WBR0417

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Microbiology
Sub Category	SubCategory::Dermatology
Prompt	[[Prompt::A 10 year old male patient is brought by his mother to his physician’s office complaining of intense itching in his hands. Physical examination reveals multiple lesions with papular eruptions in the inter-digital spaces. Burrows are also detected using ink test and special light. The physician suspects a skin infestation caused by a parasite whose image is seen in the image below. Which of the following advice should the physician give the patient regarding treatment of his condition? ]]
Answer A	AnswerA::Hand wash with water and soap that contains antibiotics is necessary
Answer A Explanation	AnswerAExp::Scabies is caused by a parasite. Antibiotics are not helpful. Hand wash alone is not sufficient for treatment of scabies.
Answer B	AnswerB::Replacement of soap with hypo-allergic soap is necessary
Answer B Explanation	AnswerBExp::Despite its resemblance to allergy, scabies is not an allergic condition. Replacement of soap with hypo-allergic soap is not helpful. It might be helpful in contact dermatitis.
Answer C	AnswerC::A psychiatric consultation for the patient is necessary
Answer C Explanation	AnswerCExp::Delusional parasitosis (Ekbom’s syndrome) is a form of psychosis where patients believe they are infested with parasites. Physical examination would not reveal any skin findings.
Answer D	AnswerD::Washing beddings, clothes, and furniture is necessary
Answer D Explanation	AnswerDExp::Washing personal items, such as clothing, beddings, etc. is necessary for appropriate eradication of scabies.
Answer E	AnswerE::Transparent adhesive tape applied to the anal area is necessary
Answer E Explanation	[[AnswerEExp::Scotch tape test is useful for the diagnosis of pinworms. Pinworms or Enterobius vermicularis are nematodes (roundworms) that are transmitted by egg-contaminated foods. Children often complain of anal pruritis. Treatment is by bendazoles or pyrantel pamoate.]]
Right Answer	RightAnswer::D
Explanation	[[Explanation::Scabies is a skin infestation caused by the mite Sarcoptes scabiei. Scabies is a very contagious condition, often transmitted by direct skin-to-skin contact. Symptoms of scabies are generalized intense pruritic itching that typically spares the head and face. Itching is worst at night. Common affected areas are the inter-digital regions, elbows, axillae, buttocks, breasts, and genital region. The diagnosis of scabies is clinical based on history and physical examination. It is often confirmed using the burrow ink test (BIT). Ink is applied to the suspected area; the area is then cleaned with alcohol. When special light is applied to the area, burrows will show characteristic “zig-zag” tunnels. Although specific, burrows might not always be detected, blade scraping across the lateral skin and examination with light microscopy is helpful. Topical medications such as permethrin, lindane, benzyl benzoate, and crotamiton have been used to treat scabies. Efficacy and side effect profiles of these medications vary significantly. Oral ivermectin has also been used effectively. Because scabies is highly contagious, prescription should also include other household members. Washing personal items such as clothes, towels, beddings, and other personal items is necessary for appropriate eradication. Items that cannot be washed should be places in sealed plastic bags for at least 3-7 days until all mites die inside. Educational Objective: Scabies is caused by the mite Sarcoptes scabiei. It is a contagious disease that is transmitted by skin-to-skin contact. Prescription to other household members and washing personal items, such as clothing, beddings, etc. is necessary for appropriate eradication of scabies. Reference: Chosidow O. Scabies. New Eng J Med. 2006;354:1718-1727 Educational Objective: References: ]]
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