阴毛 腋毛 下肢毳毛阴虱病1例

患者男 ,5 8岁。外阴瘙痒 10月余 ,腋窝及下肢瘙痒 4月。10月前 ,阴毛部位出现瘙痒 ,按“外阴瘙痒症”治疗 (用药不详 )无效。 4月前 ,双侧腋窝及下肢开始出现瘙痒 ,自用“皮炎平”等药外擦无效 ,遂来我科诊治。发病前 1月有不洁性交史。体检 :阴毛、腋毛、下肢毳毛处皮肤上散在大量针帽大小棕黄色附着物 ,紧贴皮肤不易拨除。毛干上大量针尖大小白色附着物 ,不易与毛干分离。分别夹取阴毛、腋毛及胫前毳毛处皮肤上附着物置于载玻片上 ,镜下见螃蟹状完整阴虱虫体。拔取带有白色附着物的阴毛和毳毛在显微镜高倍镜下确认为阴虱虫卵。追查其配偶…     

外阴及腋窝同患阴虱病1例

 报告外阴及腋窝同患阴虱病1例。患者男,45岁,煤矿工人。因外阴瘙痒2周,加重伴腋窝瘙痒3天就诊。皮肤专科检查：阴毛及双侧腋毛区可见红斑及丘疹,部分毛发根部可见浅褐色、大小不超过1 mm的寄生物附着,观察可发现寄生物沿着毛根向上缓慢移行。诊断：阴虱病。经50%百部酊治疗3次,2周后复诊痊愈。     

硬化性萎缩性苔藓1例

<正>1临床资料患者女,73岁。发现外阴部白斑,伴疼痛、瘙痒10年,加重3个月。10年前无明显诱因出现外阴减色斑,自觉瘙痒,皮损逐渐扩大,颜色逐渐变浅。外院多次按外阴白斑行药物和激光治疗(具体不详),效果不佳,近3个月来白斑面积增大,外阴皮肤黏膜变硬,瘙痒加重(图1)。系统检查未见异常。皮肤科情况:外阴部可见境界清楚的瓷白色萎缩性扁平丘     

眼部皮肤寄生虫感染二例

毛囊虫皮炎、疥疮及虱病等均为皮肤科常见的寄生虫感染病,前两者主要侵犯皮肤,后者主要侵犯头发、阴毛和腋毛.我们发现并诊治眼睑部位的阴虱、毛囊虫感染的2例患者,现报告如下. 例1 女,49岁,已婚.双眼睑肿胀,伴瘙痒、异物感1周,于2010年3月来本院就诊.发病后患者用氯霉素眼药水治疗,疗效不明显.追问病史,患者有外阴瘙痒1个月余,否认非婚性生活史,其丈夫2个月前于外地出差后出现外阴瘙痒,已于当地治愈.皮肤科检查:双侧睑缘轻度肿胀,上眼睑睫毛根部见栗粒大灰白色附着物,部分睫毛粘成束状,伴少许脱屑.取带有白色附着物的睫毛直接镜检,见虱卵.取患者阴毛根部附着物直接镜检见有足3对,前足细长,中足和后足强大,有钩形巨爪的虫体,头发、腋毛无瘙痒,镜检阴性.诊断:阴虱病.治疗:剪除阴毛和睫毛,生理氯化钠液清洁睑缘,碘伏涂擦,眼部外用氧氟沙星眼膏,外阴给予林丹乳膏外用.2周后复查,体检及镜检均未发现虫体或虫卵.随访1个月未见复发.     

皮肤镜观察鲍温样丘疹病一例

<正>临床资料患者,女,23岁。发现外阴褐色扁平丘疹1个月, 于2018年4月来我科就诊。患者既往体健,2个月前曾有高危性行为。系统检查无异常。皮肤科情况:外阴可见多个绿豆至黄豆大黑褐色扁平丘疹,表面光滑,无糜烂、破溃(图1)。醋酸白试验阴性。肛周皮肤未见异常。HIVAb、TPPA均阴性。皮肤镜检查见弥漫性规则分布的球状血管,局部线状排列的褐色小点(图2)。组织病理示:表皮角化不全及角化过度,棘细胞不规则增生,见挖空细胞,有异型性,极向紊乱     

双侧乳房皮肤垢着病1例

报告1例双侧乳房皮肤垢着病。患者女,14岁,双侧乳房褐色痂屑伴痒痛2个月。皮肤科检查:双侧乳房见以乳头为中心附着排列的油腻性褐色痂壳及鳞屑,大小不一,刮除痂屑可见正常皮肤。皮损处痂屑真菌镜检见簇集排列孢子。诊断:乳房皮肤垢着病。予盐酸布替萘芬乳膏、紫丙冬青油膏外用,每天早晚各1次,2周后原有皮疹基本消退,未见新发皮疹,刮取局部皮屑行真菌镜检未找到菌丝及孢子。     

