Der Hautarzt; Zeitschrift für Dermatologie, Venerologie, und verwandte Gebiete
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Comparative Study
[Treatment of endemic scabies with allethrin, permethrin and ivermectin. Evaluation of a treatment strategy].
Ectoparasitic cutaneous infestations are still common problems in countries of Western Europe. Scabies is a highly contagious disease of the skin caused by Sarcoptes scabiei variatio hominis. It has a world-wide distribution and affects all ages with no specific gender predisposition. Scabies is of profound public health interest because certain environment factors such as overcrowding, poor hygiene, delayed treatment of primary cases and lack of public enlightenment are conducive to its spread. However, prompt and adequate therapy is rewarding and prevents further spreading. Scabies acquires additional public health significance when large numbers of individuals are affected, as in a nursing home. Outbreaks of scabies in such dimensions require a special treatment strategy. ⋯ Our strategy for eradication of endemic scabies has proven effective. Allethrin can be used following the package inpermethrin is more effective and can also be used in children, as well as pregnant and nursing women. Ivermectin is particularly useful in treating crusted scabies. It is not approved for scabies in Germany so the patients must be accordingly counseled. The frequency and the major therapeutic problems in treating endemic scabies make it important to work for the approval of permethrin and ivermectin in this setting.
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In approximately 30% of cases of chronic diffuse loss of scalp hair with a duration of at least 6 months, no underlying abnormality can be found. Typically this occurs in women, starting abruptly without a recognizable initiating factor, and involving the entire scalp area with increased shedding of telogen hair. With the exception of bitemporal recession, hair thinning is usually discrete, and contrasts to the great emotional overtones in this situation. ⋯ Current therapeutic recommendations are pragmatic, and based on both experimental observations of the sheep wool industry and clinical experience. They include the use of L-cystine-containing oral preparations and of corticosteroids. Further investigation into the molecular controls of the hair cycle are required to find a more specific form of therapy, for which the expense and risk-benefit ratio seem appropriate for the treatment of this benign condition.
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In patients with painful, possibly hemorrhagic vesicles or black crusts, especially on hands/fingers or face/neck with typical history (contact to cows or feral/cats) the possibility of a cowpox/catpox infection has to be considered. The clinical diagnosis can be confirmed with the electron microscopy; cytoplasmic inclusions may be detected histologically. ⋯ We report the development of typical skin lesions of a cowpox/catpox infection in two female patients who had contact with cows or cats. Recent diagnostic and therapeutic approaches are also discussed.
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Reliable, long-acting local anesthetics reduce postoperative pain and make it easier to plan surgery. This is especially true when slow infusion anesthesia (SIA) is used. The anesthetic agent ropivacaine appears to meet the requirements of SIA especially well. ⋯ We regard ropivacaine as a major step forward in the use of local anesthesia.