Curing Scabies Permanently
The diagnosis is based on a high clinical suspicion and a positive scabies preparation. The diagnosis should be entertained when more than one family member itches. Other disorders to consider in the differential diagnosis include other bite reactions, body lice, atopic dermatitis, neurotic excoriations, and delusions of parasitosis. Suspected cases of scabies should be confirmed by performing a scabies preparation. To perform a scabies preparation, one scrapes or superficially shaves a lesion (preferably a burrow) with a 15 blade. The sample is placed on a glass slide, covered with immersion oil and a cover slip, and examined under the microscope. Mites, eggs, or scybala (feces) will be visible ( Hg , ). When possible, the diagnosis should be confirmed with a scraping prior to treatment. FIG. 242-2. Scabies preparation. The immature mite, ova, and scybala (fecal pellets) are present in this scraping of a burrow. The presence of any one of these elements is considered a positive...
Scabies infestation resembles that of lice but is generally concentrated around the hands and feet, especially in the web spaces between the fingers and toes. In children, the face and scalp may be infested as well. In adults, scabies frequently affect the nipples in females and the penis in males. The scabies mite is a universal pest that appears to follow a 30-year cycle of proliferation. During the past several years, there has been an epidemic of scabies infestation in the United States. Scabies infestation is more likely to occur by direct contact between the infested individual and the non-infested individual than by indirect contact with clothing and personal articles. The distinctive feature of scabies infestation is the burrow that the female mite digs into the skin to lay her eggs. Vesicles and papules form at the surface of these zigzag, whitish, threadlike channels that may contain small gray spots at the closed ends where the parasite rests. Burrows tend to enlarge and be...
This highly contagious infestation is caused by the Sarcoptes scabiei (0.2-0.4 mm in length). The infestation is transmitted by intimate contact or by contact with infested clothing. The female mite burrows into the skin, and after 1 month, severe pruritus develops. A multiform eruption may develop, characterized by papules, vesicles, pustules, urticarial wheals, and secondary infections on the hands, wrists, elbows, belt line, buttocks, genitalia, and outer feet.
Scabies is a highly contagious, pruritic skin disorder caused by an arachnid, Sarcoptes scabiei var. hominis. The human scabies mite is endemic in many developing countries, where the prevalence ranges from 20 to 100 percent. In some areas of Central and South America, the scabies infestation rate among young children is close to 100 percent.85 Human scabies is transmitted primarily by direct personal or sexual contact with infected individuals. Although less common, transmission may occur by contact with contaminated bedding and clothing. The mite has been found to survive for 2 to 3 days on inanimate objects. The scabies mite is motionless at room temperature and lacks the ability to jump or fly from person to person.86 The average person infected with scabies harbors 10 to 15 live adult female mites at any given time. 87 In patients with Norwegian scabies, an atypical, crusted form of scabies, mite populations are in the thousands to millions.88 This form is often seen in...
Atopic dermatitis, which may affect one or both nipples, is manifested by areas of fissuring, weeping skin, or lichenification. This condition occurs in both pregnant and nonpregnant women, most commonly between the ages of 15 and 30. This dermatitis is more common in atopic individuals. Underlying causes of these skin changes include scabies, contact allergy, local medication reaction, and irritation secondary to friction. 5
Furthermore, when considering pruritic eruptions of the extremities, one must always think about scabies. The hands, feet, and elbows along with the groin are the most common areas of involvement. Diagnostic burrows will most likely be found in the hyperkeratotic skin of the palms and soles particularly along the web spaces and the wrist. When the scabetic mite burden becomes quite high, Norwegian scabies results. Thick hyperkeratosis resembling dermatitis results Fig 239-9 (Pjate FIG. 239-9 (PJateM). Norwegian scabies. The thick scale, erythema, and exudate resemble a foot dermatitis. This disorder should not be forgotten when presented with a patient with extremely pruritic scaly eruption. Norwegian scabies is more common in immunocompromised and debilitated patients.
Disease transmission may also occur by exposure to airborne nuclei, particle droplets, or contact (direct or indirect). Diseases spread by airborne droplet nuclei include measles, varicella and tuberculosis. Diseases transmitted by large particle droplets include Haemophilus influenzae type B, Neisseria meningitidis, pertussis, adenovirus, influenza, mumps, and rubella. Diseases spread by patient contact (direct contact) or by contact with items within the patient's environment (indirect contact) include Clostridium difficile, pediculosis, and scabies. Contact isolation may also apply to those patients with gastrointestinal, respiratory, skin, or wound colonization or infection with multidrug-resistant bacteria determined to be of special clinical and epidemiologic significance. Examples include methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus. The Hospital Infection Control Practices Advisory Committee of the Centers for Disease Control and Prevention...