药物诱发的大疱性类天疱疮一例

患者,女,20岁。全身皮肤红斑水疱伴瘙痒1个月。1个月前患者因口服“氨酚黄那敏颗粒”后全身出现红斑水疱。皮肤专科查体：上唇、颈部、胸背、腋下、外阴及双大腿内侧见红斑,其上多发黄豆至蚕豆大小的水疱、大疱,疱壁紧张,部分水疱破溃,上附淡黄色痂,尼氏征(-),部分区域可见虹膜样改变,口腔黏膜、舌部受累,可见散在糜烂、水疱。实验室检查、组织病理、直接免疫荧光结合盐裂试验,诊断为药物诱发的大疱性类天疱疮。经甲泼尼龙等治疗1个月后痊愈停药。     

蜱咬伤一例

临床资料患儿,女,2岁6个月。因头顶部皮肤被叮咬伴瘙痒、刺痛1 d,于2014年7月就诊。患儿1 d前曾在杨树下玩耍,随后家长发现其头顶部偏右侧有一灰色小结节,质硬、可移动,伴有瘙痒和刺痛。体格检查:一般情况好,系统检查未见异常。皮肤科情况:头顶偏右侧可见一灰白色结节,约绿豆大小,周围皮肤轻度红肿,无触痛。皮肤镜检查:见有一虫体口器刺入皮肤,伤口周围红肿(图1a)。当日于     

毛鞘癌一例

72岁女性患者,左前臂屈侧单发灰褐色黄豆大小皮肤肿物伴瘙痒6个月。患者左前臂屈侧可见一1.1 cm×0.8 cm×0.8 cm大小的灰褐色皮肤肿物,界限清楚,表面粗糙,顶端附着褐色痂皮,触之较硬,无压痛。局部浸润麻醉下行皮肤肿物完整切除术,组织病理示:肿瘤团块由上皮样细胞组成,可见较多空泡化细胞和骤然角化现象,有少量角化不良细胞,部分细胞有异型性及不典型核丝分裂像。诊断:毛鞘癌。术后随访6个月无复发。     

儿童眉毛和发际毛发阴虱病一例

患儿女, 6岁,眉毛和前后发际部位出现褐色小斑点 3 d。患儿由家长发现双侧眉毛部位正中处数个小黑点,洗面时擦不掉而来就诊。检查发现左侧眉毛中部 2个、右侧眉毛中部 1个黑点粘附在眉毛毛根部,贴伏于皮面上,附着牢固,不易剥去;右侧前额发际及后颈部发际边缘之细毛发处各见一片成群但散在的小褐色点, 散在如黑胡椒面样,黑点牢固附着于细毛发根部,用指甲反复搔刮才能剥离,仔细观察一黑点如虫体,尚能活动。取眉毛及发际部位之黑点置玻片上,滴加一滴质量浓度为 10％氢氧化钾溶液,略加热,于显微镜下观察,见到阴虱虫体,呈棕褐色…     

Louse comb versus direct visual examination for the diagnosis of head louse infestations

The techniques used for diagnosis of head louse (Pediculosis capitis) infestation are a source of controversy. Most epidemiologic and diagnostic studies have been done using direct visual examination. The main objective of this study is to compare the efficacy of direct visual examination versus the louse comb method. The hair of each child was examined twice; one team used a screening stick and another team used a louse comb. Seventy-nine boys and 201 girls, 7-10 years old were examined. Examination with a louse comb found that 25.4% of the children were infested with both lice and nits, while another 31.3% had nits only. Boys were significantly less infested with lice and nits than girls (lice: 15.2 and 29.6%; nits: 21.5 and 35.4%, respectively). The infestation rate with lice and nits was significantly higher in children with long (68.9%) and medium-length (63.9%) hair than in children with short hair (44.0%) (p < 0.01). Direct visual examination found that 5.7% of the children were infested with both lice and nits, and another 49.0% with nits only. The average time until detection of the first louse was 57.0 seconds with the comb as compared to 116.4 seconds by direct visual examination. Diagnosis of louse infestation using a louse comb is four times more efficient than direct visual examination and twice as fast. The direct visual examination technique underestimates active infestation and detects past, nonactive infestations.     

