Pathology and histopathology

Several descriptions are published on the pathogenesis and histopathology of swimmers' itch, both from spontaneous and experimental infections. Although old, some of these descriptions are fully valid today. Vogel (1930) described sections of 24-h lesions in an individual who apparently had been previously exposed, but was only partially sensitized. He found the cercariae and some cellular exudate in the burrows. There was oedema and a mild leucocytic reaction, and the cells of the cercariae were beginning to disintegrate. Brackett (1940) made biopsies of lesions in an individual who had a history of repeated schistosome dermatitis over a period of 6 years. At 29h after infection, he found no cercariae but marked serous and cellular exudates both in epidermis and in dermis. These studies show that cercariae had been destroyed within 29h by the intensive cellular reaction. At 50h the dermis was more intensely infiltrated with eosinophils and lymphocytes.

The itching is evidently of two types: the prickling sensation experienced immediately after exposure to cercariae appears to be induced by cercariae penetrating through and

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burrowing in the skin. The latter, intensive histamine-related itch is of a diffuse type and is increased by scratching and rubbing. This occurs in the early and late papular stages of the pathogenesis and results from the antigen-antibody reaction.

In previously non-exposed individuals, the erythematous reaction to the cercariae may appear only eight days after the penetration of the cercariae. Apparently, the reaction varies depending on the species of parasite and the sensitivity of the individual affected.

Topical application of antihistamines and anti-inflammatory substances on affected skin areas will relieve the itching but has little effect on the lesions.

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