Recognition and management of common ectoparasitic diseases in travelers

This review article summarizes the ectoparasitic diseases likely to be seen by a Western dermatologist. The article aims to cover both endemic diseases and those likely to present in the returning traveler. Tungiasis is due to the gravid sand flea (Tunga penetrans) embedding into the stratum corneum of a human host. As the flea is a ground dweller, lesions are usually present on the feet and are classically periungual. The sand flea is eventually shed spontaneously but to reduce the infection risk, early surgical removal is recommended. Infestation by the Diptera species of fly causes myiasis, which may be primary, secondary, or accidental. The botfly (Dermatobia hominis) is one of the causes of primary myiasis covered in this article. Traditionally, botfly larvae are forced to partially emerge by occluding the breathing apparatus, following which manual extraction can occur. Alternatively, the larvae can be surgically removed. The common bed bug (Cimex lectularius) has experienced a resurgence over the past 10 years. Bites are typically arranged in clusters or a linear fashion and vary from urticated wheals to hemorrhagic blisters. Treatment is symptomatic with antihistamines and topical corticosteroids. In addition, bed bugs need to be eradicated from furniture and soft furnishings. Ticks are part of the Arachnid class of joint-legged animals and can transmit a variety of infections. This article briefly discusses Mediterranean spotted fever, Rocky Mountain spotted fever, and Lyme disease as well as describing tick avoidance measures. Scabies (Sarcoptes scabiei var hominis) is highly contagious and widely distributed around the world. It is common in the returning traveler and can require a high index of suspicion to diagnose. The treatment of choice in the US, UK, and Australia is permethrin 5% dermal cream, applied on two occasions, 1 week apart.