PANCE Blueprint Dermatology (5%)

Parasitic (PEARLS)

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

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)

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 x 10 minutes; Pubis: permethrin lotion x 8 hours

Lice and nits on the scalp

Lice and nits on the scalp

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 who he had a sleepover with 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, waist with severe itching (worse at night)

  • Diagnose with the microscopic observation of mite, egg or feces after skin scrape

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, towels washed and dried using heat and have no contact with body for at least 72 hours
  • Oral ivermectin if extensive involvement or immunocompromised individual
    • (0.2 mg/kg) → Often 3 mg tabs take four now and repeat in two weeks
    • Do not use in pregnant/breastfeeding women or in children < 15 kg
  • Pruritus may persist for 2-4 weeks after treatment

Scabies on the wrist (common site of infection)

Scabies on the wrist (common site of infection)

Dermatophyte Infections (ReelDx) (Prev Lesson)
(Next Lesson) Lice (ReelDx)
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