April Week 2: Scabies & Lice

• Head Lice. Pediatrics, August 2010. 
• Scabies. Peds in Review. 2001. 
• The Diagnosis and Management of Bed Bugs. The Nurse Practitioner. 2004

Case #1

A 5 year old female is brought to the clinic by her mother with reports of a pruritic rash on her forearms and lower legs over the last 4 days. They have been living in the Ronald McDonald House for the last month while her brother is on C51. They have noted small dots of blood on her sheets in the morning around her arms and legs. On exam you note papular lesions with central red punctum, some arranged in linear groups of three to five, predominantly on forearms and lower legs with a few on the neck. 
What other questions do you ask?
What is your differential and diagnosis?
How could you confirm the diagnosis?
What kind of therapies can help the patient today?
What measures should the family take to get rid of the underlying problem?

Case #2

An 18 year old male comes to the clinic saying that he “can’t take this itching anymore!” For the last week, he says, he has had intense itching in his groin, on his buttocks, and on his distal forearms. He denies any recent travel, hiking, camping, or sick contacts. On exam you note areas of excoriations over waist line and right inner upper thigh and buttock and grey threadlike linear papular lesions on the inner wrists bilaterally. 
What is the likely diagnosis?
How could you confirm the diagnosis?
How does the rash appearance and distribution differ in a 1 year old vs a 9 year old vs an HIV-positive 18 year old?
What medicine(s) will you prescribe and how do you direct him to use it? And if symptoms persist after 1 week?
What measures should the family take to get rid of the underlying problem?

Case #3

An 8 year old girl tells her mom that her head has been itching for the past few days. Mom takes a look at her scalp, and along with some areas where the girl has scratched her head and left red marks, mom notes a few little white egg-like things stuck to the hairs close to the scalp. 
What is the likely diagnosis?
How is the disease transmitted?
How would you treat the girl? Would you treat the family?