Practical Dermoscopy
Pthirus pubis Under a Digital Dermoscope: Anatomic Description
Descripción anatómica del Pthirus pubis mediante dermatoscopia digital
A. Martin-Gorgojo
, A. Comunión-Artieda, F.-J. Bru-Gorraiz
Corresponding author
Ayuntamiento de Madrid, Sección de Especialidades Médicas, Servicio de ITS/Dermatología, Madrid, Spain
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Descripción de estructuras anatómicas: imagen izquierda: cara dorsal. B: boca. Constituida por dientes (que cortan la epidermis como una sierra circular) y un haustelio (a través del cual succiona la sangre de los vasos sanguíneos dérmicos). Este último contiene, a su vez, un conjunto de estiletes: 2<span class="elsevierStyleHsp" style=""></span>dorsales (apuestos firmemente para conformar un conducto que desemboca en la faringe), uno medial (que contiene un canal salival) y uno ventral (que abraza al resto de estiletes y los agrupa en un fascículo; tiene, además, unos dientes en su punta, que ayudan a la penetración en la dermis). O: ojo. 1: primera pata (más endeble y acabada en una garra fina). D: tubo digestivo (visto a trasluz) en el que se observa la sangre ingerida. 2 y 3: segunda y tercera pata: más robustas y acabadas en garras que remedan pinzas de cangrejo, adaptadas para agarrarse fuertemente al vello. Partes constitutivas de la extremidad: c: coxa; tr: trocánter; f: fémur; tb: tibia; pt: proyección tibial; u: uña. d: dorso del artrópodo, con algunas estructuras pilosas en superficie. <span class="elsevierStyleBold">*</span>: espiráculo: estos insectos normalmente disponen de 2 pares torácicos y 6 pares abdominales. Se trata de las estructuras a través de las cuales el aparato respiratorio se conecta con el exterior. T: aparato traqueal. S: setas marginales. G: placa genital. gp: gonópodo. Tanto la placa genital como los 2<span class="elsevierStyleHsp" style=""></span>gonópodos se corresponden con el sexo femenino del artrópodo.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Imagen derecha: cara ventral. A: antena (dividida en 5 segmentos). Percibe estímulos de olor y de humedad. E: esternito: segmentos en los que se divide la cara ventral.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Martin-Gorgojo, A. Comunión-Artieda, F.-J. 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"apellidos" => "Bru-Gorraiz" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1578219021002754" "doi" => "10.1016/j.adengl.2021.10.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219021002754?idApp=UINPBA000044" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0001731021002386?idApp=UINPBA000044" "url" => "/00017310/0000011200000010/v1_202111020534/S0001731021002386/v1_202111020534/es/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S1578219021002456" "issn" => "15782190" "doi" => "10.1016/j.adengl.2021.09.004" "estado" => "S300" "fechaPublicacion" => "2021-11-01" "aid" => "2699" "copyright" => "AEDV" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "ssu" "cita" => "Actas Dermosifiliogr. 2021;112:907-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">History and Humanities in Dermatology</span>" "titulo" => "Dermatostiksia (tattooing): An act of stigmatization in ancient Greek culture" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "907" "paginaFinal" => "909" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dermatostiksia (tatuajes): un acto de estigmatización en la cultura griega antigua" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1272 "Ancho" => 750 "Tamanyo" => 123604 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Greek Red-Figure vase (450-440 B.C.) depicting the death of Orpheus by a sword-wielding, Thracian maenad bearing tattoos with geometric patterns on her bare arms. Amongst Thracian men, tattooing of men served as a marker of high social status and nobility that clearly distinguished the aristocracy from the peasantry. Conversely, the Greek essayist Plutarch suggests that Thracian women (Maenads), whose name roughly translates to the “Mad Women” or “Raving Ones, had been tattooed by their husbands as a punishment for killing Orpheus. Despite their misgivings about the practice, Ancient Greeks were also fascinated by the idea of tattoos. As a result, within the iconography of vase painting in the 5th and 4th centuries B.C., Greek artists frequently illustrated Thracian women wielding swords, spears, daggers and axes. On these vases, the geometric tattoos on the women’s bodies draw attention to athletic strength and are used to accentuate musculature and motion.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "G. Kyriakou, A. Kyriakou, Th. Fotas" "autores" => array:3 [ 0 => array:2 [ "nombre" => "G." 