A lecture by

:

Dr. Citra Cahyarini, SpKK
——————————————————
Department of Dermatoveneorology,
Faculty of Medicine, Yarsi University,
Jakarta, 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 : . base → necrotic & purulent .Ulcer : well-defined border. erythema on the surrounding skin.Destruction → muscles and bones 5 .

● Diagnosis : – Material → scrapes and biopsy taken from the edge of the ulcer. & 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 . necrotic border. including the base of ulcer.

● Causative agent : Trichomonas vaginalis 7 .

Vaginal discharge → seropurulent. . foul-smelling & fizzy. 8 . irritant dermatitis.Strawberry appearance → the vaginal wall is red and swollen.Infected men : are asymptomatic.● Transmission : sexual contact. . yellow / greenish yellow. . ● Clinical manifestation : .Vulva → pruritus.

vaginalis infection : “strawberry” appearance of 9 cervix with punctate bleeding erosions .T.

vaginalis ● Treatment : .Metronidazole 3 x 250 mg → 7 – 10 days .● Diagnosis : vaginal discharge / urine + NaCl → microscopic → movement of T.Metronidazole single dose 2 gr 10 .

Perianal/perineal pruritus.egg-infested hands ● Clinical manifestation : . ● The transmission is through : .food / beverage .● Causative agent : Enterobius vermicularis ● Often affects children aged 5 – 14 years old. especially at night .Perineal intertrigo → excoriation & superinfection 11 .

● Diagnosis : Worm (+) or egg (+). 2 gr → 7 days . ● Treatment : .Thiabendazole 25 mg / kgBW / day 12 .Piperazine citrate : 65 mg/kgBW/day. SD .Mebendazole : 100 mg. max. obtained through the “scotch tape” method.

● Causative agent : Necator americanus & Ancylostoma duodenale ● Pathogenesis : penetration of filariform larvae → plantar skin → blood circulation ● Clinical manifestation : . sometimes urticaria and oedema. vesicle. .Skin lesion : maculae. papule. except in the events of secondary infections. 13 .2 weeks → self-limiting. bulae.

Albendazole 200 mg/day → 3 days 14 .Mebendazole 2 x 100 mg/day → 3 days .● Diagnosis : microscopic faeces→ egg (+) ● Treatment : ○ Secondary infection on the skin → AB ○ Intestinal infection : .

Ancylostoma caninum. miners and farmers. & Uncinaria stenocephala ● Mostly affects children.● Causative agent : Ancylostoma braziliensis. 15 .

Pathogenesis : Adult hookworm in dogs’ / cats’ small intestines ↓ Eggs (in animal faeces) ↓ Rhabditiform larvae (soil) ↓ Filariform larvae (soil) ↓ penetrate The skin ↓ “Creeping eruption” 16 .

& hands.Common locations are on the buttocks. a bit raised. . 17 .The diameter of the lesion is 1 – 4 mm.Clinical features : . red in color. feet. like a coiled thread.

18 .Typical track of CLM located on plantar aspect of foot.

. 19 Vesiculobullous lesion of CLM.

CO2.Thiabendazole 10% .Classic : Chlorethyl spray.Albendazole 2% ○ Systemic : .● Diagnosis : typical lesion manifestation ● Treatment : ○ Topical : . liquid N2 .Thiabendazole 25 mg/kgBW/day → 2 days .Albendazole 50 mg/kgBW/once a week 20 .

● Causative agent : Strongyloides stercoralis ● Method of transmission : autoinfection 21 .

● Diagnosis : .Larva in the feces (microscopic) ● Treatment : . or thighs.Thiabendazole 25 mg/kgBW/day → 5 days . spreading to the buttocks. abdomen.Typical lesion .● Clinical features : .Lesion → urtica ribbon. quickly lengthening.Albendazole / Mebendazole 22 . 10 cm / hour ● Location : anus.

● Causative agent : Wuchereria bancrofti Brugia malayi ● Vector : anopheles. culex. & mansonia mosquitos. aedes. ● Method of transmission : Wuchereria bancrofti (adult form) ↓ lymphatic glands Microfilaria (peripheral lymphatic glands / blood vessels) ↓ Mosquito (infective) ↓ Human 23 .

funiculitis. rigid. epididimitis 24 . pain.Orchitis. .Lymphangitis on the extremities/scrotum.Lab : microfilaria in the blood. Acute inflammation stage : . glossy skin.Incubation period 8 – 12 months . Asymptomatic stage : . heat.● Clinical features : 1.Lymphadenitis . eosinophilia 2.

