Summertime is travel time. But in addition to beautiful holiday memories, you can bring one or the other unpleasant “souvenirs” back from your holiday. You can find out here which are the 6 most common and sometimes very serious parasitoses.
Parasitoses. are diseases caused by parasites. They are among the infectious diseases in the broadest sense. However, bacteria, viruses, or fungi are not in the foreground here, but more highly developed organisms such as worms, fleas, mites, or flies. The diagnosis is not always easy, even for a trained doctor. The clinical picture and the travel anamnesis are important. There are hardly any supporting, meaningful blood tests for the diagnosis of vacation dermatoses.
The tropical region in particular offers great opportunities for infection. Depending on the holiday region, there are different risks of contracting parasitosis. The transmission routes of the infection also differ from parasite to parasite.
In general, the following applies: The parasite (parasite) colonizes a host, which can be a small animal or a human being, for example, and it needs this as a food source to survive. As a result, the host is damaged and diseased. Since the skin is the largest organ in the human body and is in contact with our environment, almost all parasitosis occurs here. These are the 6 most common parasites that can disrupt your vacation.
Scabies is caused by mites. The female mites, which are barely visible to the naked eye, dig a few millimeters long passages into the horny layer and lay their eggs there, which causes severe itching. The itching intensifies above all in the heat, so that those affected suffer particularly at night under the covers and scratch themselves. Hence the name scabies.
On the skin, you can see red, scaly, pinhead-sized nodules, and scratch marks, and with a magnifying glass, you can see twisted elongated mite burrows. The pathogens are usually transmitted through intensive physical contact from person to person. Infection through blankets or clothing is also possible, but less common. This is how travelers get infected when they stay overnight in unkempt accommodations.
Anti-mite agents are available to treat scabies, which are applied to the skin from the head to the toes in adults. Treatment with tablets is also possible. In addition, drug therapy should be supplemented by general hygiene measures (cleaning of bed linen, towels, and textiles). Even if all the mites and their eggs have been killed, components of the parasites can remain in the skin and the skin's inflammatory response can continue for several weeks. Regular use of anti-inflammatory and skin barrier-strengthening creams will help the skin recover faster.
2. Orient bump
Leishmaniasis (oriental bubo) is a very common disease. More than 12 million people are infected worldwide. The disease occurs in the Far East, in Central and South America, and also in the Mediterranean (Spain, Italy, and Turkey). The infection is caused by the protozoa of the genus Leishmania. The Leishmania use mosquitoes or sand flies (also butterfly gnats) as a means of transport. If the mosquito bites a person or animal infected with leishmaniasis, it can ingest the pathogen. Leishmania continues to develop in the mosquito and migrates to a new victim with the next bite.
The tiny sandflies are mainly active at dusk and night. Their bites can be subtle and not always noticed. Mainly uncovered parts of the body (legs, arms, cheeks) are affected. There are many types of leishmaniasis in individual countries and, accordingly, different variants of leishmaniasis with different courses. The most severe internal (visceral) form affecting the internal organs occurs predominantly in Bangladesh, Brazil, India, and Sudan. Mucosal leishmaniasis (mucocutaneous form) is found almost exclusively in South America, affecting not only the skin but also the mucous membrane, mainly in the nose and throat area. Cutaneous leishmaniasis (cutaneous form) is the most common. It is distributed in 88 countries around the world. Especially in Asia, the Near East, North Africa, and in the Mediterranean.
After being bitten by an infected mosquito, the bite site reddens within a few days or weeks (sometimes years later). A red-brown nodule forms that grow slowly over weeks. As the disease progresses, a painless ulcer, one to several centimeters in size, develops with a raised edge, which can heal on its own after months, leaving scars.
How does the doctor make the diagnosis? If there is any suspicion, a good medical history should be taken, including all previous travel destinations. A tissue sample can be taken for typical skin changes. At special institutes (tropical institutes) the genetic material of Leishmania can be detected in it and also in the blood.
Therapy depends on the form and severity of the disease. In mild cases, cutaneous leishmaniasis heals on its own in 50% of cases, otherwise, it is treated locally. The other forms require internal therapy.
Preventive measures include the use of insect repellents, close-meshed mosquito nets, sleeping in higher rooms or beds, and protecting the skin with clothing.
3. Skin mole ( Creeping disease)
Larva Migrans Cutanea (skin mole or creeping disease) is a traveler's dermatosis caused by hookworm larvae. Cats and dogs infected with hookworm are vectors of the disease. Contagion areas can be found in Africa, Asia, South America, the Caribbean, and the Mediterranean. Especially where there are many stray dogs and cats on the beach. If the skin comes into contact with sand contaminated by animal excrement, the worms are ingested and thus become infected. It primarily affects children who walk or play barefoot in the sand. In the typical places with sand contact, i.e. the feet and buttocks, there is initially reddening, but itchy papules can also occur. After a few days, the formation of a thread-like duct structure in the skin is characteristic, as the larva burrows into the epidermis and migrates. This gait structure can become a few millimeters longer from day to day.
