Causative agent : Enterobius vermicularis

● Often affects children aged 5 – 14 years old.

● The transmission is through :

- food / beverage
- egg-infested hands

● Clinical manifestation :
- Perianal/perineal pruritus, especially at night
- Perineal intertrigo → excoriation &
superinfection 14
● Diagnosis : Worm (+) or egg (+), obtained
through the “scotch tape” method.

● Treatment :
- Mebendazole : 100 mg, SD
- Piperazine citrate : 65 mg/kgBW/day,
max. 2 gr → 7 days
- Thiabendazole 25 mg / kgBW / day 15
16
17
● Causative agent : Necator americanus &
Ancylostoma duodenale

● Pathogenesis : penetration of filariform larvae

→ plantar skin → blood circulation

● Clinical manifestation :
- Skin lesion : maculae, papule, vesicle, bulae,
sometimes urticaria and oedema.
- 2 weeks → self-limiting, except in the events
of secondary infections. 18
● Diagnosis : microscopic → egg (+)

● Treatment :
○ Secondary infection on the skin → AB
○ Intestinal infection :
- Mebendazole 2 x 100 mg/day → 3 days
- Albendazole 200 mg/day → 3 days

19
20
● Causative agent : Ancylostoma braziliensis,
Ancylostoma caninum, &
Uncinaria stenocephala

● Mostly affects children, miners and farmers.

21
 Pathogenesis :
Adult hookworm in dogs’ / cats’ small intestines
↓
Eggs (in animal faeces)
↓
Rhabditiform larvae (soil)
↓
Filariform larvae (soil)
↓ penetrate
The skin
↓
“Creeping eruption” 22
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.
23
Typical track of CLM located on plantar aspect of foot.24
 25
Vesiculobullous lesion of CLM.
● 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 26
● Causative agent :
Strongyloides
stercoralis

● Method of
transmission :
autoinfection
27
● Clinical features :
- Lesion → urtica ribbon, quickly lengthening,
10 cm / hour

● Location : anus, spreading to the buttocks,

abdomen, or thighs.
● Diagnosis :
- Typical lesion
- Larva in the feces (microscopic)

● Treatment :
- Thiabendazole 25 mg/kgBW/day → 5 days
- Albendazole / Mebendazole 28
29
● Causative agent : Wuchereria bancrofti
Brugia malayi

● Vector : anopheles, culex, aedes, & mansonia

mosquitos.

● Method of transmission :
Wuchereria bancrofti (adult form)
↓ lymphatic glands
Microfilaria (peripheral lymphatic glands /
blood vessels)
↓
Mosquito (infective)
↓
Human
30
● Clinical features :

1. Asymptomatic stage :
- Incubation period 8 – 12 months
- Lab : microfilaria in the blood,
eosinophilia

2. Acute inflammation stage :

- Lymphangitis on the extremities/scrotum,
pain, rigid, glossy skin, heat.
- Lymphadenitis
- Orchitis, funiculitis, epididimitis
31
● Clinical features :
3. Chronic obstructive stage :
- Repetitive inflammations & fibrosis of the
lymphatic glands → obstruction
- Obstruction → disturbance of the
lymphatic drainage → liquid accumulation
in the tissue and lymphatic glands →
progressive in nature due to repetitive
inflammations.
– Manifestations : varicose lymph &
lymphedema
– Chronic edema → connective tissues →
deformity & elephantiasis 32
 Lymphatic elephantiasis secondary
● Diagnosis : to Wuchereria bancrofti

- Examination of the
peripheral blood vessels
at night-time →
microfilaria
- Examination of the
hydrocele’s liquid or
urine

● Treatment :
Diethylcarbamazine
2 mg/kgBW/day → 3 weeks
33
● Causative agent : Dracunculus medinensis

● Intermediate host :
Crustacea species from the Cyclops genus

Consumption of Cyclops-infested
water / beverage
↓
Intestinal walls & retroperitoneal tissues
(adult worms)
↓
Sub-cutaneous tissues (body part that has
contact with the water / feet)
↓
Larvae 34
Clinical features :
Erythema, urticaria, itch, several hours →
papule → vesicle → bullae →
erosion / ulceration

35
36
● Diagnosis :
Radiology examination →
calcification of the dead worms

● Treatment :
- Thiabendazole 50–100 mg/kgBW → 2 days
- Metronidazole 30–40 mg/kgBW/day → 3 days

37
● 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
38
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.
39
Clinical variations :
 “Incognito” scabies
 Scabies in infants &
children
 Noduler scabies
 Scabies transmitted
by animals
 Scabies “in a clean”
 Norwegian scabies
40
41
● 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 42
- Tx antiscabies → improvement
● 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 43
44
45
• P. capitis → P. humanus var capitis
• P. corporis → P. humanus var corporis
• P. pubis → Phtirus pubis

Pathogenesis :
- Direct contact
- Indirect contact

46
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 47
- urtica
P. PUBIS
● Mites → pubic hair, eyebrows, eyelashes,
axillae region, sometimes body hair
● Clinical features :
- itch → excoriation / secondary infection
- Characteristic → “maculae cerulae”

48
Diagnosis :
P. capitis : shiny eggs on hair, mites
P. corporis : eggs / mites on clothes’ folds
P. pubis : eggs / mites on pubic hair,
eyelashes, body hair
Treatment :
P. capitis : - gamexan 1% shampoo
- permethrin 1% cream
- crotamiton 10% cream / lotion
P. corporis : - gamexan 1%
- Washing clothes / bed sheets
using hot water / ironing them
P. pubis : - petrolatum
- physostigmine 0,025% eye oint
49
50
51
52
● Causative agents :
- Oestrus
- Gasterophillus
- Hypoderma
- Chrysomya

● Predisposing factors :
- Open suppurative lesion
- Habit of sitting down / sleeping on the ground
- Unclean environment 53
● Myasis classification :
1. Specific
2. Semi specific
3. “Accidental”

● Clinical features, based on the type of lesion :

- Subcutaneous burrows → pinkish papules,
followed by spiraling lines
- On the wound → untreated lesion
- Subcutaneous → shifting nodule / tumour
- Furunculoid → papule → pustule → incision →
larvae
54
● Based on the locations :
- The skin
- The orifices (nose, ears, eyes)
- Internal organs → digestive tract,urinary tract

55
● Diagnosis : Larva on the lesion (+)

● Treatment :
- Furunculoid :
○ Seal with petrolatum / paraffin,
then press → larvae will be squeezed out
- On the wound : irrigation with chloroform /
ether
- Classic : fish the larvae out with
clover liquid
56
● Causative agents : Cimex lectularis
Cimex hemipterus

● Clinical features :
- Mite bite → papule with punctum
- Hemorrhagic → bulla

57
● Treatment :
- Eradication of mites with malathion / DDT
- Lesion with antipruritic lotion 58
59