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Current Geriatrics Reports
Published in: Current Geriatrics Reports 4/2018

01-12-2018 | Dermatology and Wound Care (C Sayed and D Culton, Section Editors)

Infestations in the Geriatric Patient

Authors: Ashley Dietrich, Kritika Joshi, Christopher Sayed

Published in: Current Geriatrics Reports | Issue 4/2018

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Abstract

Purpose of Review

This article seeks to review the common infestations plaguing the geriatric population including scabies, lice, and bed bugs as incidence is on the rise in this growing population. These infestations can be debilitating, embarrassing, and burdensome to patients. We discuss classic clinical presentations, diagnostic features, first-line treatment, and management of each.

Recent Findings

A special focus is included on scabies infestations as its incidence is rapidly increasing, and unique considerations are given to the geriatric population regarding management and treatment. Furthermore, increased reports of post-scabetic pruritus pose a treatment conundrum to providers.

Summary

We hope our review of common geriatric infestations including scabies, lice, and bed bugs better equips primary physicians to diagnose, treat, and manage complications following treatment.
Literature
1.
• Thomas J, Peterson GM, Walton SF, Carson CF, Naunton M, Baby KE. Scabies: an ancient global disease with a need for new therapies. BMC Infect Dis. 2015;15:250. A review of the strengths and weaknesses of current treatments for scabies highlighting the need for additional therapeutic options. CrossRef
2.
•• Karimkhani C, Colombara DV, Drucker AM, Norton SA, Hay R, Engelman D, et al. The global burden of scabies: a cross-sectional analysis from the global burden of disease study 2015. Lancet Infect Dis. 2017;17(12):1247–54. A major global study highlighting the burden of scabies is greater in the elderly population. Scabies infestation remains a major cause of morbidity in the elderly. CrossRef
3.
• Castro MCR, Ramos-E-Silva M. Cutaneous infections in the mature patient. Clin Dermatol. 2018;36(2):188–96. A review of the differential diagnosis and presentation of various cutaneous infections and infestations. CrossRef
4.
Currie BJ, McCarthy JS. Permethrin and ivermectin for scabies. N Engl J Med. 2010;362:717–25.CrossRef
5.
Hengge U, Currie B, Lupi O, Schwartz R. Scabies: a ubiquitous neglected skin disease. Lancet Infect Dis. 2006;6:769–79.CrossRef
6.
Panuganti B, Tarbox M. Evaluation and management of pruritus and scabies in the elderly population. Clin Geriatr Med. 2013;29(2):479–99.CrossRef
7.
8.
•• Micheletti RG, Dominguez AR, Wanat KA. Bedside diagnostics in dermatology: parasitic and noninfectious diseases. J Am Acad Dermatol. 2017;77:221. Mineral oil preparation is a simple, rapid, and economical way to confirm scabies infestation. CrossRef
9.
• Arlian LG, Feldmeier H, Morgan MS. The potential for a blood test for scabies. PLoS Negl Trop Dis. 2015;9(10):e0004188. Overview of failed attempts to develop reliable serologic testing for scabies. CrossRef
10.
11.
Strong M, Johnstone P. Interventions for treating scabies. Cochrane Database Syst Rev. 2007;3:CD000320.
12.
Johnstone P, Strong M. Scabies. BMJ Clin Evid. 2014.
13.
Currie BJ, McCarthy JS. Permethrin and ivermectin for scabies. N Engl J Med. 2010;362:717–25.CrossRef
14.
Hu S, Bigby M. Treating scabies: results from an updated Cochrane review. Arch Dermatol. 2008;144(12):1638–40.CrossRef
15.
Rezaee E, Goldust M, Alipour H. Treatment of scabies: comparison of Lindane 1% vs Permethrin 5%. Skinmed. 2015;13(4):283–6.PubMed
16.
17.
•• Dhana A, Yen H, Okhovat JP, Cho E, Keum N, Khumalo NP. Ivermectin versus permethrin in the treatment of scabies: a systematic review and meta-analysis of randomized controlled trials. J Am Acad Dermatol. 2018;78(1):194–8. Recent meta-analysis suggesting no clear evidence for topical permethrin vs. oral ivermectin as variation in treatment with single and repeat dosing challenges direct comparison. CrossRef