Head lice: scientific assessment of the nit sheath with clinical ramifications and therapeutic options

Head lice, like many insects, produce a protective coating for their newly laid eggs that is essential to the survival of the species. Knowledge of the composition of the sheath, which is the glue by which the egg is attached to human hair, and the nit laying process could lead to production of agents that could be used to attack louse infestations by interfering with the normally protected environment of nymph development within the egg. The physical removal of nits has become an important part of treatment of head louse infestations given the "no-nit" policy in schools. Biochemical analysis has revealed that the nit sheath of the head louse is composed of 4 bands of protein, possibly cross-linked to aliphatic components with a tertiary structure of beta sheeting. Nature has protected the louse by making the nit sheath similar in composition to the hair; thereby, agents designed to unravel the nit sheath may also damage human hair. Possible targets to destroy the nit sheath include proteases, denaturants, beta sheet breaker proteins, and small protein inhibitors of sheath formation. Better understanding of insect glues may allow us to develop compounds so that the liquid secretions of the collateral glands of the female louse, which becomes the nit sheath, do not solidify by oxidation when placed with the louse egg onto human hair. Knowledge of insect behavior, such as oviposition, may also suggest methods for repelling female lice from laying eggs onto hair. Alternatively, agents that coat the nits and restrict the oxygen transfer to the developing larvae may prove beneficial.     

Circumscribed alopecia: an unusual manifestation of pediculosis capitis

A healthy 10-year-old girl was referred for evaluation of patchy hair loss on the scalp of longer than 6 months duration. She had been diagnosed and treated for head lice approximately 1 month before onset of the hair loss. Examination of the scalp showed discrete ovoid patches of hair loss at the vertex scalp. A scrape of the area of hair loss was performed, and a nit was visible on microscopic examination. Focal hair loss may represent an atypical manifestation of ongoing pediculosis capitis.     

Epidemiological Studies on Head Lice Infestation in Israel

Of 3,079 children in a medium-sized community near Jerusalem, 11.2% were found to be infested with living lice and eggs and another 23.4% had only nits. Boys and girls were equally infested. The incidence of infestation was highest among children 4-11 years of age. About 78% of the infested children had from one to ten lice. Approximately 80% of the infested children had nits that were 2-5 cm away from the scalp. Boys with medium length hair and girls with short hair showed the highest incidence of lice infestation. Children with brown and red hair were more infested than those with black and blond hair. Boys and girls with straight and wavy hair were more infested than those with curly and frizzy hair.     

Transmission potential of the human head louse, Pediculus capitis (Anoplura: Pediculidae)

BACKGROUND: Millions of people are infested by head lice every year. However, louse transfer between hosts is not well-understood. Our goals were to determine: (1) which stages were most likely to disperse and why, (2) the likelihood of fomites transmission, and (3) if host blood gender affects louse development. METHODS: Various life stages of lice at differing densities were permitted to cross over a 15-cm hair bridge placed between two artificial blood-feeding arenas. Louse transfer caused by hot air movements, combing, toweling, and passive transfer to fabric was investigated. The ability of lice to oviposit on different foreign substrates and the hatching potential of eggs intermittently incubated for 8 h/night on a host were likewise investigated. Louse in vitro development following feeding on human female or male donor blood was compared. RESULTS: Adult lice were the most likely to disperse. Neither population density nor hunger significantly affected dispersal tendencies. Lice were dislodged by air movement, combs and towels, and passively transferred to fabric within 5 min. Females oviposited on a variety of substrates and 59% of eggs incubated for 8 h/night hatched after 14-16 days. There was no survivorship difference between lice artificially fed on female vs. male blood. CONCLUSIONS: Adult lice are the most mobile, indicating that they are most likely to initiate new infestations. Although head-to-head contact may be the primary route of transmission, less direct routes involving fomites may play a role and need further evaluation. Blood-borne factors do not appear to cause any gender-biased host preference.     

Spatial and kinetic factors for the transfer of head lice (Pediculus capitis) between hairs

Although the global increase in pediculosis is well known, little is known about the exact nature of head lice (Pediculus capitis) transmission. Several mechanisms have been proposed such as head-to-head and fomite transmission, but some contention remains concerning the primary transmission route. This study investigated spatial and kinetic factors influencing the dynamics of hair-to-hair transfer to clarify further how head lice transmit from head to head. Forty-eight factorial experimental trials, with 10 replicates each, were conducted using 480 freshly caught P. capitis from primary school children. In the trials, each louse was placed on a stationary suspended hair or a mobile hair and was presented with mobile or stationary hairs for transmission. All hair passes involved contact between the uninhabited hair and the lice. Hairs without a louse were presented dorsally, laterally, and ventrally to the louse. They were also passed from head to tail or from tail to head and were moved at speeds of 8 m and 4 m per min. The proportion of P. capitis transmission was highly dependent on the specific setting. The tail-to-head direction, slow movement, and a parallel direction all proved favorable for transmission. The highest transfer proportion of P. capitis (85%) was observed in the setting where the presented hair was laterally slow moving in a parallel way from tail to head. No transmission at all was observed under an angle of 90 degrees. Hair-to-hair P. capitis transmission occurred more frequently when hairs were in particular physical and kinetic relationships. This suggests that head lice are less likely to take advantage of many proposed fomite transmission scenarios and are most likely to rely on head-to-head contact for transmission.     

