SCABIES

SITY HAJAR MAMILE

IRMA ARMIYAH
LUSY HERAWATI ALWI
MUHAMMAD FAIZ
NUR ARIFAH
AYU SUWARAYU
SUTUPO SIDIK LAWAJO
FEADYLY LOUPATTY
MIFTAHUL JANNA TAT
AFRIYANTI MAHULETTE
MUHAMMAD ALI SAMUDA
SVETLANA J. L.
SARI RAHAYU

CASE

Name : Intje Abd. Said

Sex : Man
Age : 65 years
Job
: Pensiun PNS
Address : Unaaha,Sulawesi Tenggara
Status : Married
Religion : Islam
Diagnosis : - Scabies
- Dermatitis Seborhoik
- Candidiasis Cutis
- Eritroderma
- Diabetic foot wagner IV
- Type 2 Diabetes Melitus

ANAMNESIS
Heteroanamnesis
Chief Complaints : the patient
complains an itchy over his body.
The Itch felt since 1 week ago and it
started on his upper extremities and
then spread to all of the body. The
itchy accompanied with red fleck and
now become black because
scratched. The Itch is especially felt

 Previous Disease History :

suffered from same disease
several months ago.
Another Disease History : type2
of Diabetes Melitus, Cronic
Kidney Disease (3 years ago)
Family History : the family
members (+) wife and children
Allergy of food and medicine (-)

Physical Examination

Blood Pressure : 140/90 mmHg

Heart rate : 88x/m
Respiratory Rate : 18x/m
Temperature : 36.5 C
Head : - Anemis : -/- Icterus : -/- Cyanosis : -/ Thorax: vesicular, wheezing -,
Ronchi -.
Abdomen : peristaltic + (normal)

Dermatologic Status
Location : Regio
Generalisata
Distribution : General
Effloresce : papule
eritema,
hyperpigmented,

 Located : Head
and neck
Regio
Size : Miliar
Effolosensi :
papule
erythema,

 Regio : Truncus anterior et posterior

Effolosensi : papule ,

 Regio : Truncus anterior et posterior

Effolosensi : papule ,

Diagnostic Examination
Laboratory (10/5/2014)
HGB : 8,7
RBC : 2,97
PLT : 451
WBC : 11,9
GDS : 403
UR/CR: 33/1,4
SGOT/SGPT : 17/17
ALB: 3,0
Na: 135
Cl: 107
K: 46
INR : 94,06

Radiology
(30/4/2014)
Foto Pedis Ap-OBLIQ
d/s:
Kesan :
Fasculitis plantaris
sinistra
Osteoporosis senilis
Gas Gangren on
dorsum pedis
sinistra.

THERAPY
Dermatology :
Diagnosis:
Scabies

Internal therapy:
Diagnosis: DM
type 2

Scabimite 1x (night)
Cetirizine 10 mg 1x1
Merilon cr. + Miconazole
cr (morning and evening)
Salycilate Acid 2% +
Mesone cr. 15 gr +
Fuson cr 15 %
(night)

Diet 1700 Kkal/day

Meropenam 1gr/12
hours/ IV
Novorapid 12-14-14
UI/SC
Levemir 0-0-20 UI/SC
Cilostasol 2 x 50 mg
Lanzoprasol 1 x 30 mg

DEFINITION
Scabies is an itchy immune hypersensitivity
reaction to infestation of the skin by the mite
Sarcoptes scabiei.
Synonim : The itch, pruritic

Transmition : direct and indirect contact

ETIOLOGY
Sarcoptes scabiei var, hominis

- Obligat parasite, phylum arthropods, class arachnida, ordo accarima,

family sarcoptes.
- : 0,2 mm long by 0,15 mm broad : 0,4 mm long by 0,3 mm broad.
- cannot fly or jump but crawl at the rate 2,5 cm/minute.