Scabies and lice preparations are useful in patients with possible infestation. In scabies infestations, the rash itself may resemble other dermatologic syndromes microscopic analysis will confirm the diagnosis. The donor site for skin specimen selection is very important. The best sites include burrows (10-mm elongated papule with a pustule or vesicle) and papules located on the fingers, wrists, and elbows. Within the vesicle or pustule, a small black dot is noted, which is the mite. The point of the scalpel is scraped across the lesion while holding the skin taut the mite is then removed. A single drop of mineral oil may be applied to the blade to ensure that the scrapings adhere to the instrument. The material is then placed on the microscope slide with an additional drop of mineral oil gentle pressure on the coverslip will flatten thick specimens. Using low power, the slide is scanned for presence of the mite, eggs, or feces. Mites are eight-legged creatures that are easily...
We found no recent published data on incidence or prevalence from any developed country. Scabies is a common public health problem in developing countries, where prevalence may exceed 50 in some communities, and prevalence has been estimated at 300 million cases worldwide.1 Older studies have shown that prevalence is highest in teenagers and schoolchildren.2-4 However, incidence has increased recently in the institutionalised elderly. Historical data from Denmark show that epidemic cycles arise at 15-20-year intervals.2
Scabies tends to be an extremely pruritic eruption, often disturbing sleep (except Norwegian scabies, which tends to have minimal associated pruritus). Ihe most common sites of involvement include the hands, feet, flexural surfaces of the elbows and knees, umbilicus, groin, and genitals. Facial involvement is usually seen only FIG. 242-1. Human scabies. Numerous scabetic burrows are visible near the axilla of this infant infested with scabies. In Norwegian scabies (Fig.239-9), one develops thick, dirty-appearing hyperkeratosis on the hands and feet. The nails are often affected as well. Because of the large mite burden, this form of scabies is highly contagious.
Scabies is an itchy immune hypersensitivity reaction to infestation of the skin by the mite Sarcoptes scabiei. Adult female mites burrow through the skin at the junction of the stratum corneum and the prickle cell layer, where they lay their eggs. Burrows then move out progressively towards the skin surface with the stratum corneum. Adult males and juvenile mites (larvae and nymphs) live mostly at the skin surface but may make temporary burrows for moulting from one development stage to another.
Sexually transmitted diseases are mentioned briefly so as not to forget them when presented with a patient with an eruption in these areas. Sexually transmitted diseases can occur in the intergluteal cleft, the perianal area, and the groin with or without genital involvement. The chancre of primary syphilis and condyloma lata of secondary syphilis can occur in these areas. The perineum or perianal area is a common site for primary or recurrent herpes simplex virus. The sacrum is also a common site of recurrent HSV. Condyloma acuminatum frequently involves the inguinal creases and perianal area in addition to the genitalia. Furthermore, pediculosis pubis ( crabs ) and scabies should be considered in pruritic excoriated eruptions of the groin and axilla. Finally, the clinical findings in granuloma inguinale and lymphogranuloma venereum predominate in the inguinal folds.
An eosinophilic immunologic response is also seen during infection of human skin by the scabies mite, Sarcoptes scabiei. During infection, the female mite burrows through the epidermal cornified layer and deposits eggs and feces. These antigens provoke an immunologic response that results in skin lesions that may be papular, vesicopapular, nodular or diffuse (crusted Norwegian scabies). Although the mites and their products do not penetrate below the epidermis, they provoke a prominent dermal perivascular inflammatory response containing lymphocytes, histiocytes and numerous eosinophils. Diffuse dermal infiltration by eosinophils is not uncommon. The increased propensity of patients coinfected with S. scabiei and human immunodeficiency virus 1 (HIV-1) to have diffuse scabetic involvement of the skin, highlights the importance of cellular immunity in orchestrating an appropriate eosinophilic and IgE-mediated antibody response.
Water-washed diseases are those associated with poor hygiene and are often associated with unreliable access to clean water. Water-washed pathogens can cause diseases such as scabies, trachoma, and flea, lice, and tick-borne diseases when contaminated water is brought into contact with human skin and eyes.
