SCABIES

Yuni Eka Anggraini

SCABIES

• Skin disease caused by mite Sarcoptes

scabiei var. hominis
• a common companion of the human
species > 2500 years
Epidemiology
• A worldwide problem
• all ages, races and socioeconomic groups are susceptible.
• Environmental factors hastening spread : overcrowding, delayed
treatment of primary cases, and lack of public awareness of the
condition.
• Variation in prevalence : in some developing countries ranging from 4%
to 100%
• Higher incidences occur with overcrowding : refugee camp, hostels,
“pesantren”
• Scabies can be transmitted directly by close personal contact, sexual or
otherwise,or indirectly via fomite transmission.
• Prevalence is higher in children and in people who are sexually active
Etiology
• The highly host-specific, eight-legged mite
Sarcoptes scabiei var. hominis
• obligate human parasite.
• All developmental stages burrow into
epidermis shortly after contact.
• The mite is 0.35 μ 0.3 mm in size
• The entire 30-day life cycle of mites is
completed within the epidermis
• Female lifespan 4–6 weeks; lays 40–50
eggs.
• Lays 3 eggs per day in tunnels; eggs
hatch, require 10 days to mature.
....Etiology cont’d
• The incubation period before
symptoms: from days to months.
• In first-time infestations : 2–6 weeks
before the host’s immune system
becomes sensitized to the mite or its
products pruritus and cutaneous
lesions.
• A subsequent infestation is usually
recognized : 24–48 hours.
• Asymptomatic scabies-infested
individuals are not uncommon, and
these individuals can be considered
‘carriers’.
Clinical Feature
• Basis of the clinical diagnosis :
1. Intense pruritus which is accentuated
at night
2. The epidemiologic history (e.g.
pruritus in household members or
close personal contacts),
3. The distribution and types of lesions
4. The finding of mites with KOH 10%
5. The finding of burrows/Tunnels on the
skin
• Cutaneous lesions are symmetrical.
Common cutaneous findings can be
classified:
1. Lesions occurring at the sites of mite infestation
:
Burrow :
• The pathognomonic sign is the burrow, representing
the tunnel that a female mite excavates while laying
eggs.
• Clinically, the burrow is wavy, thread-like, grayish-
white and 1–10 mm in length.
• Many patients, however, do not have any obvious
burrows on inspection, especially in warm climates.
Scabietic (Scabious) Nodule
• Inflammatory papule or nodule, burrow sometimes
seen on the surface of a very early lesion.
• Distribution : Areola, axillae, scrotum, penis
 .....Clin Feat Cont’d
Hyperkeratosis/Crusting Psoriasiform/Norwegian scabies
• In areas of heavily infested crusted scabies, The number of
infesting mites may be >1 million or up to 4700 mites/g skin.
• well-demarcated plaques covered by a very thick crust or
scale
• Immunocompromised persons

2. Cutaneous manifestations of hypersensitivity to mites

• Pruritus
• "Id" or Autosensitization-Type Reactions : Characterized by
widespread small urticarialedematous papules mainly on
anterior trunk, thighs, buttocks, and forearms.
• Urticaria Usually generalized.
• Eczematous Dermatitis At sites of heaviest infestation:
hands, axillae
3. Lesions secondary to chronic rubbing and scratching
• Excoriation, lichen simplex chronicus, prurigo nodules.
• Generalized eczematous dermatitis.
• Postinflammatory Hyper- and Hypopigmentation

4. Secondary infection
...Clin Feat cont’d
Laboratory examination

• Mites, eggs, fecal pellet

• Mineral oil/ KOH 10%
Differential Diagnosis

• Pruritus, Localized or Generalized, Rash

Adverse cutaneous drug reaction, atopic dermatitis, contact dermatitis
• Pyoderma Impetigo, ecthyma, furunculosis.
• Nodular Scabies Urticaria pigmentosa (in young child), papular
urticaria (insect bites),prurigo nodularis, secondary syphilis
• Crusted Scabies Psoriasis, eczematous dermatitis, seborrheic
dermatitis, erythroderma,
Treatment
Non-pharmacotherapy
• Clean clothing should be put on afterward
• Clothing and bedding are decontaminated by Machine-washing at
60°C.
• Decontamination of Environment Bedding,
• clothing, and towels should be decontaminated or removed from
body contact for at least 72 h.
• Lindane (γ-Benzene Hexachloride) 1% Lotion or Cream Applied thinly
to all areas of the body from the neck down; wash off thoroughly
after 8 h.
Alternative regiments
• Principles of Treatment
• Infested individuals and close physical contacts should be treated at the same
time, whether or not symptoms are present.
• Topical agents are more effective after hydration of the skin, i.e., after bathing
• Application should be to all skin sites
Recommended Regimens
• Permethrin 5% Cream Applied to all areas of the body from the neck down. Wash
off 8–12 h after application. Adverse events very low.
• Crotamiton 10% Cream Applied thinly to the entire body from the neck down,
nightly for 2 consecutive nights; wash off 24 h after second application.
• Sulfur 2–10% in Petrolatum Applied to skin for 2–3 days.
Thank You