EPIDEMIOLOGY
The reported prevalence of scabies worldwide
was about 300 million cases / year (Chosidow 2006)
Baur (2013) in india that was 20,4%
Onayemi (2005) nigeria 28,6%
Zayyid (2010) among the children 10 12 Y.O in
penang malaysia

EPIDEMIOLOGY
Kline (2013) scabies generally endemic among
aborigin at australia and the country in Oceaia that was
30%.
Heukelbach Brazil 8,8 %
HOW ABOUT INDONESIA RECENTLY???

EPIDEMIOLOGY
Health departement of Indonesia based on data from all health
centre (Puskesmas) at the year of 2008 was range from 5,6 to
12,95% 3rd of 12 commonest skin disease (Azizah 2011)
Incidence and prevalence at Pesantren in Lamongan 64,2%
(Marufi et al)
70% in Pondok Pesantren Pasuruan (Kuspiantoro 2005)
Sungkar (1997) Bad hygiene: Up to 78,7% and good hygiene:
3,8%.

RISK FACTOR
Poor
sanitati
on

Densely
populated
and social
disruption

Low
econo
mic

PATHOGENESIS
Transmitted
Direct
Skin to skin /
sexual

Indirect
Bed cover, clothes,
etc

Sensitation
and
infestation on
skin

Sensitation
and
infestation
on skin

- Secreta
- Excreta

Clinical finding
Itch
- Papul,
vesicle,
Urticaria
- erotion,
excoriation,
crust +
secondary

46
weeks

8 12 days

EFFLORESENCE OF
SCABIES

Papules, erithematous

CLINICAL FINDING
Additional
test

Cardinal Sign
Nocturnal
pruritic
Attack to
group of
people
Find
burrow/tunne
l
Find mite

Skin scrapping
Burrow ink test
Take with neddle
Epidermal shave
biopsy
Biopsy with
Hematoxylin
eosin
Tetracyclin test

DIAGNOSIS
2 from 4 cardinal sign
Additional test

TREATMENT

DRUGS AND TOPICAL AGENTS

DRUG
Permethri
n 5%
cream
Lindane
1%lotion

DOSE
Applied for 8-14 h;
often repeated in
7 days.
Applied for 8 h
then washed off,
Second
application
recommended
after 1 wk.

Crotamito Applied on 2
n 10%
consecutive days;
cream
repeated once
within

COMMENT
First-line treatment

Not recommended for

Children under 2
months, during
pregnancy, or
lactation;
resistance has been
increasing; banned in
california
Antipruritic Qualities;
may not be as
effective as other
topicals

DRUG
DOSE
Precipitated Applied for 3
sulfur 5%days and
10%
then washed
off.

Benzyl
benzoate
10% lotion
lvermectin,
200 ug/kg

COMMENT
safe in children under
2mo and during
pregnancy, but messy
to
apply and limited
efficacy data
Applied for 24 Not available in United
h then
States
washed off.
Single oral
Highly effective with a
dose, can be good safety profile; can
repeated in
be used along with
10-14 days,
topical agents,
particularly in crusted or
resistant cases

DIFFERENTIAL DIAGNOSIS

PREVENTION

COMPLICATION

PROGNOSIS

THANK YOU

LITERATURE
1. Handoko,PR. Skabies. In: Prof.Dr.dr.Adi Djuanda,
editor. Ilmu penyakit kulit dan kelamin. Ed 6.
Jakarta. FK UI; 2010.p.122-123
2. Stone SP, Goldfarb JN, Bacelieri RE. Scabies,
other mites, and pediculosis In: Wolff K, Lowell A,
Katz GSI, Paller GAS, Leffell DJ, editors.
Fitzpatricks dermatology in general medicine. 7th
ed. United state of America. McGraw-Hill; 2008.
p. 2029-2032.
3. Burns DA. Diseases caused by arthropods and
other noxious animals. In: Rooks textbook of
dermatology. 8th ed. United kingdom. Willeyblackwell; 2010. p. 38.36 38.38.
4. Amiruddin MD. Skabies. In. Amiruddin MD, editor.
Ilmu Penyakit Kulit. Ed 1. Makassar: Bagian ilmu