Parasites

Parasitic infection should always be included in the differential diagnosis of patients with perianal pruritus. Pinworms (Enterobius vermicularis) are the most common cause of perianal itching in children. The diagnosis can be made by microscopically evaluating perianal skin samples collected on cellulose tape. It is imperative that other family members be evaluated so they can be treated and recontamination does not occur. The symptoms usually occur in the evening, when these 6-mm-long parasites migrate to the perianal skin. Scabies, a contagious skin infestation due to the mite Sarcoptes scabiei, can elicit severe pruritus. Although usually found on the finger webs or sides of the fingers, these lesions can often be identified in the perianal region. The diagnosis of scabies can be confirmed by demonstrating the mite or its products, such as ova or feces, from scrapings prepared on a slide with one drop of 10% potassium hydroxide. Lesions appear initially as vesicles as the mite burrows its way into the stratum corneum. Treatment consists of the application of an appropriate scabieticide such as Kwell lotion (Reed & Carnrick, Jersey City, NJ). The parasite Pediculosis pubis (crab or louse) can often be found grasping the base of a hair shaft and is

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