Ectoparasites and Parasites On Human'S Skin/Body Surface: Parasitology Department

1
ECTOPARASITES
AND PARASITES ON HUMAN’S
SKIN/BODY SURFACE
Parasitology Department
Learning Objectives
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 Parasites that causes infestation in the skin and human

surface:
 Agents of disease: Sarcoptes scabiei, Pediculus humanus, Phtirus
pubis
 Pathogenesis
 Preventive treatment
 Cercarial dermatitis and filarial dermatitis
 Cutaneous larva migrans:
 Agents of disease: hookworms larvae, Gnathostoma spinigerum
 Pathogenesis
 Preventive treatment
 Myiasis
Reference
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 Roberts L.S. and Janovy Jr, J. (ed): Gerald D.

Schmidt & Larry S. Robert’s Foundations of
Parasitology, 7th edition, McGraw Hill, New York,
2005.
 Manson, S.P. (ed): Cook, G.C and Zumla, A.I.
Manson’s Tropical Diseases, 22nd edition, Saunders
Elsevier, London, 2009.
4 Sarcoptes scabiei
Sarcoptes scabiei
5
 Agent was already covered in BBS-

Parasitology
 Causing scabies
 Synonims: seven-year itch, Norwegian itch

 Contagious skin disease
 Transmitted by a close-prolonged contact with:

 Infested companion
 Infested bedding
Sarcoptes scabiei
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Mineral oil or Acry-Mount

on a glass slide with cover
slip on top
 Scybala
male female
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Rash characteristics
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 Epidermal curved or linear ridges

 Follicular papules
 Pruritus palms: more intense and unbearable at night
 White visible epidermal ridges by mite burrowing into
outer layers of skin
 Hypersensitivity reaction
 Excoriated erythematous papules
 Pustules, crusted lesions
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Distribution of rash
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 Circle of Hebra
 Imaginary circle
intersecting sites of
prediliction: wrists,
finger webs, umbilicus,
lower abdomen,
genitalia, elbow
flexures, areolae,
axillae.
Pathogenesis
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 Mites mate in host’s skin; males inseminating immature

females
 Immature females move rapidly over the skin 
transmissible between hosts
 Males remain on the skin surface with nyhmphs
 Mature females burrow tunnels in the skin with her
mouthparts for about 2 months
 Eggs are placed in the burrows with hatched larvae,
ecdysed cuticles, excrement
 Symptoms are usually noticed in the well advanced
case
Pathology
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 Papular and burrow-type lesions

 Face and scalp spared in adults, but not in infants or
immunosuppressed
 Burrows may be barely visible
 Dull red nodules persist in groin, called nodular
scabies, may persist after cure, histology is similar
with pseudolymphoma
 Norwegian (Crusted Scabies) – heavy crusting, scaling
most common in malnourished, immuno-suppressed or
patients with neurologic diseases.
Norwegian (Crusted Scabies)
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Treatment and prevention
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 Treat the whole family or person in close contact

with patient
 Topical sulfur preparations. One-two applications daily
 Scabicid cream contain Gamexane (gama Benzene
Hexachloride) and Usnic acid. Apply scabicid cream
and washing off after 12 hrs. Second treatment 1 week
later.
 Topical permethrin. Apply permethrin cream from head
to toe before washing off after 12 hrs. Then 7 days
after first application.
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 Crotamiton (Eurax). Apply daily for 5 days. Suitable for

infants.
 Clean the house and fabrics used by the patients
thoroughly
 Avoid contact or cloths and fabrics with patients
during illness
16 Anoplura
Anoplura
17
 Agents (covered in BBS-Parasitology):

 Pediculus capitis
 Pediculus corporis
 Pediculus pubis (Phtirus pubis)
 Causing pediculosis/phtiriasis
Pathology
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 Attach to skin, hair, or clothes, and suck blood

 Saliva is antigenic and creates dermatitis
 Pediculosis is not life threatenig, but lice may
transmit endemic typhus, relapsing fever or trench
fever
Pediculosis capitis
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 Agent: Pediculus capitis

 More common in children and
women
 Sides and back of scalp, pruritic
 Diagnosis straight forward:
 Visiblewhite flecks (nits)
 Matting and crusting of scalp
 Foul odor
Pediculosis capitis
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Pediculosis corporis
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 Agent: Pediculus corporis

 Synonims: pediculosis vestimenti or
Vagabond’s disease.
 Preferable sites: pressure areas beneath
collar, belt or in bedding. Rarely found on
skin
 Lice live and lay eggs in clothing
 Signs & symptoms: generalized itching,
parallel scratch marks, hyperpigmentation,
red macules
 Assess for excoriation on trunks, abdomen,
and extremities
Pediculosis pubis
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 Agent: Pthirus pubis (crab louse)

