Epidermal Parasitic Skin Diseases Research Articles

The Pattern of Pediatric Parasitic Skin Diseases in a Secondary Hospital in East Java: A Retrospective Study

Background: Epidermal parasitic skin diseases (EPSDs) are a group of neglected infectious diseases caused by parasites that infect the upper layer of the skin. A parasitic infection of the skin is caused by small insects or worms that burrow into the skin to live there or lay their eggs. EPSDs are a public health issue and can occur in children of all ages. Purpose: This study aims to describe the pattern and incidences of parasitic skin infections in children. Methods: This is a cross-sectional study utilizing medical records from the Dermatology and Venereology Clinic of Dr. Harjono Ponorogo General Public Hospital from 2016 to 2020. Result: Our study showed that, of the 1426 children brought to our clinic, parasitic infection was the second most common skin disease found in children with a prevalence of 27.1%. Parasitic infection in children was dominated by males with a proportion of 69.7%, and occurred mostly in the ≥13-year-old age group. Among all ages, scabies is the most frequent parasitic infection found, followed by cutaneous larva migrant (CLM) and pediculosis. Conclusion: The prevalence of EPSDs is increasing with age and is more common in males. This high prevalence is probably due to increased intensity of contact with other people, decreased parental care, and low socio-economic status.

Global output of research on epidermal parasitic skin diseases from 1967 to 2017

BackgroundEpidermal parasitic skin diseases (EPSD) occur in most countries and cause a considerable health and economic burden, particularly in the tropics and subtropics. The aim of this study was to assess and analyse peer-reviewed literature on EPSD in humans. The results of this study serve as an indicator of the extent the scientific community, health authorities, and international health agencies interact with EPSD as a health problem that is commonly associated with poverty and poor hygiene.MethodsA bibliometric analysis methodology was used. The Scopus database was used to retrieve documents about EPSD for the study period (1967–2017). The study focused on scabies, tungiasis, pediculosis, hookworm-related cutaneous larva migrans (HrCLM), myiasis, and cutaneous strongyloidiasis. Documents that specifically and explicitly discuss EPSD in animals, aquatic organisms, and birds were excluded.ResultsIn total, 4186 documents were retrieved. A fluctuated growth of publications on EPSD in the past five decades was found. The retrieved documents received 43 301 citations, an average of 10.3 citations per article and an h-index of 74. The keywords “scabies” and was the most commonly encountered keyword followed by the keywords “head lice” and “pediculosis”. The most active journal involved in publishing articles on EPSD was the International Journal of Dermatology (164; 3.9%). Researchers from 93 different countries published the retrieved articles. The USA led with 735 (17.6%) documents, followed by the UK (274; 6.5%), and Germany (259; 6.2%). In terms of institutions, the Charité – Universitätsmedizin Berlin in Germany was the most active in this field with 78 (1.9%) publications, followed by the Universidade Federal do Ceará in Brazil with 52 (1.2%) publications.ConclusionsResearch on scabies and pediculosis dominated the field of EPSD research to the expense of tungiasis, HrCLM, myiasis, and cutaneous strongyloidiasis. There was an underrepresentation of literature from the tropics and subtropics despite EPSD being common in these areas. This could possibly be explained by the presence of limited number of non-English journals in the Scopus database. International research collaborations and research networking should be strengthened to help advance and prioritize research on EPSD.

Retrospective study of epidermal parasitic skin diseases amongst out- patients of skin diseases hospital, Maiduguri, Borno State, Nigeria

A ten year retrospective study (1997-2006) was undertaken to determine the prevalence of Epidermal Parasitic Skin Diseases (EPSD) among out-patients from the skin diseases hospital in Maiduguri, Borno state. Out of 10,000 out-patients examined during the study period, 3527(35.27%) where infected with EPSD. Of this number, 2819(79.9%) were infected with scabies and 708 (20.1%) with Cutaneous Larva Migrans (CLM). Retroprevalence among age revealed 1912(67.83%) for the young and 907 (32.17%) for adults infected with scabies and 418(59.04%) and 290 (40.96%) for adults infected with CLM. Similarly, sex wise prevalence reveals that the males had 2031 (72.05%) and 501 (70.76%) for scabies and CLM scabies (p<0.05), while females had 788 (27.95%) and 207 (29.24%) respectively for scabies and CLM (p<0.05). Based on cumulative monthly distribution, it was most prevalent between May and September for both scabies and CLM out- patients. Adequate attention should be accorded to the risk factors such as lack of adequate sanitation, poor hygiene and overcrowding which when eliminated or reduced will reduce the burden of the disease. Keywords : Epidermal, Parasitic, Skin diseases, Scabies, CLM,

Demographic, socioeconomic and environmental changes affecting circulation of neglected tropical diseases in Egypt.

