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Discussed in this article are the epidemiology, diagnosis, and management of common skin infections in children, including impetigo and cutaneous dermatophytosis and fungal disease.

In keeping with the aims of the Workshop, this presentation is confined to common types of skin infections with the highest incidence in the population at large. The rare and exotic will not be discussed, since they seldom constitute a public health problem.

• Ovicidal activity and killing times were evaluated for six pediculicides, using viable eggs and recently fed head lice from infested children. Lice were continuously exposed to the products until death, and elapsed time was recorded. Eggs were immersed for ten minutes, rinsed, and dried. Four synergized pyrethrin products (RID, R&C Shampoo, A-200 Pyrinate Shampoo, A-200 Pyrinate Liquid) killed all lice in ten to 23 minutes, and 23% to 32% of treated eggs hatched; 0.5% malathion lotion (Prioderm Lotion) killed lice within five minutes and was highly ovicidal, with only 5% of eggs hatching. One percent lindane shampoo (Kwell Shampoo) was the slowest-acting pediculicide, requiring approximately three hours to kill all lice; 30% of the eggs hatched after treatment. The in vitro results for RID, Prioderm Lotion, and Kwell Shampoo were validated by clinical trials.(Arch Dermatol 1986;122:267-271)

Epidemic inflammatory dermatophytosis among US combat forces in Vietnam was caused by a pancreatopeptidase E-producing, small (a) mating type, zoophilic variety of Trichophyton mentagrophytes,a variety not ordinarily isolated in the United States. An abundant reservoir of zoophilic T mentagrophytes was discovered in commensal rats; carriage was frequent on normal-appearing perineal skin. Variations in prevalence and severity of infection were related to differences in clothing, wet terrain exposures, and duration of tropical service.Our findings suggest that (1) T mentagrophytes infections were acquired in Vietnam, possibly from rats; (2) risk of infection was directly related to degree of exposure to wet clothing; (3) Americans were distinctly more susceptible to T mentagrophytes infections than were adult Vietnamese.

Scabies and pediculosis capitis are frequent and often unrecognized causes of multiple streptococcal and staphylococcal pyodermas.

After more than three years experience with improved topical therapy for major thermal wounds,1,2 it is apparent that wound infection remains a significant threat to burned man. Although the frequency of burn wound sepsis and death therefrom has been much reduced and survival significantly improved, infection by Pseudomonas aeruginosa continues to cause more deaths than any other complication when careful bacteriologic and autopsy examinations are regularly done.3The careful studies of Brentano et al4 indicated that increasing numbers of bacteria were elaborated from the burn wound concomitant with clinical invasive sepsis. Studies undertaken with a simpler technique for serial quantitative bacteriologic assay of the burn wound indicated that significant increases in bacterial wound density preceded invasive infection as well as all clinical signs thereof.5 It was surmised and subsequently confirmed, that prompt detection of such increased bacterial density might allow earlier diagnosis of burn wound infection,

Initial skin cultures yielded 100% recovery of group A streptococci from the lesions of 66 patients suffering from ecthymatous impetigo. Of the 66 patients, 85% also had coagulase-positive staphylococci in their lesions with 45% of the staphylococci resistant to penicillin G.Patients were divided into two treatment groups. The first treatment group (30 patients) received 600,000 units of benzathine penicillin G intramuscularly in a single injection; whereas the second treatment group (36 patients) received 600,000 units of procaine penicillin G intramuscularly in a single injection. All patients receiving benzathine penicillin G showed complete healing within a week, whereas only 38% receiving procaine penicillin G healed within two weeks.

Streptococcal surveys in foreign countries or remote areas may be greatly enhanced by the use of calcium alginate swabs desiccated in sterile silica gel. Delays of up to 4 weeks before return to a base laboratory are feasible, and the need for fresh media or laboratory facilities in the field may be eliminated. Comparison of direct plating on crystal violet blood agar versus delayed silica gel preservation during surveys in Uganda, Haiti, Colombia, and Miami, Fla., showed no significant loss of positive cultures from skin lesions and suggests that desiccated swabs increase the recovery of bacitracin-sensitive Streptococcus pyogenes(presumptive group A) from throats.

