Management

There is a stigma that having fleas means you are dirty so that patients often need careful reassurance.

Emphasize that the human flea is very rare - 95% of fleas are cat fleas. The human flea is only associated with inadequately washed clothes.

Explain that other people have probably been bitten but haven't noticed. Many people are relatively immune to the bites so that although several may have been bitten, only one person may be troubled. Young people often do not react to bites and people with cats can become desensitised and no longer react.

Reactions to flea bites can be treated with a steroid cream (e.g. 1% hydrocortisone) or a topical antipruritic e.g. 'Eurax-hydrocortisone' cream.

It is better to treat the cause. Consult a veterinary surgeon for advice.

• a Prescribers' Journal review stated that 'One of the most effective preparations for use on carpets, soft furnishings, and pets' bedding is "Acclaim Plus". This contains permethrin, which kills adult fleas, and methoprene (a synthetic equivalent of an insect growth regulating hormone), which blocks flea metamorphosis (1).'
• a more recent review (2) however stated that pyrethroids (such as permethrin) and organophosphates are generally less favoured than more insect-specific and less potentially toxic agents. The best treatment option was stated as a combination of prescription adulticide (insecticide designed to kill the fleas on animals) plus an insect growth regulator. Suitable combinations would therefore be Frontline (R) (fipronil), Advantage (R) (imidacloprid), or Stronghold (R) (selamectin) (all spot-on) or oral Capstar (R) (nitenpyram), together with Program (R) (lefenuron) (systemic) as a growth regulator

Fleas may be difficult to eradicate completely and the patient may need further professional advice from Environmental Health Officers or professional pest controllers.

Any fleas left in the clothes will be killed by boiling, or better still, tumble drying.

Reference:

1. Prescribers' Journal (1998), 38(2), 80-6.
2. Dermatology in Practice (2003), 11 (5), 22-6.