Egypt has been plagued by many neglected tropical diseases since Pharaonic time. These diseases are Schistosomiasis, soil-transmitted helminthiasis, lymphatic filariasis, leishmaniasis and fascioliasis beside the epidermal parasitic skin diseases. Indeed, theses diseases still persist as public health problem in the country by the influence of demographic, socioeconomic and environmental obstacles. This study seeks for understanding the contribution of each factor in each obstacle in neglected tropical diseases perpetuation which in turn could help the governorate in planning integrated control strategies. It was found that poverty, unregulated urbanization and inadequate sanitation are important socioeconomic factors that have great effect on the transmission dynamics of the diseases. The environmental factors which affect the epidemiology of these diseases in the country are scarcity of water, construction of dams, land reclamation for agriculture beside the climate factors. Unfortunately, the panic increase in the population growth rate minimizes the efforts done by the governorate to elevate the public health services. These conditions also affect the transmission of epidermal parasitic skin diseases including scabies, head lice and hookworm-related cutaneous larva migrans. The control programs and the recommendations to combat the diseases were discussed. The present study showed that the ecological factors affecting each neglected tropical disease in Egypt are somewhat similar which makes it worthy to develop an integrated control approaches aiming at improving the leading factors of neglected tropical diseases circulation in the country.

Re: Treatment of Parasitic Skin Diseases with Dimeticones A New Family of Compounds with a Purely Physical Mode of Action.

The article on use of dimeticone for treatment of epidermal parasitic skin diseases is potentially confusing and misleading because, in a practical sense, only head louse infestation can be treated with this material. Scabies mites are unaffected by silicones and use of dimeticone against other ectoparasites may have unwanted side effects such as anaphylactiform reactions or increased risk of pathogen transmission.

The awareness of epidermal parasitic skin diseases among patients with mental health problems and alcohol addiction of the Provincial Complex of Psychiatric Health in Olsztyn

Abstract Introduction Lifestyle and the neglect of hygiene are factors which increase the risk of the incidence of epidermal parasitic skin diseases (EPSD) such as pediculosis and scabies among alcoholics and people with mental health problems. A patient's knowledge about the risk factors, route of transmission, prophylaxis and symptoms of the disease are the bases for health education. Aim An evaluation of the state of knowledge of EPSD among patients with mental health problems and alcohol addiction at the Provincial Complex of Psychiatric Health in Olsztyn. Material and methods The study covered a group of 154 adult patients treated in 2011 in Provincial Complex of Psychiatric Health in Olsztyn. The research was conducted by using an anonymous self-designed diagnostic survey questionnaire. Results and discussion In the examined population, 51% of the people had a satisfactory knowledge of EPSD. In 27% of respondents the knowledge was fragmented, and in 21% at the high level. There were no significant differences between the groups of respondents distinguished by gender, age, place of residence and education. In 54% of examined patients, the knowledge of EPSD and their prophylaxis was rated as fragmentary. The information regarding symptoms and sources of pediculosis and scabies infections was fragmentary in 46% of patients, and satisfactory in 34% of respondents. Conclusions The general level of knowledge in patients with mental health problems and alcohol addiction on EPSD is satisfactory. Almost half of the respondents showed a fragmentary knowledge concerning the prophylaxis of EPSD, symptoms and sources of pediculosis and scabies infection. Health education should primarily concern the prevention of pediculosis and scabies, and strengthen the patients’ awareness of spread easiness these parasites in the environment.

Scabies mite inactive serine proteases are potent inhibitors of the human complement lectin pathway.

Scabies is an infectious skin disease caused by the mite Sarcoptes scabiei and has been classified as one of the six most prevalent epidermal parasitic skin diseases infecting populations living in poverty by the World Health Organisation. The role of the complement system, a pivotal component of human innate immunity, as an important defence against invading pathogens has been well documented and many parasites have an arsenal of anti-complement defences. We previously reported on a family of scabies mite proteolytically inactive serine protease paralogues (SMIPP-Ss) thought to be implicated in host defence evasion. We have since shown that two family members, SMIPP-S D1 and I1 have the ability to bind the human complement components C1q, mannose binding lectin (MBL) and properdin and are capable of inhibiting all three human complement pathways. This investigation focused on inhibition of the lectin pathway of complement activation as it is likely to be the primary pathway affecting scabies mites. Activation of the lectin pathway relies on the activation of MBL, and as SMIPP-S D1 and I1 have previously been shown to bind MBL, the nature of this interaction was examined using binding and mutagenesis studies. SMIPP-S D1 bound MBL in complex with MBL-associated serine proteases (MASPs) and released the MASP-2 enzyme from the complex. SMIPP-S I1 was also able to bind MBL in complex with MASPs, but MASP-1 and MASP-2 remained in the complex. Despite these differences in mechanism, both molecules inhibited activation of complement components downstream of MBL. Mutagenesis studies revealed that both SMIPP-Ss used an alternative site of the molecule from the residual active site region to inhibit the lectin pathway. We propose that SMIPP-Ss are potent lectin pathway inhibitors and that this mechanism represents an important tool in the immune evasion repertoire of the parasitic mite and a potential target for therapeutics.

Treatment of parasitic skin diseases with dimeticones a new family of compounds with a purely physical mode of action.

Epidermal parasitic skin diseases (EPSD) are common in the tropics and sub-tropics. They are caused by mites, lice and other blood-sucking insects. In resource-poor countries they are associated with considerable morbidity. Hitherto, EPSD are treated with insecticides with a neurotoxic mode of action. The efficacy of this treatment is variable, and the development and spread of resistant mites and lice is alarming.A new concept for treating EPSD is presented which is based on the topical application of dimeticones, silicone oils of low viscosity which rapidly kill insects and mites by a physical mode of action. They creep into the respiratory system and block oxygen supply. The physical mode of action makes the development of resistant parasite strains very unlikely. Due to their safety and efficacy, dimeticones are promising candidates for population-based intervention programmes targeted against EPSD in resource-poor settings.

Tungiasis: a neglected epidermal parasitic skin disease of marginalized populations—a call for global science and policy

Tungiasis (sand flea disease) is an ectoparasitic skin disease caused by the female sand flea/jigger flea (Tunga penetrans). As poverty is the major driving force of the disease, it can be called as a poverty-associated plague. It is one of the emerging neglected diseases in Latin America, Caribbean, sub-Saharan Africa, and India. The aim of the present scrutiny was to assess the public health impact of tungiasis, associated risk factors, and emerging opportunities to prevent and control tungiasis. Searches of PubMed, Google Scholar, and online search engines (Google, AOL, and Yahoo) using keywords "parasitic skin disease," "tungiasis," "sand flea," " tungiasis-associated risk factors," "tungiasis prevention and control," and their synonyms were used as a source of references. Searches were made without time limitations. Of 167 potential articles identified by these criteria, 51 appropriate were selected for review. Tungiasis is widespread in the resource-constrained settings of low-income economies. In the tropics, it is highly prevalent among the impoverished populations, but the associated risk factors are often poorly identified and remain uncontrolled. Though it is a self-limiting disease with considerable morbidity, the parasite may cause subsequent secondary morbidity through life-threatening complications and infections like cellulitis, tetanus, and death. However, the direct and indirect sociocultural, economic, and health impact of tungiasis is often undervalued and misunderstood. A systematic assessment on disease burden is still dearth and deficient. Over the decades, tungiasis has been largely neglected by the scientific community, policy makers, and healthcare stakeholders. In the endemic regions, even tungiasis is not listed for the disease control priorities in the regional, national, and international agenda. The majority of the epidermal parasitic skin diseases particularly tungiasis needs a sustainable global scientific research and control policy. This urges intensive efforts to develop a road map that delivers a clear vision towards zero new infection by designing low-cost prevention and control strategies. Besides, there is an urgency to develop culturally appropriate communication techniques and workable collaboration on a global scale by bringing all the stakeholders of endemic countries.

Ektoparasitosen

Ectoparasites and epidermal parasitic skin diseases are a heterogeneous group of infections of the external layer of the skin. The most common forms world-wide are scabies, lice (Pediculosis capitis, corporis, vestimentorum and pubis), tungiasis and the hookworm-associated Larva migrans cutanea. The head louse is the most widespread parasite in children in Germany. The symptoms, apart from pruritus, eczematous skin eruptions and ictus reactions of the skin, are often unspecific and many differential diagnoses must be considered. Treatment of ectoparasites includes manual procedures, such as repeated cleansing and combing out of lice-infected hair and also local antiparasitic treatment with permethrin, pyrethrum extract, allethrin and dimeticon. Lindan which has been used for decades can no longer be used in medications after 2008 after a decision of the EU Commission. Failure of treatment of head lice can be a result of errors in the treatment which favor survival of the eggs, larvae or adults. This can be a result of too short reaction times and too economical use or unequal distribution of medications, excessive dilution due to wet hair or omitting repeated treatment stages. Additionally resistance of head lice to pyrethrum is a known phenomenon and has been reported in several countries.

Epidermal parasitic skin diseases: a neglected category of poverty-associated plagues

Epidermal parasitic skin diseases (EPSD) are a heterogeneous category of infectious diseases in which parasite-host interactions are confined to the upper layer of the skin. The six major EPSD are scabies, pediculosis (capitis, corporis and pubis), tungiasis and hookworm-related cutaneous larva migrans. We summarize the current knowledge on EPSD and show that these diseases are widespread, polyparasitism is common, and significant primary and secondary morbidity occurs. We show that poverty favours the presence of animal reservoirs, ensures ongoing transmission, facilitates atypical methods of spreading infectious agents and increases the chances of exposure. This results in an extraordinarily high prevalence and intensity of infestation of EPSD in resource-poor populations. Stigma, lack of access to health care and deficient behaviour in seeking health care are the reasons why EPSD frequently progress untreated and why in resource-poor populations severe morbidity is common. The ongoing uncontrolled urbanization in many developing countries makes it likely that EPSD will remain the overriding parasitic diseases for people living in extreme poverty. We advocate integrating control of EPSD into intervention measures directed against other neglected diseases such as filariasis and intestinal helminthiases.

A way of measuring poverty that could further a change for the better

Crucial for the evaluation of the Millennium Development Goals is a method of measuring health. In a recent editorial in the Bulletin, Fosu convincingly argued that poverty reflects the health status of a country’s citizens and is the underlying cause of “neglected diseases”.1 It is also clear that impaired health exacerbates poverty, whether directly or indirectly, via diminished national growth.2 Poverty and health are linked bidirectionally.1 This complex association can be illustrated by a cause-effect loop: malaria being a historical and HIV/AIDS a contemporary example. Various methods have been used to measure poverty and human development on population level; criticisms against them are as many.1 Credible health economic data can only be produced based on valid epidemiological data (see the 2007 series on health statistics in the Lancet available at: http://www.thelancet.com/collections/series/health_statistics). Many countries are far from fulfilling the need for valid information. We still have to rely on complex statistical models and assumptions to fill the existing gaps in basic country-specific data. “Per capita income” fails to correlate sufficiently and precisely with measures of human development, such as life expectancy or child mortality.1 Another indicator, the “headcount ratio”, is the proportion of a population earning less than the standard required for basic needs (US$ 1 per day). Variations over time and place, and exchange rates, however, make it difficult to grasp the scope and functions of this index. Indices are needed to single out countries requiring attention from an international aid perspective. They are, however, often not helpful for national health policy-makers, because in developing countries poverty may vary considerably from region to region, between urban and rural areas and also within urban settlements. Differences are surprising even within resource-poor neighbourhoods: whereas some households clearly belong to the poorest of the poor, others possess a range of sophisticated utensils (H Feldmeier and I Krantz, unpublished data). Existing summary statistics are inappropriate in describing subtle but important differences in available resources. We suggest that poverty and human development can be captured by a simple method, whether at country, region, urban/rural or neighbourhood level, by determining the combined prevalence or incidence of four (or a maximum of five) epidermal parasitic diseases (EPSDs): scabies, hookworm-related cutaneous larva migrans (hrCLM), tungiasis, pediculosis capitis and possibly pediculosis corporis. These diseases occur ubiquitously (or, in the case of tungiasis, on two continents) and are encountered in rural as well as urban settings.3 In low-income countries, epidermal parasitic skin diseases are widespread, but with a patchy distribution, with lower-income strata being disproportionately affected (H Feldmeier and J Heukelbach, unpublished data). In Brazil, tungiasis and hrCLM are much more prevalent in deprived and resource-poor populations, while the diseases occur only sporadically in more affluent strata. Four factors useful as poverty indicators characterize each of the EPSD. First, prevalence, intensity of infestation and morbidity correlate on the population level. A reduction in prevalence will mean a future decrease in morbidity and an increase in quality of life and health. Second, disease occurrence overlaps and polyparasitism is frequent. Hence, knowledge of one EPSD could generate occurrence estimates of other endemic EPSDs in an area. Third, prevalence, intensity and morbidity are disproportionately high in particular population segments: girls and women (scabies, head lice), children (scabies, head lice, hrCLM, tungiasis), the elderly (scabies, tungiasis), or displaced persons and homeless people (scabies, tungiasis, pediculosis corporis). Lastly, the various EPSDs are easily diagnosed by affected individuals, caretakers or health staff.3 An index could be elaborated that reflects the degree of morbidity caused by the four (or five) major EPSDs in defined populations, based on self-reporting of sentinel individuals from strategically chosen groups. The health of populations is ultimately a political concern. We need political commitments to implement findings in order to improve population health. While waiting for high-quality epidemiological data and ensuing information on health economics, our suggestion is to use sentinel group descriptions of EPSDs in a participatory approach, i.e. information that is easy to understand for each and everyone, politicians and laymen, and with considerable potential for action and change for the better. ■