Special Operations Forces Medical Handbook

4-63

3. Examine and treat all family members and personal contacts at the same time. Remove nits with a very
   ne-toothed nit comb. “Step-2” or Clear Lice Egg remover Cleansing Concentrate applied to the hair will help
   aid in nit removal (no pediculocide is 100% ovicidal).
   Alternative: Lindane shampoo 1.0% (may not be available in US), and pyrethrins shampoo 0.3% used in
   a similar fashion as above.
   Secondary: Relieve pruritus with oral antihistamines, cool baths or compresses, and topical steroids. Topical
   antipruritics like saran lotion or prameGel are alternatives.

Patient Education
General: Do not clean the hair or body excessively, as this can lead to excessively dry skin and a secondary
focus of pruritus.

Follow-up Actions
Evacuation/Consultant Criteria: No need to evacuate. Consult dermatology as needed.

Spirochetal Diseases

Skin: Yaws

MAJ Joseph Wilde, MC, USAR

Introduction: Treponema pallidum subspecies pertenue causes this chronic relapsing infectious disease. It
is found primarily in warm rural areas of the tropics. Yaws is transmitted by broken skin (i.e., cut, abraded, or
inamed) coming in direct contact with active skin lesions.

Subjective: Symptoms
Single, exophytic skin lesion that tends to ulcerate and crust; may be followed by period of healing, then
reappearance or multiple raspberry-like lesions. Finally, untreated patients may have bone involvement,
resulting in joint pain, difficulty walking or fractures.

Objective: Signs
Using Basic Tools: Yaws may have three clinical phases. The primary stage shows a single erythematous,
inltrated plaque, which eventually heals with scarring. The secondary stage emerges rapidly, with multiple
papules that ulcerate and form yellowish crust. The tertiary stage develops after several years and shows
deep ulcerated nodules with underlying involvement of bone.

Assessment: Diagnose based on clinical ndings in an endemic region and conrm with darkeld
microscopic exam of the exudates from skin lesions.
Differential Diagnosis - syphilis, paracoccidiomycosis, leishmaniasis. See appropriate sections.

Plan:
Treatment
Primary: Penicillin 2.4mU single IM dose
Alternative: Oral antibiotics such as tetracycline 500 mg bid or erythromycin 500 mg qid x 14 days.

Patient Education
General: Avoid contact with infected persons having active lesions.

Follow-up Actions
Evacuation/Consultation Criteria: No need to evacuate. Consult dermatology as needed.