18.
•• Ahmad HM, Abdel-Azim ES, Abdel-Aziz RT. Clinical efficacy and safety of topical versus oral ivermectin in treatment of uncomplicated scabies. Dermatol Ther. 2016;29(1):58–63. Recently available topical ivermectin solution was equally effective as oral ivermectin with all patients cured after two treatments in both groups. CrossRef
19.
Chhaiya SB1, Patel VJ, Dave JN, Mehta DS, Shah HA. Comparative efficacy and safety of topical permethrin, topical ivermectin, and oral ivermectin in patients of uncomplicated scabies. Indian J Dermatol Venereol Lep-rol. 2012;78(5):605–10.CrossRef
20.
•• Hewitt KA, Nalabanda A, Cassell JA. Scabies outbreaks in residential care homes: factors associated with late recognition, burden and impact. A mixed methods study in England. Epidemiol Infect. 2015;143:152–1551. Recent study recognized elderly female patients with dementia at highest risk for scabies infestation. Burrows on exam are diagnostic, but not always present. Lack of burrows does not rule out scabies infestation. CrossRef
21.
Cavalcante MLSN, Borges CL, Moura AMFTM, Carvalho REFL. Indicators of health and safety among institutionalized older adults. Rev Esc Enferm USP. 2016;50(4):600–6.
22.
Chambliss ML. Treating asymptomatic bodily contacts of patients with scabies. Arch Fam Med. 2000;9:473–4.CrossRef
23.
FitzGerald D, Grainger RJ, Reid A. Interventions for preventing the spread of infestation in close contacts of people with scabies. Cochrane Database Syst Rev. 2014;24(2):CD009943.
24.
25.
26.
Roberts RJ. Clinical practice. Head lice. N Engl J Med. 2002;346:1645–50.CrossRef
27.
28.
Devore CD, Schutze GE, Council on school health, Committee on infectious diseases of the American Academy of Pediatrics. Head lice. Pediatrics. 2015;135:e1355.
29.
• Koch E, Clark JM, Cohen B, Meinking TL, Ryan WG, Stevenson A, et al. Management of head louse infestations in the United States. Pediatr Dermatol. 2016;33(5):466–72. An excellent review of current management strategies for head lice in the pediatric population that is applicable to the geriatric population. CrossRef
30.
Burkhart CN, Burkhart CG, Morrell DS. Infestations. In: Bolognia JL, Jorizzo JL, Schaffer JV, editors. Dermatology. 3rd ed. London: Elsevier Saunders; 2012. p. 1426–9.
31.
•• Drugs for Head Lice. JAMA. 2017;317(19):2010–1. Recent review of medications available for treatment of head lice. Strongest evidence suggests topical malathion or topical ivermectin versus oral ivermectin.
32.
Pearlman DL. A simple treatment for head lice: dry-on, suffocation-based pediculicide. Pediatrics. 2004;114(3):e275–9.CrossRef
33.
Pearlman D. Cetaphil cleanser (Nuvo lotion) cures head lice. Pediatrics. 2005;116(6):1612.CrossRef
34.
35.
Goddard J, deShazo R. Bed bugs (Cimex lectularius) and clinical consequences of their bites. JAMA. 2009;301:1358–66.CrossRef
36.
Goddard J, Edwards KT. Effects of bed bug saliva on human skin. JAMA Dermatol. 2013;149:372–3.CrossRef
37.
Cleary CJ, Buchanan D. Diagnosis and management of bedbugs: an emerging U.S. infestation. Nurse Pract. 2004;29:46–8.CrossRef
38.
Thomas I, Kihiczak GG, Schwartz RA. Bedbug bites: a review. Int J Dermatol. 2004;43:430–3.CrossRef
39.
Panuganti B, Tarbox M. Evaluation and management of pruritus and scabies in the elderly population. Clin Geriatr Med. 2013;29(2):479–99.CrossRef
40.
41.
Johnston G, Sladden M. Scabies: diagnosis and treatment. BMJ. 2005;331:619–22.CrossRef
42.
Pickett MM, Muszynski MA, Norton SA. Of lice and men. JAMA Dermatol. 2014;150(3):250.CrossRef
Metadata
Title
Infestations in the Geriatric Patient
Authors
Ashley Dietrich
Kritika Joshi
Christopher Sayed
Publication date
01-12-2018
Publisher
Springer US
Published in
Current Geriatrics Reports / Issue 4/2018
Electronic ISSN: 2196-7865
DOI
https://doi.org/10.1007/s13670-018-0255-z

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