General Information: Persistent Rashes: Scabies, Methicillin-Resistant Staphylococcus Aureus (MRSA), Mycosis Fungoides

Persistent Rashes: Scabies

Scabies is a highly contagious, but curable, skin disease that affects nearly 1/3 of a billion people worldwide. It is caused by a tiny mite, just barely visible to the naked eye, that spends nearly its entire life in, or on, the human skin. Although more common in warm climates, scabies can occur anywhere and within all social and income levels. It affects men, women and children of all ages from infants to the elderly.

Because of its highly contagious nature, scabies is easily transmitted from person to person through close physical contact such as between family members, sexual partners and children playing at school. Although scabies mites cannot live long without a human host, there have been a few cases of apparent transmission through infested clothing and bedding. Even so, heroic cleaning efforts are generally unnecessary. Normal, hot water laundering of towels, linens and all clothes used within the previous 48 hours is typically sufficient to prevent reinfestation. Clean clothes or heavy winter jackets and sweaters need not be cleaned.

Treatment:

The safest and most effective topical treatment for scabies is called Elimite (permethrin) 5% cream. It kills the mites and relieves the itching. Elimite cream is proven safe for children as young as two months old. To avoid reinfestation, your doctor may recommend that all affected household members be treated at the same time within the same 24-hour period.

For treatment, thoroughly and gently massage Elimite cream into all skin surfaces from the head to the soles of the feet. It is critical to apply Elimite cream on every square inch of your body and not just on the rash. Apply between the finger and toe creases, in the folds of the wrist and waistline, in the cleft of the buttocks, on the genitals and in the belly button. Keep your nails clipped short.

Scabies mites can hide under your fingernails. Leave the cream on for 8 to 14 hours then remove it by bathing and shampooing. You may notice a mild itching, burning or stinging sensation after applying the cream. This is usually just a minor, temporary reaction to the medication. For infants, younger children, and the elderly, follow the same instructions as above, except also apply Elimite cream into the additional areas of the neck, scalp, hairline, temples and forehead.

If you wash your hands or any other area of your body during the treatment period, new cream must be reapplied immediately. It is not unusual for the itching and redness to continue for as long as two to six weeks after treatment. These symptoms may be a temporary reaction to the remains of the mites. This does not mean the Elimite cream did not work or that it needs to be reapplied. If you feel that the itching and rash are excessive or persistent, consult your physician.

The most effective oral treatment for scabies is ivermectin (Stromectol). A single dose of ivermectin can eliminate scabies. This oral dose is especially useful for patients who cannot adequately apply topical permethrin due to physical or mental disability.

Persistent Rashes: Methicillin-Resistant Staphylococcus Aureus (MRSA)

What is MRSA?

MRSA infection is caused by Staphylococcus aureus bacteria — often called "staph." MRSA stands for methicillin-resistant Staphylococcus aureus. It's a strain of staph that's resistant to the broad-spectrum antibiotics commonly used to treat it. MRSA can be fatal.

Most MRSA infections occur in hospitals or other health care settings, such as nursing homes and dialysis centers. It's known as health care-associated MRSA, or HA-MRSA. Older adults and people with weakened immune systems are at most risk of HA-MRSA. More recently, another type of MRSA has occurred among otherwise healthy people in the wider community. This form, community-associated MRSA, or CA-MRSA, is responsible for serious skin and soft tissue infections and for a serious form of pneumonia.

Symptoms

Staph skin infections, including MRSA, generally start as small red bumps that resemble pimples, boils or spider bites. These can quickly turn into deep, painful abscesses that require surgical draining. Sometimes the bacteria remain confined to the skin. But they can also penetrate into the body, causing potentially life-threatening infections in bones, joints, surgical wounds, the bloodstream, heart valves and lungs.

Causes

MRSA is a strain of staph that's resistant to the broad-spectrum antibiotics commonly used to treat it.

