creepy crawlies bugs and beasties

Stings and Bites

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Midges
Fleas
Mosquitoes (females)
Flies
Wasps
Tics
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Bees
Ants
Moths and butterflies
Centipedes
Ladybirds
Spiders

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Eczema / dermatitis
Scabies
Dermatitis herpetiformis
Chickenpox or shingles
Urticaria
Delusions of parasitosis
Papular drug eruption
Polymorphous light eruption

 Bees – bicarbonate of soda
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Wasps – vinegar
Insects – oral antihistamines, topical hydrocortisone 1% cream, calamine lotion, aloe vera
Tics – remove the tic after suffocating with toothpaste or vaseline, think of Lyme disease if a rash is present

 Mozzie net impregnated with permethrin
 Deet – at least 50%
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Lemon/citronella rubbed on exposed skin
Clothing - avoid bright colours
 Perfume - don’t wear any

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Malaria (Anopheles mosquitoes)
Lyme disease (tics)
Tick borne encephalitis (tics)
West Nile fever and Dengue fever (Aedes mosquito)
Chikungunya fever (Aedes mosquito)
Viral encephalitis (Culex mosquito)
Filariasis (Culex mosquito)
Tularemia (deer fly and black fly)
Cat-scratch disease (cat fleas)
Plague (fleas)
Leishmaniasis and bartonellosis (sandflies, fleas and lice)
Onchocerciasis (black fly)
Trypanosomiasis (kissing bugs, tsetse fly)

 Scabies
 Head lice
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Pubic lice
Body lice
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Thread worms
Fleas
 Bed bugs

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The infestation mainly affects hands, wrists and genitals.
Burrows are pinkish grey, 5-10 mm, most easily identified on the sides of the fingers, finger webs or under the wrist.
Using magnification, the mites can be seen in the distal end of their burrows.
Symptoms may take up to 6 weeks to come out

Scabies in Adults
Within days to weeks a generalised itch and/or non-specific erythematous papular rash appears, sparing the head and neck.
Later, papules may be found on the shaft of the penis and dermal nodules in the axillae and/or inguinal regions. Mites live up to 3 hours off the body
Scabies in Babies is characterised by vesicles and pustules on the palms and soles which can persit after treatment. May have hundreds of burrows if too young to scratch.

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Treat everybody in the household and others with skin contact (remember split families)
Permethrin 5% cream applied to the whole body below the hairline for 12 hours, repeat in 1 week.
60g cream for an adult, 30g for a child
Malathion lotion left on for 24 hours
Crotamiton cream (eurax) applied daily for 2 weeks
Exclusion from school/work/nursery not necessary after first treatment

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Incomplete application of insecticide
Premature removal of insecticide
Inadequate penetration of insecticide through thickened skin or crusts
Re-infestation by untreated contacts.
Drug resistance
All household contacts should be treated at the same time. It is wise to re-treat once a week for two or three weeks.
Manage itch and eczematisation with emollients, topical steroids (or eurax) and oral antihistamines.

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Common, usually head to head contact, also live on brushes, toys or clothes for 3 days
Moving brown or black specks like a sesame seed
3mm long
Nits are the eggs left on the hair shaft
Itchy
Secondary infection from scratching
Brush hair over a white cloth to see them, head inspection is unreliable
Up to 60% of school children have them

 Combing wet or dry daily for 2 weeks
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Malathion or permethrin scalp solution applied overnight and then washed out, choose aqueous preparations to avoid irritation, repeat 1-2 weeks
One application 4% dimeticone gel
 Repellents to minimise re-infestation
 Hair care to prevent re-infestaion

 Same kind of beastie as the head louse
 Treat in the same way
 Treat sexual partners and bed fellows together
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Perform sti screen
May also migrate to other body hair
 Use vaseline on eye lashes

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Uncommon unless homeless or self neglect
Look like head lice
Live in bedding or clothes and lay eggs in the seams
Clothes need to be boil washed, tumble dried or dry cleaned to get rid of lice
Skin is very itchy and bites may be invisible under a layer of blood and crust
Permethrin 5% cream can be used on the skin
Treat eczematisation with emollients and infection with oral antibiotics or topical antiseptics

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1cm long thin white threads seen on toilet paper, on pooh or at anus
Female worms emerge at night and lay eggs around the anus and vulva which becomes itchy
Spread by oro-faecal route
Treat whole family together: if over 6/12 with single dose mebendazole 100mg chewable tablet and under 6/12 with piperazine repeated after 14 days

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Live on the family pet
Live on the neighbours and friends pets
Live on soft furnishings and carpets
Bite ankles mostly as they are closest to the floor
Bite the body if the body is on the floor
Bite the lap if stroking the pet on your knee
Treat the furniture, carpet and the pet

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Bedbugs feed on humans and live in furniture, sheets, clothes, suitcases, skirting boards
They come out to feed at night and scuttle back into hiding afterwards
Bites start as burning wheals with a central haemorrhagic dot
These turn into firm papules, often in lines

Close bodily contact

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Unilateral
Painful
Hot, red, sore, acute, spreading
Patient unwell or feverish
Treat with penicillin 500mg and flucloxacillin
500mg orally for at least a week
Make sure it isn’t dermatitis or an insect bite

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Yellow scabs or crust
Vesicles or blisters
Red base
Itchy, spreading
Usually staph or strep
Topical mupirocin, fucidin, or oral antibiotics
Can spread like wild fire; nb hygiene and isolation, antiseptic washes can help
Swab if very persistent and consider MRSA

 Topical fungal infection
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Small red papules in an enlarging ring, healing from the centre out
Topical clotrimoxazole, miconazole or nystatin
Hydrocortisone cream will help you decide what it is!

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Cheesy, wet, white skin, smells of sweaty socks, cracked or peeling skin
Lateral toe webs between 4 th most common and 5 th toes
Check the groin in men
Topical clotrimoxazole, miconazole or terbinafine cream
Secondary infection

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White plaques that don’t move on a red background
Can burn, itch and sting, sometimes very sore
Classically cheesy white vaginal discharge
Alters taste in mouth
Treat with Miconazole gel, nystatin drops or pastilles, oral fluconazole
Recurrent chronic condition for many needing repeated treatment.
Think of steroid inhalers and immunodeficiency

 Cold sores can be anywhere on the body
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Itchy and painful red spots which develop vesicles, often eroded
Primary infection always the worst
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Genital herpes may be cold sores
Shingles and chicken pox can easily be mistaken for insect bites

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Anywhere on the body
Run in families
Last for years
Lots of topical treatments but need to remove the dead skin first (freezing, salycilic acid 50%, hydrogen peroxide 1%, occlusion, acupuncture, efudix, imiquimod)
Idea is to cause inflammation in skin so that the immune system finds the wart and then kills it
OTC treatments safe and ok

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Pox virus on the skin
Small pink papules with a belly button
No symptoms unless they have become infected
Can be massive and extensive in eczema or the immune compromised
No treatment normally needed
Last for months, contagious, no isolation required
New otc product available molludab 5% potassium hydrochloride