BACTERIA of the Mima-Herellea group were not recognized as distinct and remained undescribed until 1942, when De Bord1 suggested the name Mimeae for a new tribe of gram-negative, nonmotile organisms which resembled Neisseria morphologically, but differed in biochemical characteristics. He named the two new organisms Mima polymorpha and Herellea vaginicola.During subsequent years, other authors reported similar organisms but gave them different names so that the situation became extremely confusing. Synonyms for bacteria in this group include "B5W,"2Bacterium anitratum,3Moraxella glucidolytica,4Achromobacter lwoffi,5 and Acinetobacter anitratum.6 Reviews of the literature are given by Rosebury in 19627 and Daly et al in 1962.8Presumably due to the uncertain taxonomic position of these bacteria, they were not included in the seventh edition of Bergey's Manual of Determinative Bacteriology. This, combined with the confusing variety of synonyms, resulted in failure to identify this group

Eleven volunteers wore a noninsulated boot on one foot and an insulated rubber boot filled with water on the other foot during 72 hours of immersion in swamps. Both feet were continuously wet, but the temperature of one foot of each man was approximately 20 F (11.2 C) higher than the other throughout the study. Results indicated that symptomatic tropical immersion foot can be produced without any element due to cold injury or heat loss, and that symptoms occurred more rapidly at the higher temperature.

Pitted keratolysis is a superficial infection of the skin confined to the stratum corneum. The causative organism has not been identified. The clinical syndrome is distinct and is characterized by pits and superficial erosions in the pressure areas of the soles and in the lateral surfaces of the toes. The histopathology of the lesions is presented and world literature is reviewed. It is concluded that this disease is not limited to the tropical climates, although cases tend to be more severe in these areas.

Before studying the changes griseofulvin induces in Trichophyton organisms, it was necessary to define the normal fine structure of the fungus. No previous study of sections of these organisms has appeared. The preliminary report by Laden and Erickson10 of the internal structure of Epidermophyton floccosum is the only study of its type with a dermatophyte.Several workers have attempted to visualize fungi in the electron microscope without sectioning the organisms, but these reports demonstrated little that could not be seen with a light microscope.9,11,14,19 In ultrathin sections it was noted that algae (Allomyces) contain many of the most prominent intracellular structures described in animal cells, such as mitochondria with the classical mitochondrial membrane and cristae, as well as an organized cell nucleus with a double-structured nuclear membrane.22,23 No typical ergastoplasm, however, was found in these aquatic phycomycetes. The most recent studies of bacteria reveal a thin cytoplasmic

Tropical bacterial pyodermas have been a leading cause of disability among American soldiers in Vietnam. The predominant lesions were ecthymatous ulcers of the lower extremities, 90% of which yielded group A β-hemolytic streptococci on culture. Combat-related exposure to environmental sources of minor skin trauma appeared to account for the greater than threefold difference between combat and support troops in prevalence of pyoderma involving the foot and ankle. Pyodermas were more than 21/2 times as prevalent in whites as in those with darker skins, a difference which existed independent of environmental exposure. Systemic addition of penicillin to standard topical treatment significantly reduced healing time. Coagulase-positive staphylococci were commonly isolated from pyodermas, but evidence is adduced that they were secondary wound colonizers rather than primary pathogens.

Disability from skin diseases among American troops in Vietnam engaged in combat in warm wet areas is often the greatest medical cause of noneffectiveness. Infections are the leading causes of cutaneous disease.The most common infection is produced by a griseofulvin-sensitive elastase producing Trichophyton mentagrophytes but other dermatophytes and Candida albicans are also frequent.Modern treatment has reduced medical evacuation in comparison with World War II. The statistics give dramatic evidence of the reduction in prolonged disability from skin diseases in Vietnam as compared with the Southwest Pacific in 1944-1945. Little has been accomplished in preventing skin diseases in combat troops.The statement by a military commander that "the fighting strength of troops, such as those in the Mekong delta region, would be almost doubled by improving prevention and treatment of dermatological disorders" poses a real challenge to the military and to dermatology.

The authors have attempted to critically review the subject of mycetoma emphasizing clinical and laboratory aspects which will aid the clinician to correctly diagnose this entity. Specific laboratory techniques are presented, as well as latest therapeutic measures known for mycetoma.