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Dermatologic Disorders

Spiders. There are about 30,000 species of spiders in the world but only about 50 of those species bite humans, and although they may be painful, most have no medical sequelae either because the spiders have short fangs, small fangs or inadequate venom. So although they might hurt and people might say, "Iíve been bitten by a spider" most of them donít have much medical importance that you have to worry about.

Six species in the United States are capable of delivering necrotic bites, and the necrotic bites are the ones that we are most concerned about and the ones that we worry about, and obviously are the worst problem for the patient. Those are the ones that lead the sequelae and also cause quite a bit of pain.

Wolf spiders are very common, they are very ugly spiders and they also produce a very painful bite. And they are very scary so somebody is going to really be upset if they get bitten by a wolf spider. There is something called a Hobo Spider, which has just started to be seen in the Northwestern part of the United States.

This is the distribution of these spiders in the United States and this is from the CDC/MMMR report and it discusses the so-called Hobo spider, Tegenaria aggrestus. And this is the area that the Hobo spider has been reported in, but as you can see, itís kind of creeping down. It used to be up in the far Northwest.

The papular urticaria is another situation and what that is, is each new mosquito bite produces a recurrence of all the recent bites. So when you get one bite, all the old bites itch and therefore it looks like you have a clinical picture. Scabies occurs in epidemics, in 30-year cycles with 15-year gaps between the cycles. The current epidemic we are in began in the mid-1960ís but unfortunately itís still going. About 2% of dermatologic visits are due to scabies.

This is an infant and these are blisters. The only time you see blisters with scabies is infants. This is interesting. This looks like a fungus infection. It looks like a dermatophyte. The other thing about scabies to be concerned about and to think about, is when you have diagnosed the family as having scabies but you treat them and they just wonít go away, you need to think of Chiotielo, which are ear mites.

How do you treat them? I think most people now use the Elimite, which is the pyrethrum 5% cream, single application. Works very well. Kwell isnít used as much as it used to be. For pregnant women and infants I use the sulfur, %6 in petrolatum applied nightly for three nights. Works very nicely. The newest thing, of course, is the ivermectin.

Alternative treatment for scabies, which is ivermectin and they just had a dosage guideline. Itís called Stromecti, itís the brand name for ivermectin. He says it simplifies the treatment of scabies with one oral dose.

Head lice, another problem. Iíve been involved with head lice too. I probably went in and bought the family size nits about a year ago at the drugstore. Last school year 80% of the school districts had at least one outbreak. It doesnít transmit disease, although most of the studies havenít been done. You can get group A strep and staph infections. You need a clean scalp for the blood meal, so when the parents say, "I feel so terrible, Iím not taking good care of my child." You can say, ĎNo, your child has such a nice clean scalp that they appeal to the lice."

Ticks: hard ticks, soft ticks, seed ticks of immature forms. Although everybody says they have a seed tick on them. The hard ticks, what they do is they quest and when they climb up a blade of grass and wait for somebody to walk

I think everybody knows what a tick looks like. Characteristic appearance. The important thing really is to check everywhere. Here it is under the hair. If you didnít look under the hair and this finger is pushed out the hair, you wouldnít find the tick until who knows. The next time you went to the barber shop. So anyway, itís important to