Comparative efficacy of two nit combs in removing head lice (Pediculus humanus var. capitis) and their eggs

BACKGROUND: Fine tooth lice combs fall into two classes based on the material from which their teeth are made: plastic or metal. Metal combs are further divided into those that are made from a flat sheet of metal, and hence have rectangular teeth, and those that have cylindrical teeth embedded in a plastic base. METHODS: The efficacy of two fine tooth combs [Lice Meister comb (metal) and Lady Jayne comb (plastic)] in removing head lice (Pediculus humanus var. capitis) and their eggs from the hair of children was evaluated after treatment with a viscous head lice product (Lice Blaster; Emerald Forest Pharmaceuticals Pty Ltd, Currumbin, Qld, Australia). The hair of 27 children was divided into two sections sagitally, and each comb was randomly assigned to one half of the hair, and the lice and eggs removed by the combs were counted. RESULTS: In 96% of subjects, the Lice Meister comb removed more eggs than the Lady Jayne comb, with an average of three to four times more hatched, dead, and live eggs removed. The Lice Meister comb removed more lice than the Lady Jayne comb in 10 subjects, the same in eight subjects, and less in nine subjects. CONCLUSION: Overall, the Lice Meister comb is recommended as a more effective comb for use in controlling head lice infestations, whether employed with conditioner or with insecticide treatment. This appears to be the first study investigating the efficacy of nit combs in vivo. Further research is needed to determine which characteristics of fine tooth combs are the most important in removing head lice eggs.     

婴儿脓癣伴体癣1例

患儿女,8个月。额头上发际处红斑丘疹1月余,头皮丘脓疱疹及右上臂圆形环状红斑1周。真菌镜检可见发外大量真菌孢子,皮屑中有透明分隔菌丝。根据培养镜下形态和鉴别试验鉴定为须癣毛癣菌。诊断为脓癣伴体癣。采用灰黄霉素口服配合外用药疗效明显。治疗期间无任何不良反应。     

Scanning electron microscopy of adult head lice (Pediculus humanus capitis) with focus on clinical implications

BACKGROUND: The incidence of head lice infestations in North America is escalating with an estimated 12 million cases of head lice per year despite the existence of insecticidal therapies. OBJECTIVE: To evaluate certain characteristics of the human head louse, including their chitinous structure, nymphal developmental stages, legs with claw adaptations, antennae with sensory perceptions, and spiracles by which oxygen exchange occurs, for assessment of possible means to control the spread and growth of this insect. METHODS: Scanning electron-microscopic examination of head lice was performed. RESULTS: Newer treatments of head lice must acknowledge defense mechanisms that are based on anatomic structure and physiologic characteristics, details of louse transmission, and the insects' ability to 'resurrect' after sham death. CONCLUSIONS: An understanding of lice entomology is essential in the pursuit of novel means to control the lice epidemic.     

Ektoparasitosen

Ectoparasites and epidermal parasitic skin diseases are a heterogeneous group of infections of the external layer of the skin. The most common forms world-wide are scabies, lice (Pediculosis capitis, corporis, vestimentorum and pubis), tungiasis and the hookworm-associated Larva migrans cutanea. The head louse is the most widespread parasite in children in Germany. The symptoms, apart from pruritis, eczematous skin eruptions and ictus reactions of the skin, are often unspecific and many differential diagnoses must be considered. Treatment of ectoparasites includes manual procedures, such as repeated cleansing and combing out of lice-infected hair and also local antiparasitic treatment with permethrin, pyrethrum extract, allethrin and dimeticon. Lindan which has been used for decades can no longer be used in medications after 2008 after a decision of the EU Commission. Failure of treatment of head lice can be a result of errors in the treatment which favor survival of the eggs, larvae or adults. This can be a result of too short reaction times and too economical use or unequal distribution of medications, excessive dilution due to wet hair or omitting repeated treatment stages. Additionally resistance of head lice to pyrethrum is a known phenomenon and has been reported in several countries.