Pinworms/updated treatment options

Itchy butt at night? Uh oh. It might be pinworms. All things considered, in the big scheme of things there are a lot of worse things that can happen, but you are certainly entitled to give a big groan if this is happening to you or one of your family members. The Pinworm (Enterobius vermicularis if you want to impress folks the next time it comes up in conversation) is the most common worm infection in the USA. The target age range is for the primary infection is children between the ages of 5 and 10. These kids are usually the culprits bringing it home, but it is really easy for the pinworms to spread among family members if you live in close quarters and spend any snuggle time in the same bed. Animals do NOT get pinworms, but they can carry them around on their fur and spread them that way. The most common way for a person to get infected is by ingesting (or inhaling) the eggs. The eggs can live out of the body for up to 3 weeks. If you happen to touch a surface that is contaminated and then put your fingers in your  mouth or handle food...tag you're it. The eggs are way too small to be seen by the naked eye, but can be seen under a microscope. It takes between one of two months after the exposure for the symptoms to appear. The eggs mature into the worms. They are very small, white and threadlike. They live in the intestine and gradually make their way down the GI tract until they are close to the anus. The male worms die fairly quickly, but the female worms make their way out of the of the body and lay the eggs on the anus. They tend to do this at night. One theory is that the body temperature is a little higher at night and this drives them out. It is common for children with pinworms to wake at night. Children that are old enough to communicate may tell you that they are itchy or that their butt hurts. Little girls might have itchy vaginas or vaginal discharge. Some kids just have mysterious tummy aches. Diagnosis is done several ways. Sometimes you can actually see little wiggling things in the poop. You can just imagine the calls I get when that happens. It isn't usually quite so easy. Some folks suggest putting a piece of scotch tape across the anus and looking in the morning to see if there is anything stuck on it. I prefer the actual look and see method. I suggest that a parent to go check in the middle of the night. Make sure that they go to sleep with a very clean butt, perhaps take a good bath. Once your child has been asleep for several hours, take a flashlight and spread the butt cheeks far enough that you can actually visualize the anus. Tell your child ahead of time that you are planning on doing a butt inspection, so that if they wake up they are not going to be startled.   Pinworms will look like little white threads. They will likely be moving. Once the diagnosis is made, most folks opt to treat. The medications do not kill the eggs, just the worms, so they should be taken initially and then repeated in one to two weeks. There is an over the counter medication called Pin X. I have had patients have some success with this. It works about half of the time (which is fine if you are in the right half.) We used to count on a prescription medication called Mebendazole under the trade name Vermox as our standard treatment, but for some mysterious reason Vermox  was taken off the market. We have worked with compounding pharmacists to take the generic Mebendazole and turn it into a form appropriate for any age. My current compounder is the marvelous Eddie Lau at Feel Good Compounders 650-898-8221 www.feelgoodcompounders.com (he can make all sorts of yucky tasting medicine easier to swallow.) Their cost for the 2 dose pinworm treatment is as follows (updated 8/2016) : $75/ gummy form (may not be available same day) $65/ capsule $65/ liquid They will do free shipping, but that might take a day or so and most parents don’t want to wait. There is  a $15-20 delivery charge to get the medication the same day. THIS IS A PRESCRIPTION OPTION! Our office will need to be contacted in order to get this medication. Compounding does take some time. Showing up at the store with no prior prescription will not give you instant gratification. The other option is a prescription medication called Albendazole (albenza) which can also be quite pricey. This also only comes in a tablet so it is a bit challenging for younger kids. This one is still over $400 but at least gives the 2 dose course. Mebendazole is just coming back on the market this year with a new name EMVERM, but it is VERY VERY expensive. According to Walgreen's, each dose is over $400! ScriptDash is a fairly new pharmacy option (worth knowing about)  that competes with normal pharmacies and offers same day delivery for the same price. They accept all insurance companies. They will beat the Walgreen’s price on the Emverm and automatically apply a manufacturer's coupon, but in this instance, as long as it is available, compounding is the clear winner. The entire family should be treated if you want to really get rid of this as quickly as possible. None of the medications are ideal for pregnant, breastfeeding or children under two, but there have been no adverse reactions reported. Natural remedies include eating a diet high in garlic and/or believe it or not, enjoying some pumpkin seeds. Worms love carbohydrates. Studies have shown that limiting sugar and white flour (which is a good idea anyway) may keep them from thriving. Probiotics, which stimulate the healthy bacteria in the gut will also make the environment one where they can't flourish as well. Vaseline around the anus at night will make it harder for the eggs to be laid. Some folks suggest crushing up garlic and making a paste with the Vaseline and putting that around the butt every night. The fact is that if there were absolutely no further ingesting of the eggs, pinworms could resolve untreated after about 14 weeks (two life cycles), but the problem is most folks just keep on ingesting the eggs which gets them reinfected and so the cycle continues. It is gross, I know, but the most common issue is fingers scratching an itchy butt and then making their way to the mouth. We must do our best to eliminate the eggs and prevent the egg to mouth circuit. Scrub under the fingernails and make sure that they are cut short. Focus on frequent and effective good hand washing. Do a nightly bath with particular attention to the butt. Add some apple cider vinegar to the bath water. As mentioned earlier, the eggs can live on a surface outside of the body for up to 3 weeks. They do better in moist environments. High heat will kill them. They can be easily dispersed into the air. Pay attention to this when changing the sheets. Avoid shaking the sheets out into the air as much as possible. Wash all sheets, towels, pajamas and underwear in HOT water. You want to vacuum or mop, NOT sweep. Scrub the bathroom and any surfaces. Put toothbrushes through the dishwasher. Remind yourself that there are worse things. but this is indeed the proverbial pain in the butt.

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