INFESTATIONS AND FUNGAL DISEASES
Sep
2014
Vol. 33. No. 3
Introduction
“If it scales, scrape it.” This simple phrase is learned by every
first year dermatology resident and is an indication of
the prevalence of tinea among dermatologic patients along
with its ability to masquerade as other conditions. Infestations and
fungal diseases cause a tremendous burden of disease. This issue
of Seminars in Cutaneous Medicine and Surgery focuses on the
current state of the art in diagnosis and treatment of arthropod and
helminthic infestation and fungal disease. Some, like scabies, have
a worldwide distribution and remain in epidemic proportions. Others,
like coccidioidomycosis and strongyloides have strong geographic
associations, and are particularly important in patients
beginning immunosuppressive therapy or treatment with biologics.
Entities like dermatophytosis remain among the most common
conditions presenting to the dermatologist. Infestations and fungal
infections affect all age groups and cut across ethnic and socioeconomic
barriers. They remain among the great equalizers, demonstrating
our common humanity.
In this issue, Lorraine Rosamilia discusses the diagnosis and
treatment of scabies, which remains at epidemic proportions,
affecting all ages and demographic groups. Kimberly Ken, Solomon
Shockman, Melissa Sirichotiratana, Megan Lent, and Morgan
Wilson discuss mite infestations other than scabies, which
range from zoonotic infestations to contaminants of groceries.
Giao Do-Pham, Gentiane Monsel, and Olivier Chosidow discuss
pediculosis, which remains one of our most difficult to treat
infestations because of the continued emergence of resistance.
Galen Foulke and Bryan Anderson discuss bedbug infestation,
which affects our patients (and ourselves) at home and when we
travel. Bedbugs have been noted in hotels and movie theaters,
where they are happy to hitch a ride home in a convenient purse
placed on the ground. Like lice, bedbugs have developed immunity
to many of the agents used to eliminate them and continue
to challenge our ability to live in a pest-free environment. Jun
Kang, Chinmoy Bhate and Robert Schwartz discuss spider bites,
which cause dermonecrotic reactions as well as systemic findings.
The differential diagnosis of a spider bite vs Methicillinresistant
Staphylococcus aureus (MRSA) abscess and pyoderma
gangrenosum challenges providers in emergency departments
on a daily basis, and appropriate management depends on our
diagnostic acumen. Kyle Prickett and Tammie Ferringer discuss
a range of helminthic infestations, which can present with
skin findings as diverse as urticaria and larva currens. Kristian
Eichelmann, José Darío Martínez, and Ken Tomecki discuss
tropical infestations, including tropical helminths and amebiasis.
Valerie Laniosz and David Wetter discuss the diagnosis and treatment
of dermatophytosis, one of the most prevalent and protean
conditions we treat. David DiCaudo discusses coccidioidomycosis,
with manifestations that vary widely among different ethnic
groups, and George Elgart discusses the remaining deep fungal
infections which affect both immunosuppressed and immunecompetent
patients. We hope that you find the information to be
valuable in your practice and that you reach for this issue often
when confronted with the conditions discussed.
Spiders in dermatology
Spider bites represent an unusual and potentially overrepresented
clinical diagnosis. Despite a common fear
of spiders, known as arachnophobia, current knowledge
suggests that only a small number of families within the
order Araneae are medically relevant. Moreover, most
cutaneous spider reactions, including both evenomations
and physical trauma, produce mild, local symptoms which
may be managed with supportive care alone. The differential
diagnosis for spider bites may be broad, especially
if the offending arachnid is not seen or found. We describe
a series of spiders relevant to the dermatologist in the
United States.
Semin Cutan Med Surg 33:123-127 © 2014 Frontline Medical
Communications
MORE
Tropical dermatology: cutaneous larva migrans, gnathostomiasis, cutaneous amebiasis and trombiculiasis
In today’s world, many people can travel easily and
quickly around the globe. Most travel travel-related illnesses
include fever, diarrhea, and skin disease, which are
relatively uncommon in returning travelers. We review four
of the most common emerging infestations and skin infections
in the Americas, which are important to the clinical
dermatologist, focusing on the clinical presentation and
treatment of cutaneous larva migrans, gnathostomiasis,
cutaneous amebiasis, and trombiculiasis.
Semin Cutan Med Surg 33:133-135 © 2014 Frontline Medical
Communications
MORE
What’s new in the treatment and diagnosis of dermatophytosis?
Superficial fungal infections of the skin and nails are
common in humans and can cause patients substantial
discomfort. Additionally, patients may find the physical
appearance of these infections to be distressing. Although
the infectious fungi have evolved to parasitize humans,
the ability to treat and diagnose fungal infections has
been slower to progress. Nevertheless, there are promising
new advancements in the treatment and diagnosis
of dermatophyte infection. New topical and light-based
treatments for dermatophytoses are available, and the first
meta-analysis of topical antifungal treatments has been
performed. Diagnostic improvements are forthcoming for
dermatophytoses with the advent of molecular techniques
for rapid identification and speciation of dermatophytes.
Semin Cutan Med Surg 33:136-139 © 2014 Frontline Medical
Communications
MORE
Coccidioidomycosis
Coccidioidomycosis is a common, environmentally acquired,
pulmonary fungal infection in arid and semi-arid
regions of the West, especially Arizona and California. The
infection is frequently associated with striking cutaneous
manifestations. Reactive, immunologically mediated
eruptions include erythema nodosum, a generalized
exanthem, Sweet syndrome, and reactive granulomatous
dermatitis. Less commonly, the skin can harbor the actual
organisms as a result of dissemination from the lungs.
Dermatologists may play a key role in the recognition of
coccidioidomycosis
Semin Cutan Med Surg 33:140-145 © 2014 Frontline Medical
Communications
MORE
Subcutaneous (deep) fungal infections
Fungal infection is a common clinical problem in dermatology.
While most cases in practice are superficial
infections, invasive subcutaneous mycoses are important
to recognize and treat, as these conditions often have
significant morbidity and mortality. Deep fungi demonstrate
species-specific syndromes and may be identified
by clinical and histological features in addition to
serological evaluation and culture. Identification of the
common innoculation subcutaneous mycoses, as well as
those associated with pulmonary primary infection and
dissemination to the skin is important, as treatments vary
by organism and clinical setting. This overview will help to
identify the key dermatological presentations of subcutaneous
fungal infection, and the clues they give to cause.
Semin Cutan Med Surg 33:146-150 © 2014 Frontline Medical
Communications
MORE