The good news is that humans are dead-end hosts for the larvae, so they cannot develop further and die off within a time window of around 5-6 weeks. Spontaneous healing occurs.
Local therapeutic agents that are effective against roundworms, such as thiabendazole, albendazole, or ivermectin, are used as a supportive therapy, which kills the larvae and thus leads to faster healing.
Preventive measures: Do not walk barefoot on the beach where dogs and cats roam. Better always on a towel or a lounger and not directly on the sand.
Tinea corporis (ringworm) is a fungal infection of the skin. In particular, it occurs with holidaymakers who love animals (especially children) who become infected by petting stray animals (e.g. cats).
The infection spreads as a circular, scaly, itchy lesion that can be a few millimeters to several centimeters in size. As the disease progresses, several such patches of skin can fuse, forming large, map-like shapes. Pustules
can form especially on the edge. The skin spots fade away from the center. The infection spreads exclusively in the stratum corneum – the top layer of the epidermis.
The incubation period is about 10 days. If only individual skin changes are visible, antimycotics such as ciclopirox or terbinafine are used for therapy.
Important: The therapy should last at least 2-4 weeks after the visible fading away of skin changes to avoid a recurrence! In severe cases, after the pathogen has been determined, antimycotic therapy in tablet form with, for example, terbinafine or fluconazole is required. The only effective prevention is to avoid direct contact with stray animals, as they do not show an infestation.
Cimikosis (bed bug bites) is quite common. Bed bugs nest primarily in dark places such as behind pictures or cracks in furniture or walls. At night, the bugs become active and seek out humans to suck blood through a bite. The salivary secretion transmitted by the bite leads to wheal-shaped, later papular skin changes, similar to mosquito bites. In the foreground is a strong itching. The corresponding skin changes are often found in groups or in the form of a linear cul-de-sac since the bed bug usually has to bite several times before it hits a blood vessel in the skin. The skin changes usually go away on their own after about 10 days.
Topical steroids (cortisone ointments), for example, can be applied to the skin as supportive therapy. Antihistamines in tablet form are recommended for severe itching. Infested rooms can be cleaned up with the help of insecticides or an exterminator. To prevent this, wear long-sleeved nightwear and use insect repellent.
6. Head lice
Head lice (Pediculus capitis) are by far the most common parasitosis in childhood. They are transmitted through direct contact, for example when playing games. In principle, they can occur all year round but may occur more frequently in the summer months in the Mediterranean regions due to tourism. Head lice are tiny parasites that lodge in the hair and feed on blood from the scalp.
Their bites can be very itchy. Head lice attach their eggs, called nits, to the hairline near the scalp. The new generation of lice hatches within a week. The relatively unproblematic treatment is carried out with appropriate preparations and subsequent combing out. Reinfections are avoided by regular examinations of all contact persons.
Dermatoses are diseases of the skin. Accordingly, the diagnosis and treatment are primarily a matter for a dermatologist. However, as a preventative measure, beauticians can always recommend the use of insect repellents to their clients and always offer high sun protection to avoid sunburn. This is because when the skin is irritated (as with sunburn erythema) it is much more susceptible to infection. In the case of stings, the patient should be cooled immediately and, if possible, disinfected.
If clients exhibit post-holiday symptoms suggestive of traveler's dermatosis, refer them to a dermatologist.
The earlier the disease is counteracted, the smaller the effects and the better the chances of recovery. Many dermatoses attract attention because the skin at the site looks different than healthy skin. One also speaks of the so-called “ efflorescences ”. Some of these efflorescences are not particularly noticeable, while others cause severe discomfort (itching, burning, pain).
The well-trained beautician knows the different efflorescences and can use them to decide whether their treatment belongs in the hands of a doctor. If necessary, the therapy can be supported with cosmetic measures or products - perhaps only after the acute phase of the disease has subsided. The beautician can draw the customer's attention to the fact that the treatment of the diseases may affect the skin barrier and/or the skin's microbiome and that the skin needs supportive measures and special care. However, she may neither make a diagnosis nor treat without consulting a doctor.
Cooling gels or gel masks are conceivable as supportive therapies. Creams with herbal "cortisone equivalents" such as monk's head (balloon vine) or antibacterial facial tonics. Antipruritic ointments, for example, those with a high zinc content, can be applied locally to the existing bites. Everything, however, is only in consultation with the doctor. Since there are many synergies between dermatologists and beauticians, it is advisable to consult a dermatologist with an affiliated cosmetics practice.
dr medical ChristineSchrammek-Drusio
Dermatologist Allergist Managing Director