Scabies : Defenition, Historically, Diagnosis and Natural Treatment with Management

Scabies : Defenition, Historically, Diagnosis and Natural Treatment with Management

Definition : - scabies is one of the commonest intensely pruritic, highly contagious infectious conditions of the skin caused by a mite Sarcoptis scabei and transmitted by close personal and sexual contacts

Historically

It has been recognized as a disease for over 2500 years. In 1687 Francesco Redi identified Sarcoptes scabei Scabies is one of the first diseases with a known cause. In Latin, scabere means to scratch. Romans used the term to describe any pruritic skin disease; so, it has been known as the great imitator

Etiologic agent

Sarcoptes scabei var. hominis, the female measures 0.4mm long and 0.3mm broad and the smaller male is 0.2mm long and 0.15 mm broad.

Epidemiology

-Commoner in children and adolescents
-It is a disease of disadvantaged community
-Epidemic occurs during wars and social upheavals
-Endemic in many developing countries

Transmission Pathogenesis

Female and male make mating on the surface of the skin. The male mite dies and the gravid female mite burrows into the epidermis lays up to 3 eggs per day for the duration of her 30-60 day lifetime.
-In a typical infestation host harbors 8-11 adult female mites. The eggs hatch in 3-4 days and the larvae leave the burrow to mature on the skin.

-Fewer than 10% of the eggs laid result in mature mites.
-Type IV hypersensitivity reaction to the mites, their eggs, or scybala (packets of eces) occurs approximately 30 days after infestation

Clinical features

Classic scabies :

The lesions are erythematous, excoriated, papulovesicular and found bilaterally. It starts on the wrist, finger webs and on the medial sides of fingers, the flexor aspect of the wrist, the elbows and the anterior axillary folds, the genitalia and inner thighs andthe gluteal folds

More disseminated presentation in infants and toddlers.

Scabies in infants and young children

-Distribution and morphology:- generalized
-The face the scalp, palms an soles are affected
-Papules, vesicle and pustules
-Secondary eczematization and impetiginazation are common

Crusted (Norwegian) scabies

In 1848, Danielssen and Boeck described a highly contagious variant of scabies occurring in immunocompromised patients, elderly or mentally incompetent patients. Thousands to million mites are found instead of the normal 8-11 mites in the normal host. But 2-3% of HIV/ AIDS patients manifest Norwegian scabies.

In Norwegian scabies, pruritus may not be there (in about 50% of the cases do not itch) It is psoriasiform and generalized with nail changes and scalp involvement Skin becomes thickened and involves all part of skin including face, palms and sales.

DDX Acropustulosis of Infancy, Atopic Dermatitis, Contact Dermatitis ….

Diagnosis of scabies

o Itching, worse at night
o Presence of similar condition in the family or intimate contacts
o Characteristic distribution of lesions
o Demonstration of the mite, eggs or feces
o Therapeutic test

Management

o Treat with a scabicide agent
o All family members and close contacts should receive treatment at the same time
o Provide antihistamines to alleviate pruritus
Treatment of secondary infections.
o For crusted scabies, crust and scale impair scabicide penetration.
o Bed linens, clothing, and towels should be washed in a warm cycle (Dry in sun).
o Infected individuals should avoid skin-to-skin contact with uninfected individuals.
o Decontamination of clothing, bed linens, etc, must coincide with medical treatment
o Trim finger nails

Scabicide agents

-Lindane (gamma benzene hexachloide) 1% lotion or cream – single application
-Benzyl benzoate 25% lotion – for 3 consecutive days
-Permethrin (Elimite) -- 5% cream – single application
-Crotamiton (Eurax) -- 10% lotion or cream - 2 times daily for 10 days
-Sulfur in petrolatum -- 10% - for 07 days
-Ivermectin - 9-18 mg PO in 2 doses, 1 wk apart 200 mcg/kg twice - effective for common as well as crusted scabies in epidemic outbreaks

Method of application

-Apply neck to toe, to Benzyl benzoate lotion advice not to wash between applications
-Advice to reapply if hands are washed during the day.

Complications of scabies

Bacterial super infection
Eczematization
Nodule formation
Urticaria

Treatment of complications : - Use antibiotic and anti histamine.

Causes of therapeutic failure

Improper counseling
Poor compliance of patient
Inadequate application
Improper application
Not treating family members who have close contacts.

Scabies : Defenition, Historically, Diagnosis and Natural Treatment with Management 2018-12-24T05:25:00-08:00 Rating: 4.5 Diposkan Oleh: David Maharoni