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RECOGNIZING PARASITIC INFECTIONS

Q: We have a male friend with a skin problem that could be scabies. The lesion looks like a deep red varicose vein on his ankle. It is C-shaped, approximately five inches long and about as wide as a pencil lead. He says he had it once before, a long time ago, on his waist. His wife and daughter have not contracted this problem. He has an outside cat, dog and rabbit and an indoor cockatiel. I hope I've given you enough information. Could it be scabies?

-- J.D., Miami

A: The short answer to your question is yes, it could be scabies, but given your description it's not likely. I'll discuss scabies and similar parasitic infections to help you understand what may be going on.

Scabies is caused by infestation with a tiny parasitic mite. The female mite burrows under the skin and deposits eggs, which causes intense itching (worse at night) in the areas of the burrows. The burrows can appear as thin, wavy lines, but only up to half an inch long and often much shorter.

The most common areas for this burrowing are between the fingers, on the wrists, elbows and armpits, along the belt line and around nipples and genitals.

Usually, the combination of intense itching and the appearance of burrows are enough to diagnose the condition as scabies. The diagnosis is confirmed by looking at skin scrapings under a microscope.

The infestation is easily transmitted from one person to another by sharing bed linens and clothing, and by other close physical contact. Normal laundering of the shared objects usually destroys the mites and extensive fumigation is not usually required.

Scabies mites can be controlled by topical application of a cream containing permethrin (e.g., Elimite or Acticin) or lindane. Both are effective, but must be prescribed by a health-care provider. Lindane is more toxic and should not be used by infants or pregnant women. Except for pregnant women -- for whom infestation should be documented first -- all persons in the household should be treated, or there can be a reinfestation.

Your friend's condition may be due to another parasitic infection, a hookworm infection known as creeping eruption or cutaneous larva migrans. This infection is caused by a hookworm that inhabits dogs and cats, and it is transmitted to humans through skin contact with the animal feces on the ground.

Similar to the scabies mite, this hookworm enters at the site of penetration, burrows and migrates along in a meandering thread-like line in the skin. This infection is also characterized by an intense itch.

Creeping eruption can be controlled effectively by thiabendazole applied to the affected skin area. This medication also must be prescribed.

Most other arthropod mites -- chiggers, bird mites, rodent mites, carpet mites, etc. -- are more commonly known as biters, not burrowers. And even some burrowers do not migrate.

If your friend has intense itching (which you didn't mention), it sounds like he may have one of these or some other parasitic infection. He may need to see a doctor to get a definite diagnosis. He'll have to anyway, to get prescription medication.

Update on child abuse: I feel sick in my heart when I hear another statistic pointing to the incredibly cruel and barbaric way that many children are treated by their caregivers.

A published study in the Journal of the American Medical Association provides just such statistics. The researchers found that 85 percent of the murders of children under age 11 stem from child abuse, three times what had been previously thought.

Even more saddening is that only 3 percent of the time was the perpetrator a stranger. Imagine the horror a young child must feel living with someone who is a deadly threat every day of his or her life.

While I don't condone and often cannot forgive an adult who abuses a child, I understand that abuse is usually the result of psychological and social problems that are part of the person's life. A lot can be done to prevent the abuse of millions of children. The sooner the problem is tackled, the more lives we'll save.

Dr. Allen Douma welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Douma in care of Tribune Media Services, 435 N. Michigan Ave., Suite 1400, Chicago, Ill. 60611. His e-mail address is DRFamily@aol.com.

This column is for informational and educational purposes only. It is not intended to provide medical advice or take the place of consultation with a doctor or other health-care provider.

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