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Scabies, bedbugs, and body lice infestations are best addressed when dermatologists take standardized histories that account for social drivers of health.

That's one conclusion from a recent literature review published in . Its authors concluded that measures such as large-scale decontamination are often ultimately needed, even if such measures are not always viable for every patient population.

Co-author Aileen Chang, MD, is an associate professor of dermatology at the University of California San Francisco School of Medicine. Her exchange with the Reading Room has been edited for length and clarity.

What was the key objective of this review?

Chang: We wanted to summarize the pathophysiology, clinical presentation, diagnosis, treatment, and prognosis of scabies, bedbugs, and body lice infestations. We also wanted to raise clinician awareness of other ectoparasitic infestations and diagnoses to consider.

What were the key findings or conclusions?

Chang: Along with a physical examination, accurate diagnosis of an ectoparasitic infestation requires taking a history that accounts for such social drivers of health as housing status, living environment, etc.

First-line treatments include scabicides for patients with common scabies and their close contacts. Scabies, bedbug, and body lice infestations should be treated with decontamination measures.

Did anything surprise you about the review or its findings?

Chang: I was surprised by the relative paucity of epidemiologic data on bedbug infestations.

Do you have any suggestions for dermatologists when it comes to effective physician-patient communication around social drivers of health?

Chang: To avoid introducing harm from implicit bias, physicians should take a standard approach by asking every patient about their housing status and living environment when considering a diagnosis of ectoparasitic infestation.

When discussing this topic with patients, explain the rationale for this line of inquiry so that the clinically relevant context for the questions is clear. For example, when considering body lice infestation as the diagnosis, one could say, "Sometimes people who can't bathe regularly can get an itchy rash similar to yours. How often are you able to take a bath or shower?"

As another example, if considering infestations as a broad diagnostic category, you could observe that "itchy rashes like yours can be related to someone's living situation. May I ask you some questions about this to better understand what could be causing your itch?"

What does the future hold on this issue from a clinical, research, societal, or other perspective?

Chang: It can be very hard to identify an environmental source for an ectoparasitic infestation. Professional pest control services are typically needed, which can be cost-prohibitive for patients.

The critical issue our society needs to address is housing -- specifically housing supply, housing affordability, and housing quality. Body lice infestation happens because an individual is unable to bathe regularly. This is a completely preventable condition.