Intertriginous infections with either Candida or Trichophyton are often seen in patients with HIV and can be diagnosed by microscopic examination of potassium hydroxide preparations of lesion scrapings. Treatment includes topical imidazole creams, such as clotrimazole, miconazole, or ketoconazole. Scabies occurs in about 20 percent of HIV-infected patients, but classic intertriginous lesions are less common. Any patient with a scaly, persistent pruritic eruption should have lesions scraped and examined histologically for scabies mites. Treatment is with permethrin 5 cream or lindane lotion. Human papillomavirus infections occur with increased frequency in immunocompromised patients. Treatment is cosmetic or symptomatic and may include cryotherapy, topical therapy, or laser therapy. Other dermatologic conditions that occur with increased frequency among HIV-infected patients include psoriasis, atopic dermatitis, and alopecia. Referral for dermatologic consultation is appropriate.
Pediatr Rev 15 110, 1994. 86. Molinaro MJ, Schwartz RA, Janniger CK Scabies. Cutis 56 317, 1995. 87. Sterling GB, Janniger CK, Kihiczak G, et al Scabies. Am Fam Physician 46 1237, 1992. 88. Sirera G, Ruis F, Romeru J, et al Hospital outbreak of scabies stemming from two AIDS patients with Norwegian scabies. Lancet 335 1227, 1990. 89. Schlesinger I, Oelrich DM, Tyring SK Crusted (Norwegian) scabies in patients with AIDS The range of clinical presentations. South Med J 87 352, 1994.
Epilepsy, on various occasions, has been looked down upon as a transmissible, contagious disease. Rhazes, in Arabic medicine, included epilepsy among the eight cardinal contagious diseases, the others being bubonic plague, phthisis, scabies, erysipelas, anthrax, trachoma, and leprosy.
There are occasional reports of cats with scabies due to Sarcoptes scabiei mites, presumably with mites originating from dogs or foxes (Ferguson, 1994). The head may be affected or lesions can be generalised. Pruritus is usually severe and in-contact people may report lesions. The clinical presentation can be confused with allergic diseases such as food allergy and atopy, or other parasites including Otodectes, and in cases with severe crusting autoimmune skin diseases such as pemphigus foliaceus should be considered. It is important to consider that amitraz is neither licensed nor recommended for the treatment of scabies or other parasites in the cat, owing to fears about adverse reactions including hypotension, bradycardia and anorexia.
Treatment for body lice infestation is similar to that for scabies. Permethrin or pyrethrin shampoos and creams are usually effective in eliminating body and hair infestations, but sterilization of clothing, bedding, and personal articles also must occur. Lice and eggs are destroyed by temperatures in excess of 52 C, necessitating hot water washing. Storage of articles in plastic bags for 2 weeks also can eliminate infestations.
Scabies are also parasitic infections (more contagious) spread by person-to-person contact or via fomites. Patients may present with papular and or vesicular eruptions on genitals or extremities, as well as with intractable itching. Close observation reveals that the source of itching is the site where adult parasites have burrowed into skin and laid eggs. Adults, larvae, or eggs may be seen.
The evidence for effectiveness of scabies treatments is still largely rudimentary and the majority of studies have employed inadequate criteria for diagnosis and evaluation of efficacy. What evidence exists indicates that none of the topical products is reliable with a single application. The limited evidence available for ivermectin is far from the aspirations expressed by those dealing with problems of long-term infestation. Consequently, further investigation is required for this and other treatments to determine adequate drug regimens.
There are no established standard criteria for making a diagnosis or judging treatment success. Trials used different methods, and in many cases the method was not stated. Treatment success should be given as the percentage of people completely cleared of scabies mites, ova or faecal pellets in skin scrapings viewed under magnification. Clinical success includes elimination of papular and vesicular eruptions and pruritus. Ideally, outcomes should be assessed 28 days after the start of treatment. This allows lesions to heal. If treatment fails, eggs hatch within 3 days and emerging mites become mature 9-10 days later.
Bites of fleas, lice, and scabies produce lesions so similar that diagnosis is often difficult. Flea bites are frequently found in zigzag lines, especially on the legs and in the waist area. The lesions have hemorrhagic puncta surrounded by erythematous and urticarial patches. Pruritus is intense, and often, even after the lesions clear, dull red spots persist.
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