Fatimah

Nevetigah thavashoty
M.Mirza aditya hakim


SCABIES
Definition
Human infestation caused by Sarcoptes
Scabei var hominis an obligate human
parasite that live itsentire life cycle in and on
the skin
Epidemiology
Scabies is the term for infestation with the itch
mite, Sarcoptes scabiei var humanus. The
mite was first described in 1687, making
scabies one of the first infectious diseases
with a known cause.1 The disease is found
worldwide, in all races and in all age groups. It
can be transmitted sexually as well as by
nonsexual close skin-to-skin contact,
especially within the family and at school.
When more than one member of a household
is afflicted with an intensely pruritic eruption,
scabies infestation must be considered
ETIOLOGY
Sarcoptes Scabei Var hominis
Sarcoptes Scabei var Animalis



CLINICAL MANIFESTATION
The hallmark of scabies is intractable pruritus,
characteristically more severe at night. The
itching, often disproportionately severe, is
associated with lesions that initially appear on
the web spaces, then the sides of the fingers,
the flexor surfaces of the wrists, elbows and
anterior axillary folds.
Scabies. Several, slightly scaling, threadlike burrows are
seen on the medial aspect of the palm, associated with a
more generalized eczematous process; scrapings of a
burrow have the highest yield in detection of a scabies
mite
SCABIES
Scabies incognito
Originally described in patients taking
glucocorticoids, other immunosuppressive
drugs also may lead to confusing presentations
of scabies, including crusted scabies mimicking
contact dermatitis or Darier's disease. Scabies
must be considered whenever a widespread,
scaly, pruritic dermatosis develops in an
immunosuppressed patient.

SCABIES
Nodular scabies
The lesions are reddish-brown, pruritic papules
and nodules on covered areas (most
frequently the male genitalia, groin, and
axillary regions), which often persist long
after adequate



Scabies, with nodular lesions. The penis and scrotum
are common sites for scabies infestations; crusted
excoriated papules are seen on the glans and shaft, and
nodular scabies lesions on the scrotum.
SCABIES
Scabies in infants and young children
In this age group, the face, scalp, palms, and soles
may be involved; the most common presenting
lesions are still papules, vesicopustules, and
nodules, but the distribution may be atypical.
Crusted scabies.hyperkeratotic plaque papulated
with thousand of mite
SCABIES
Scabies in the elderly
In this age group, scabies may be missed because
the cutaneous changes may be minimal or atypical.
The intense itching may be attributed to senile
pruritus, xerosis, drugs or psychogenic causes.
Older patients who spend prolonged periods of
time in bed or in chairs may have involvement of
the back.
Scabies several thread like burrows are present in the
web spaces of the finger and on the knuckles a common
location for the lession in scabies longitudinal scraping
of a burrow with often reveal the mite or mite product
under microscopic examination
SCABIES
Crusted (Norwegian) scabies
Historically, this condition has been associated with
advanced age, debility, and developmental disabilities
such as Down's syndrome. It is now also seen with
immunosuppression of all types. Hyperkeratotic,
nonpruritic lesions are most common, but the
condition may range from crusting with or without
pruritus to a pruritic, papular dermatitis and may
mimic Darier's disease or psoriasis. Finger- and
toenail involvement may simulate psoriasis or
onychomycosis.
SCABIES
Scabies and HIV/AIDS
Scabies occurs in at least 2 to 4 percent of patients
with AIDS. Unusual forms of scabies in AIDS can
be divided into crusted scabies and atypical papular
scabies. Patients with HIV/AIDS may present with
classical scabies, and as the CD4 count drops, they
may develop crusted scabies and the pruritus may
decrease or disappear. Because of the atypical
appearance, diagnosis may be delayed, increasing
the risk of spread to others.

Crusted or Norwegian scabies in an AIDS patient. The
clinical presentation of generalized hyperkeratosis and
scaling is often misdiagnosed; rather than an infestation
with a dozen mites, many thousands to millions are
present.
DIAGNOSIS
Clinical Manifestation
Direct examination
Dermoscopy
Polymerase chain reaction
Scabies.microscopic examination of a mineral oil
preparation after scraping a burrow reveals a gravid
female mite with oval gary eggs fecal patient .
DIFFERENTIAL DIAGNOSIS
Atopic dermatitis
Insect bite reaction
Contact dermatitis

TREATMENT
Treatment for Scabies
Drug Dose Comment
Permethtrin 5 % cream Applied for 8-14 h, often repeated
in 7 days
First line treatment in united
states, pregnancy category B
Lindane 1 % lotion Applied for 8 days, then washeoff
second aplication recommended
after 1 week
Not recommended for children
under 2, during pregnancy or
location, resistance has been
increasing , banned california
Crotamiton 10% cream Applied for 2 concecutif days,
repeated once whitin 5 days

Antipruritic qualities, may not be
as effective as other topical
Precipitated sulfur 5-10% Applied for 3 days and then
washed off

Safe in children under 2 mo
during pregnancy but messy to
apply and limited efficay data
Benzyl benzoate 10% lotion Applied for 24 days and then
washed off
Not Avalaible in United States
Ivermectin 200 ug/kg Singel oral dose can be repeated
in 10-14 days
Highly effective with a good
safety profile, can be used along
with topical agent , particulary in
crusted or resistant case
COMPLICATIONS
Eczema, particularly in atopics,
Excoriation may lead to secondary pyoderma,
and colonization with nephritogenic strains of
streptococci may lead to acute gomerulonephritis.
acarophobia or delusions of parasitosis

PROGNOSIS
Bonam