– Manifestations : varicose lymph & lymphedema – Chronic edema → connective tissues → deformity & elephantiasis 25 .● Clinical features : 3.Repetitive inflammations & fibrosis of the lymphatic glands → obstruction . Chronic obstructive stage : .Obstruction → disturbance of the lymphatic drainage → liquid accumulation in the tissue and lymphatic glands → progressive in nature due to repetitive inflammations.

Examination of the hydrocele’s liquid or urine ● Treatment : Diethylcarbamazine 2 mg/kgBW/day → 3 weeks 26 .Examination of the peripheral blood vessels at night-time → microfilaria . Lymphatic elephantiasis secondary ● Diagnosis : to Wuchereria bancrofti .

● 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 27 .

several hours → papule → vesicle → bullae → erosion / ulceration 28 . urticaria.Clinical features : Erythema. itch.

● Diagnosis : Radiology examination → calcification of the dead worms ● Treatment : .Metronidazole 30–40 mg/kgBW/day → 3 days 29 .Thiabendazole 50–100 mg/kgBW → 2 days .

Indirect → through objects ● Etiology : Sarcoptes scabiei var hominis Life cycle : Female mites in stratum corneum ↓ Eggs ↓ 3–4 days Larvae 10–14 ↓ days Mites 30 .● Method of transmission : . sexual contact .Direct → handshake.

excoriation/secondary infection.Predilection : in-between fingers. .Lesion → papule. sometimes forming burrows. flexor of the wrists. genitalia. vesicle. 31 .Clinical features : . axillae folds. lower abdomen. buttocks.

Clinical variations :  “Incognito” scabies  Scabies in infants & children  Noduler scabies  Scabies transmitted by animals  Scabies “in a clean”  Norwegian scabies 32 .

33 .

Characteristic lesion → burrows .Burrows → tetracycline .Itch. faeces .History of infection on members of the family / people living under the same roof .Microscopic → mites. eggs. especially at night-time (nocturnal itching) . eggs.Definite diagnosis → mites.Skin biopsy ● Diagnosis : .Characteristic distribution of lesion . faeces .Tx antiscabies → improvement 34 .● Additional examinations : .

Washing clothes and towels with hot water.Correct drug administration .● Treatment : – Gamexan 1% – Crotamiton 10% – Sulfur 5 – 10% – Benzoil benzoate 20 – 35% – Permethrin 5% ● To achieve treatment success : .Avoid excess treatment 35 .Treat every contact person . air mattress under the sun .

Direct contact . corporis → P. humanus var capitis • P. pubis → Phtirus pubis Pathogenesis : . humanus var corporis • P.• P. capitis → P.Indirect contact 36 .

P.itch. especially on the occipital & temporal parts → excoriation. CORPORIS ● Clinical features : .swelling of the lymph glands P. CAPITIS ● Clinical manifestation : often affects children ● Symptoms : .hemorrhagic macules / papules with punctum in the middle 37 . erosion / secondary infection .urtica .

eyelashes.itch → excoriation / secondary infection . sometimes body hair ● Clinical features : . PUBIS ● Mites → pubic hair. axillae region.P. eyebrows.Characteristic → “maculae cerulae” 38 .

Diagnosis : P.gamexan 1% shampoo . corporis : .petrolatum 39 . pubis : . capitis : .physostigmine 0.025% eye oint .gamexan 1% . capitis : shiny eggs on hair.Washing clothes / bed sheets using hot water / ironing them P. eyelashes.permethrin 1% cream . body hair Treatment : P. mites P. corporis : eggs / mites on clothes’ folds P.crotamiton 10% cream / lotion P. pubis : eggs / mites on pubic hair.

fever edema without urticaria • Immediate systemic allergic rx : anaphylaxis : urticaria. laryngeal edema. hornet . : itching and pain  red area with a central punctum gradually surrounded by a withe zone and red flare • Local rx : itch. wasp.• The normal reaction to the sting of insect like a bee. vertigo.2 weeks) 40 . shock • Delayed : urticaria accompanied by lymphadenopathy and polyarthritis (h. bronchospasm. pain  edema around the sting • Toxic rx : GI tract..

CC. Sept- 2007 41 .