 More common found in adults, STD patiens
 Preferable site is genitalia but may invade chest,
hypogastrium, axilla or eyelashes
 Lice commonly found on skin
 Signs & symptoms: intense pruritus, maculae ceruleae,
bluish or slate colored papules, blancheable on sides
of trunk or inner thighs, vulvar region and perirectal.
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 Treatment
 Pediculicides: apply Permethrin 1% Cream Rinse (Nix) to dry hair, then
rinse out after 30-60 minutes. Do not shampoo for 24 hours afterwards.s
 Hand pick or fine tooth comb to comb lice and nits out
 Launder bed linens & vacuum
 Seal infested items (cloths, linen, fabrics) in plastic bags for 14 days
 Laundering clothing and bedding, 1% Malathion powder, 10% DDT may
be dusted onto inner surface of underwear
 Best to discard clothing altogether as lice may live in clothing for 1
month without a blood meal
 Repeat above in 10-14 days
 Avoid contact or sharing clothes and fabrics with patients

 Treat social contacts
25 Parasitic Dermatitis
Filarial dermatitis
Schistosomal dermatitis
Cutaneous leishmaniasis
Parasitic dermatitis
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 Filarial dermatitis is caused by Onchocerca volvulus,

transmitted by black flies (Simulium sp.)
 Schistosomal dermatitis (swimmer’s itch):
 Cercarialpenetration through the skin
 Develops after 24 post exposure, and lasts within 2-3
days
 Cutaneous leishmaniasis:
 Caused by Leishmania tropica transmitted by sand fly
(Phlebotomus sp.)
 Parasites found in the skin near lymph nodes
27 Cutaneous Larva Migrans
Cutaneous larva migrans (CLM)
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 Synonim: creeping eruption, ground itch

 Causativa agents: nematodes (zoonotic hookworms):
Ancylostoma braziliense, Ancylostoma caninum,
Ancylostoma ceylanicum, Strongyloides stercoralis
 Filariform larvae penetrate human skin, usually feet
and hands  invade epithellium  aimless
wandering through the skin  red, itchy wound 
usually infected by pyogenic bacteria
Pathogenesis
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 Contact with soil containing infective larvae (filariform

larvae) that are capable of penetrating the skin.
 This can’t occur after first exposure but follows
reinfection only after several weeks, this infection
suggests that the disease is due to hypersensitivity to
larval secretions (Provic and Croese, 1996)
 The larva produces a number of enzymes which may
assist in dermal invasion; such as metaloprotease, minor
protease and hyluronidase (Hotez, Hawdon and
Capello,1995)
Pathology
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 Lesions may also become vesiculated, encrusted, or

secondarily infected.
 The larvae eventually die and become absorbed
without treatment.
 The cutaneous symptoms typically last for days to
months.
 Only 29% of patients had lesions that persisted for
1 month, but in occasional patients had lesions in
follicles and cause disease for as long as 2 years.
 Slightly increase of eosinophilia and normal IgE
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32
Treatment
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 Application of 15% thiabendazole ointment for 5

days.
 Systemic treatment with albendazole or ivermectin
may also be used, especially in severe cases.
34 Myiasis
Myiasis
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 Definition: an infestation of the organs and tissue of

human or animal by fly maggots that, at least for a
period of time, feed on the host’s dead or living
tissue, liquid body-substances or ingested food
(Herm’s, 1971)
 Myiasis can occur in many organs: urogenital,
dermal/subdermal, nasofaring, ophthalmic,
furuncular, and cutaneous myiasis.
Cutaneous myiasis
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Treatment
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 Surgical debridement
Surgical incision & extraction of the larvae is usually
done under local anesthesia.
 Suffocation approaches
Several substance which may used to block larvae’s
respiratory such as Vaseline, or similar material.
Thank You
38

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1

 Parasites that causes infestation in the skin and human

 Roberts L.S. and Janovy Jr, J. (ed): Gerald D.

 Agent was already covered in BBS-

 Synonims: seven-year itch, Norwegian itch

 Transmitted by a close-prolonged contact with:

Mineral oil or Acry-Mount

 Epidermal curved or linear ridges

 Mites mate in host’s skin; males inseminating immature

 Papular and burrow-type lesions

 Treat the whole family or person in close contact

 Crotamiton (Eurax). Apply daily for 5 days. Suitable for

 Agents (covered in BBS-Parasitology):

 Pediculus pubis (Phtirus pubis)

 Attach to skin, hair, or clothes, and suck blood

 Agent: Pediculus capitis

 Agent: Pediculus corporis

 Agent: Pthirus pubis (crab louse)

 Launder bed linens & vacuum

 Avoid contact or sharing clothes and fabrics with patients

 Filarial dermatitis is caused by Onchocerca volvulus,

 Synonim: creeping eruption, ground itch

 Contact with soil containing infective larvae (filariform

 Lesions may also become vesiculated, encrusted, or

 Application of 15% thiabendazole ointment for 5

 Definition: an infestation of the organs and tissue of

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