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Martin-Gorgojo, A. Comunión-Artieda, F.-J. Bru-Gorraiz" "autores" => array:3 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Martin-Gorgojo" "email" => array:1 [ 0 => "alejandromartingorgojo@aedv.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Comunión-Artieda" ] 2 => array:2 [ "nombre" => "F.-J." "apellidos" => "Bru-Gorraiz" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Ayuntamiento de Madrid, Sección de Especialidades Médicas, Servicio de ITS/Dermatología, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Descripción anatómica del <span class="elsevierStyleItalic">Pthirus pubis</span> mediante dermatoscopia digital" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 762 "Ancho" => 1750 "Tamanyo" => 185260 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Pthirus pubis</span>. Anatomic structure. Left, dorsal view. M: mouth. Formed by teeth (which cut into the epidermis like a circular saw) and a haustellum to suck the blood from the dermal vessels. The haustellum, in turn, contains 2 dorsal stylets (firmly positioned to form a conduit that empties into the pharynx), a medial stylet (containing a salivary canal), and a ventral stylet (that groups together the other stylets to form a fascicle). It also has distal teeth, which help penetrate the dermis. E: eye. 1: first leg (less robust than the other legs; fine terminal claw). D: digestive tube (seen against the light). Note the ingested blood. 2 and 3: second and third legs (more robust than the first leg; terminal claw similar to that seen in crabs, designed to grasp tightly to the hair of the host). Parts of the leg (c: coxa, tr: trochanter, f: femur, tb: tibia, tp: tibial projection; n: nail). D: dorsum showing some hair structures on the surface. <span class="elsevierStyleBold">*</span>: spiracle. <span class="elsevierStyleItalic">Phthirus pubis</span> usually has 2 pairs of thoracic spiracles and 6 pairs of abdominal spiracles that connect the respiratory system to the outside. T: tracheal system. S: marginal septae. G: genital plate. gp: gonopod. Both the genital plate and the 2 gonopods are found in female specimens.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Right image: ventral view. A: antenna (divided into 5 segments). Used to detect smell and moisture. St: sternite (segments constituting the ventral side).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case Report</span><p id="par0005" class="elsevierStylePara elsevierViewall">A 42-year-old man presented with increasingly severe pruritus mainly affecting the pubic region. He attributed its onset to sporadic sexual intercourse with a man. Physical examination showed expected findings, and in addition, the patient brought in a small pot containing about a dozen of the culprit arthropods, which were still moving.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">What Is Your Diagnosis?</span><p id="par0010" class="elsevierStylePara elsevierViewall">One of the insects was placed on a gauze and viewed under a digital dermoscope at a magnification of ×50 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Comment</span><p id="par0015" class="elsevierStylePara elsevierViewall">Dermoscopy showed a sucking louse (Anoplura) with features consistent with <span class="elsevierStyleItalic">Pthirus pubis</span> (crab louse). The crab louse is round, can measure up to 2 mm in length and has a clearly distinct anatomy to that of the head or body louse (<span class="elsevierStyleItalic">Pediculus humanus capitis</span> or <span class="elsevierStyleItalic">corporis</span>).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Pubic lice have been reported to be more common among gay, bisexual, and other people with a penis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Their presence has been identified as a predictor of chlamydia in adolescents.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The anatomy of <span class="elsevierStyleItalic">Pthirus pubis</span> can be characterized using different methods. Although these parasites have traditionally been examined by optical or electron microscopy,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> dermoscopy (which is of clear diagnostic value<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>) can also be used, both in vivo and ex vivo.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Digital dermoscopes are ideal for studying the anatomy of public lice as they reduce the physical proximity needed for examination.