Scabies

Sitti Rahmah Umniyati

 Learning objective

• Explain the pathogenesis, signs

and symptoms. Diagnosis,
differential diagnosis, prognosis,
management, epidemiology and
social aspect of scabies.
• Scabies rash on the • Scabies burrows
hands. Burrows are between the fingers
visible.
• Scabies with flexural • Scabies with
wrist involvement inflamed lesions in
periumbilical
distribution
 Scabies
• Scabies is human
skin disease caused
by the mite
Sarcoptes scabiei.
• It is usually
associated with
crowded living
conditions, and its
outbreaks often
accompany wars,
famine and human
migration
Sarcoptes scabiei (itch mites)
• