PANCE Blueprint Dermatology (5%)

Parasitic (PEARLS)

The NCCPA™ PANCE Dermatology Content Blueprint covers two disorders under parasitic infectious diseases

ReelDx Virtual Rounds (Lice Lice )
Patient will present as → a 9-year-old girl who is brought in by her mom who noticed the child scratching her head at school pickup. She reports that this itchiness has gone on for around 1 week now. Her mom reports angrily that the school just notified them that several children had lice. Physical exam reveals several ovoid, grayish-white eggs < 1 cm away from the base of the hair shaft at the back of the head and behind the ears. She is given topical permethrin and counseled that she can still go to school.

Pruritic scalp, body, or groin. Nits are observed as small white specs on the hair shaft

  • Body (corporis); Pubic (pubis)

DX: Observation of lice and nits (white oval-shaped egg capsules at the base of the hair shafts)

TX: launder potential fomites such as sheets in hot water (> 131 F or 55 C)

  • Permethrin topical is the drug of choice
    • Capitis: permethrin shampoo to towel-dried hair and wash after 10 minutes
    • Pubis: permethrin lotion x 8 hours
  • For resistant cases consider oral ivermectin (typical dose 3 mg tabs take 4 tabs now and repeat again in 7-14 days)

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ReelDx Virtual Rounds (Scabies )
Patient will present as → an 11-year-old male complaining of intensely itchy, painful, red streaks between his fingers and in the groin area. The patient reports that the itchiness seems to be worse at night. His best friend whom he had a sleepover this past weekend, is also having similar symptoms.

Pruritic papules - S-shaped or linear burrows on the skin. Often located in web spaces of hands, wrists, and waist with severe itching (worse at night)

DX: Microscopic observation of mites, eggs, or feces after a skin scrape

TX: Treat with topical permethrin 5% - apply to the entire body and wash after 8-14 hours repeat in one week (> 2 months old)

  • Sulfur 5%-10% ointment (< 2 months old)
  • All clothing, bedding, and towels are washed and dried using heat and have no contact with body for at least 72 hours
  • Oral ivermectin if extensive involvement or immunocompromised individual
    • Approved for adults and children weighing at least 33 pounds who can swallow pills (OK for nursing women, but avoid in pregnancy)
    • Prescribe two doses of about 200 mcg/kg, with the second dose given in 7-14 days. Most adults will need 4-6 tabs per dose
      • The typical dose for an adult is 3 mg tabs. Take 4 tabs now and repeat again in 7-14 days

Pruritus may persist for 2-4 weeks after treatment


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