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We present high-resolution dermoscopic images of <span class="elsevierStyleItalic">Pthirus pubis</span> that clearly show many of the anatomic structures of a female specimen of this ectoparasite, which has an admirable ability to adapt to hostile environments.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflicts of Interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:5 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case Report" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "What Is Your Diagnosis?" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Comment" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of Interest" ] 4 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martin-Gorgojo A, Comunión-Artieda A, Bru-Gorraiz F-J. Descripción anatómica del <span class="elsevierStyleItalic">Pthirus pubis</span> mediante dermatoscopia digital. Actas Dermosifiliogr. 2021;112:905–906.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 762 "Ancho" => 1750 "Tamanyo" => 185260 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Pthirus pubis</span>. Anatomic structure. Left, dorsal view. M: mouth. Formed by teeth (which cut into the epidermis like a circular saw) and a haustellum to suck the blood from the dermal vessels. The haustellum, in turn, contains 2 dorsal stylets (firmly positioned to form a conduit that empties into the pharynx), a medial stylet (containing a salivary canal), and a ventral stylet (that groups together the other stylets to form a fascicle). It also has distal teeth, which help penetrate the dermis. E: eye. 1: first leg (less robust than the other legs; fine terminal claw). D: digestive tube (seen against the light). Note the ingested blood. 2 and 3: second and third legs (more robust than the first leg; terminal claw similar to that seen in crabs, designed to grasp tightly to the hair of the host). Parts of the leg (c: coxa, tr: trochanter, f: femur, tb: tibia, tp: tibial projection; n: nail). D: dorsum showing some hair structures on the surface. <span class="elsevierStyleBold">*</span>: spiracle. <span class="elsevierStyleItalic">Phthirus pubis</span> usually has 2 pairs of thoracic spiracles and 6 pairs of abdominal spiracles that connect the respiratory system to the outside. T: tracheal system. S: marginal septae. G: genital plate. gp: gonopod. Both the genital plate and the 2 gonopods are found in female specimens.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Right image: ventral view. A: antenna (divided into 5 segments). Used to detect smell and moisture. St: sternite (segments constituting the ventral side).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phthirus pubis in a sexually transmitted diseases unit: A study of 14 years" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J.A. Varela" 1 => "L. Otero" 2 => "E. Espinosa" 3 => "C. Sanchez" 4 => "M.L. Junquera" 5 => "F. Vazquez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Sex Transm Dis" "fecha" => "2003" "volumen" => "30" "paginaInicial" => "292" "paginaFinal" => "296" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phthirus pubis as a predictor for <span class="elsevierStyleItalic">Chlamydia</span> infections in adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.L. Pierzchalski" 1 => "D.A. Bretl" 2 => "S.C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 14 | 9 | 23 |
| 2024 October | 138 | 64 | 202 |
| 2024 September | 112 | 39 | 151 |
| 2024 August | 126 | 77 | 203 |
| 2024 July | 110 | 53 | 163 |
| 2024 June | 117 | 44 | 161 |
| 2024 May | 121 | 42 | 163 |
| 2024 April | 108 | 40 | 148 |
| 2024 March | 93 | 42 | 135 |
| 2024 February | 105 | 51 | 156 |
| 2024 January | 120 | 44 | 164 |
| 2023 December | 119 | 51 | 170 |
| 2023 November | 144 | 41 | 185 |
| 2023 October | 116 | 27 | 143 |
| 2023 September | 98 | 31 | 129 |
| 2023 August | 77 | 28 | 105 |
| 2023 July | 113 | 59 | 172 |
| 2023 June | 153 | 27 | 180 |
| 2023 May | 136 | 31 | 167 |
| 2023 April | 90 | 40 | 130 |
| 2023 March | 172 | 55 | 227 |
| 2023 February | 142 | 33 | 175 |
| 2023 January | 100 | 33 | 133 |
| 2022 December | 91 | 61 | 152 |
| 2022 November | 77 | 81 | 158 |
| 2022 October | 60 | 52 | 112 |
| 2022 September | 79 | 64 | 143 |
| 2022 August | 81 | 40 | 121 |
| 2022 July | 48 | 33 | 81 |
| 2022 June | 34 | 41 | 75 |
| 2022 May | 53 | 37 | 90 |
| 2022 April | 65 | 61 | 126 |
| 2022 March | 61 | 70 | 131 |
| 2022 February | 49 | 39 | 88 |
| 2022 January | 62 | 57 | 119 |
| 2021 December | 61 | 63 | 124 |
| 2021 November | 112 | 67 | 179 |
| 2021 October | 92 | 85 | 177 |
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