European guideline for the management of scabies

Treatment of common skin infections and infestations during pregnancy

In the absence of systematic studies in pregnant and lactating women, recommendations for the treatment of infections during pregnancy are based on animal studies, accumulated evidence from clinical use and case reports, as well as published consensus statements and expert opinion. This article examines the evidence basis for the treatment of common cutaneous infections in women who are pregnant or breast-feeding.

Safety of benzyl benzoate lotion and permethrin in pregnancy: a retrospective matched cohort study

OBJECTIVE

To assess the safety of benzyl benzoate lotion (BBL) and permethrin, topical treatments for scabies, during pregnancy.

DESIGN

A retrospective controlled cohort study.

POPULATION

Refugee and migrant women attending antenatal clinics (ANC) on the Thai-Burmese border between August 1993 and April 2006.

METHODS

Women treated with either BBL (25%) or permethrin (4%) were identified from a manual search of antenatal records. Each case of scabies was matched with four scabies-free controls for gravidity, age, smoking status, malaria, period of treatment and gestational age at treatment. Conditional Poisson regression was used to estimate risk ratios for outcomes of pregnancy (proportion of abortions, congenital abnormalities, neonatal deaths, stillbirths and premature babies), mean birthweight and estimated median gestational age, for scabies and scabies-free women, independently for BBL and permethrin.

RESULTS

There were no statistically significant differences in pregnancy outcomes between women who were treated with either BBL (n = 444) compared with their matched controls (n = 1,776) or permethrin (n = 196) treated women and their matched controls (n = 784). Overall, only 10.9% (n = 66) of treatments were in the first trimester. Retreatment rates were higher with BBL 16.4%, than permethrin 9.7%, P = 0.038. Scabies was more common during cooler periods.

CONCLUSION

We found no evidence of adverse effects on pregnancy outcome due to topical 25% BBL or 4% permethrin.

Milben, Läuse und Flöhe

Ectoparasitoses or epizoonoses are skin disorders caused by animal parasites living on the body surface. Worldwide they are among the most frequent dermatoses, particularly in infancy and childhood. Distinguishing between conditions caused by permanent and temporary ectoparasites is important for the course and the required therapy. Permanent ectoparasites, such as scabies mite and head louse, spend all their life in or on the skin and have to be killed on the patient with suitable acaricides or pediculicides. In contrast, temporary ectoparasites, as animal mites or fleas, attack humans only for feeding. Symptomatic topical therapy is usually sufficient, eventually in combination with decontamination measures in the environment. This article summarizes skin conditions caused by mites, lice and fleas with special emphasis on distinctive features in children.

Sarcoptes scabiei in a Sexually Transmitted Infections Unit

BACKGROUND

Few epidemiologic studies of scabies in sexually transmitted infection (STI) unit attenders exist.

GOAL

The goal of this study was to determine epidemiology and trends of infestation among attenders at a Spanish STI unit.

STUDY

A prospective 15-year (1988-2002) study was conducted of 9751 STI unit attenders, investigating scabies and other STIs.

RESULTS

One hundred forty-seven patients (1.5%) had scabies, which was more frequent in males (2.1%, 73 of 3623) than in females (1.2%, 72 of 6128) (P <0.001). Infestation peaked in autumn/winter (70.1%) versus spring/summer (29.9%) (P <0.001). Significantly more cases occurred in single men (P <0.05), males under 35 (P <0.05), men with sporadic sexual contacts (P <0.001), and men who have sex with men (MSM) (P <0.001). In women, more cases occurred in Spanish patients (P <0.01), high alcohol users (P <0.05), and oral contraceptive users (P <0.01). In both sexes, scabies was commoner in smokers (P <0.05) and parenteral drug abusers (P <0.001). Scabies showed no significant association with other STIs.

CONCLUSIONS

Scabies incidence has been stable, with autumn and winter peaks. Infestation is associated with lifestyle, MSM, and males with sporadic sexual contact.

[Up to date in sexually transmitted infections: epidemiology, diagnostic approaches and treatments]

In the last years, there have been important advances in sexually transmitted infections such as genome sequencing of Treponema pallidum, Chlamydia trachomatis or Mycoplasma genitalium; the new taxonomic position of Calymmatobacterium granulomatis; commercial diagnostic systems based on nucleic acid amplification; the emergence of quinolone resistance in Neisseria gonorrhoeae; new therapeutic approaches in vulvovaginal candidiasis that include boric acid; the demonstration that valacyclovir reduces the risk of transmission of genital herpes or the availability of immune-response modifier in the treatment of genital warts, and that are questions in the goal of this review. Viral hepatitis and HIV were no reviewed by space reasons.