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INTRODUCTION

KEY POINTS

  • Parasitic infestations and infections are encountered commonly in developing countries, where the environment is ideal for them to thrive. International travel to tropical destinations plays an important part in the acquisition of parasitic diseases.

  • Factors such as geography, environment, and low socioeconomic status causing overcrowding and pollution, poor hygiene, food and water contamination, malnutrition, delayed access to medical care, and the presence of appropriate vectors play an important role in transmission of parasitic diseases.

  • Skin diseases associated with parasitic infection or infestations, including scabies and cutaneous larva migrans, are encountered in skin of color patients.

Parasites are ubiquitous in nature and associated with a variety of diseases in many different hosts. They are more common in regions of the world where various environmental factors, including climate, population dynamics, food and water sources, and the presence of appropriate vectors, enable them to thrive. In addition, host factors such as nutritional status and immune function play a key role in the transmission and acquisition of parasitic diseases and determine disease severity. Genetic susceptibility to specific parasites may also play a role. Susceptible individuals who travel to destinations where parasites are endemic are at increased risk for acquiring parasitic illnesses.

Racial differences in skin properties, such as including epidermal melanin content, melanosome dispersion, hair structure, and fibroblast and mast cell size and structure may explain differences in disease prevalence and presentation among different groups.1,2,3,4

Various skin disorders, including those caused by or associated with parasitic infection or infestation, are commonly encountered in people with skin of color, that is, African Americans, Asians, Hispanics/Latinos, and Native Americans. Complex interactions between the host factors, such as genetic makeup, nutritional status, and immune function, and environmental factors, such as geography and climate, play a key role in disease acquisition. Socioeconomic indicators such as poverty, overcrowding, and decreased access to medical care may also contribute to parasitic disease acquisition.3,4

This chapter will review some common and important parasitic illnesses that are known to cause significant skin disease in humans and focus on possible race-related variations in disease presentation. Skin manifestations of specific parasitic diseases that will be covered include the ectoparasitic infestation scabies and the cutaneous migratory endoparasitic phenomenon known as cutaneous larva migrans.

SCABIES

Background

Scabies is a common and highly contagious ectoparasitic infestation of global and public health significance caused by the arthropod Sarcoptes scabiei var. hominis. Scabies affects all individuals regardless of age, gender, race/ethnicity, or socioeconomic status. Worldwide, an estimated 300 million cases occur annually.5 Prevalence rates in developing countries are higher than those in developed nations. Overcrowding, poor hygiene, delayed diagnosis and treatment, and lack of public education are some of the factors that contribute to the prevalence of scabies in both industrial and nonindustrial nations. In ...

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