Staph infections

Staph bacteria are normally found on the skin or in the nose of about one-third of the population. If you have staph on your skin or in your nose but aren't sick, you are said to be "colonized" but not infected. Healthy people can be colonized and have no ill effects. However, they can pass the germ to others.

Staph bacteria are generally harmless unless they enter the body through a cut or other wound, and even then they often cause only minor skin problems in healthy people. However, staph infections can cause serious illness. This most often happens in older adults and people who have weakened immune systems, usually in hospitals and long term care facilities. But in the past several years, serious infections have been occurring in otherwise healthy people in the community, for example athletes who share equipment or personal items.

Treatments and drugs

Both hospital- and community-associated strains of MRSA still respond to certain medications. In hospitals and care facilities, doctors often rely on the antibiotic vancomycin to treat resistant germs. In the doctor’s office, dermatologists typically prescribe one or two antibiotics to treat the MRSA. In some cases, antibiotics may not be necessary. For example, doctors may drain a superficial abscess caused by MRSA rather than treat the infection with drugs.

What you can do to prevent MRSA in your community?

Protecting yourself from MRSA in your community — which might be just about anywhere — may seem daunting, but these common-sense precautions can help reduce your risk:

Wash your hands. Careful hand washing remains your best defense against germs. Scrub hands briskly for at least 15 seconds, then dry them with a disposable towel and use another towel to turn off the faucet. Carry a small bottle of hand sanitizer containing at least 60 percent alcohol for times when you don't have access to soap and water.

Keep personal items personal. Avoid sharing personal items such as towels, sheets, razors, clothing and athletic equipment. MRSA spreads on contaminated objects as well as through direct contact.

Keep wounds covered. Keep cuts and abrasions clean and covered with sterile, dry bandages until they heal. The pus from infected sores may contain MRSA, and keeping wounds covered will help keep the bacteria from spreading.

Shower after athletic games or practices. Shower immediately after each game or practice. Use soap and water. Don't share towels.

Sit out athletic games or practices if you have a concerning infection. If you have a wound that's draining or appears infected — for example, is red, swollen, warm to the touch or tender — consider sitting out athletic games or practices until the wound has healed.

Sanitize linens. If you have a cut or sore, wash towels and bed linens in a washing machine set to the "hot" water setting (with added bleach, if possible) and dry them in a hot dryer. Wash gym and athletic clothes after each wearing.

Use antibiotics appropriately. When you're prescribed an antibiotic, take all of the doses, even if the infection is getting better. Don't stop until your doctor tells you to stop. Don't share antibiotics with others or save unfinished antibiotics for another time. Inappropriate use of antibiotics, including not taking all of your prescription and overuse, contributes to resistance. If your infection isn't improving after a few days of taking an antibiotic, contact your doctor.

Persistent Rashes: Mycosis Fungoides

Mycosis fungoides

Mycosis fungoides is a condition in which the skin is infiltrated by patches or lumps composed of white cells called lymphocytes. It is more common in men than women and is very rare in children. Its cause is unknown but in some patients it is associated with a pre-existing contact allergic dermatitis or infection with a retrovirus.

Mycosis fungoides has an indolent (low-grade) clinical course, which means that it may persist in one stage or over years or sometimes decades, slowly progress to another stage (from patches to thicker plaques and eventually to tumors).

Investigations

The diagnosis of cutaneous T-cell lymphoma is made by a dermatopathologist as there are characteristic microscopic changes seen on skin biopsy. The diagnosis is often delayed for months or years and may require several biopsies, as early cutaneous T-cell lymphoma can be difficult to tell apart from other skin conditions, particularly eczema.

Treatment

Treatment of individual patients varies, and depends on the stage, local expertise and available drugs and equipment. The following may be useful.

Cutaneous T-cell lymphoma may remain confined to the skin for many years, but the abnormal cells may eventually infiltrate other tissues including blood, lymph nodes, lungs, heart, liver and spleen. Unlike some other lymphomas, the outlook is generally good. Symptoms can usually be controlled with treatment. However treatment is not curative.