SCABIES

done by
sudha
07-Oct-06
 HUMAN SCABIES
SARCOPTES SCABEI VAR HUMANUS OR
ACARUS SCABEI DISCOVERED IN 1687
AFFECTS BOTH SEX,ANY AGE
SPREADS BY SKIN TO SKIN CONTACT
(NOT CASUAL CONTACT)
SEXUAL TRANSMISSION
THE FEMALE MITE BURROWS INTO THE
EPIDERMIS WHERE IT BREEDS AND
CAUSES ITCH.

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STATISTICS
INCIDENCE OF SCABIES VARIES
BETWEEN 5.1-22.4%.

STUDY CONDUCTED IN JIPMER-

SCABIES CONTRIBUTES 14.2% OF
CASES AMONG ALL PAEDIATRIC
DERMATOLOGIC DISEASES.

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CLASSIC SCABIES
PRESENTS AS NOCTURNAL
ITCHING
BILATERAL LESIONS
SMALL
ERYTHEMATOUS,EXCORIATED
PAPULES
PATHOGNOMIC BURROWS-
SHORT,WAVY,DIRTY APPEARING
LINE.
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 – SEEN IN FINGER
WEBS,AXILLA,WRIST,ELBOW,
AREOLA,UMBILICUS,GENITALIA,
BUTTOCK.

– SECONDARY ECZEMATIZATION IS
USUAL.

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 Hand scabies

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 Scabies abdomen

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 Whole body

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Scabies burrow-finger web

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 Burrow- sole

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 Genital scabies

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Breast scabies

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SPECIAL FORMS:SCABIES
INCOGNITO
DUE TO USAGE OF STEROID
MASKS FEATURES
BUT TRANSMISSION OCCURS
ATYPICAL AND WIDE
DISTRIBUTION.

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 NODULAR SCABIES
RED BROWN PRURITIC NODULES
ON COVERED PARTS-
GENITAL,AXILLA
HYPERSENSITIVITY REACTION TO
RETAINED MITES

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 IN INFANTS AND CHILDREN

PRESENTS AS
PRURITIC,GENERALISED,ON
FACE,SCALP,PALMS,SOLES
PAPULES,VESICULO PUSTULES.
BURROWS DIFFICULT TO FIND IN
<2 YRS.
MISDIAGNOSIS CAN OCCUR
D/D

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In children

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 In children

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 infective eczema

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CRUSTED/NORWEGIAN SCABIES:

VERY CONTAGIOUS BECAUSE OF

INCREASED NO. OF MITES.
IN HANDS AND FEET
DYSTROPHY OF NAILS
ITCHING MINIMAL
MR,IMMUNODEFICINCY,LEUKEMIA

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 Crusted scabies

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IN HIV:
2- 4% OF AIDS PATIENTS HAVE.
PRESENTS AS
CRUSTED/ATYPICAL PAPULAR
SCABIES
CAN PROGRESS TO
BACTERIAEMIA

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DIAGNOSIS

BY MICROSCOPIC IDENTIFICATION
OF MITES,EGGS,FAECAL MATTER

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 SKIN SCRAPINGS

SCRAPINGS ARE EXAMINED

UNDER LOW POWER

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 Itch mite

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 In crusted scabies

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CURRETTAGE
LONG AXIS OF BURROWS ARE
CURRETTED AND EXAMINED
UNDER LOW POWER
USEFUL IN INFANTS,SMALL
CHILDREN,ANXIOUS,HIV
PATIENTS.

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COMPLICATIONS:

BACTERIAL INFECTIONS
NEPHRITOGENIC
STREPTOCOCCUS COLONIZE IN
LESIONS-ACUTE GN.
ECZEMA IN ATOPICS
ACAROPHOBIA

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TREATMENT
SHOWER AND DRY
APPLIED THINLY
FROM NECK
LEFT FOR 10 HRS
RINSED
WASH CLOTHES
TREAT FAMILY MEMBERS

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5%PERMETHRIN CREAM
DRUG OF CHOICE
LEFT FOR10 HRS
LOW TOXIC
C/I IN <2 MONTHS
INFANTS,PREG,LACTATING

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BENZYL BENZOATE 25%
APPLIED BELOW CHIN LEFT FOR
12 HRS.
REPEATED AFTER 12 HRS
WASHED AFTER 12 HRS
NOT MORE THAN 2 APPLICATIONS
BECAUSE IRRITANT DERMATITIS
CAN OCCUR.

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1% LINDANE (GAMMA-HCH)

WITH COCONUT OIL AND LEFT

FOR 8 HRS.
APPLIED AGAIN AFTER 3 DAYS.
TOXIC-CNS
C/I:CNS DISEASES

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TETMOSOL
5 % SOLUTION.
3 DAYS APLLICATION.

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PPTD 6% SULFUR IN PETROLATUM

IN INFANTS,PREG,LACTATING
WOMAN
LESS TOXIC
APPLIED FOR 4 DAYS.
CHEAP REMEDY.

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CROTAMITON

NOT EFFECTIVE

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OTHERS
ANTIPRURITIC
ANTIBIOTICS

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CRUSTED SCABIES
PERMETHRIN FOLLOWED BY
LINDANE & SULPHUR
PRE TREATMENT WITH
KERATOLYTICS
PERMETHRIN CAN BE REPEATED
PROPHYLACTIC ANTIBIOTIC

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STUDIES

ORAL IVERMECTIN Vs TOPICAL

PERMETHRIN
PERMETHRIN BETTER CURE

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 USE OF IVERMECTIN IN A
OUTBREAK IN A PRISON

PROVED TO BE EFFECTIVE
GOOD COMPLIANCE

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 IN CRUSTED SCABIES
IVERMECTIN
/BBE/IVERMECTIN+BBE
BEST IS BBE+IVERMECTIN

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REFERENCES
DERMATOLOGY IN GENERAL
MEDICINE-FITZPATRICKS
ANDREWS DISEASES OF SKIN
DERMATLAS.MED.JHMI.EDU
PARK TEXTBOOK OF COMMUNITY
MEDICINE

07-Oct-06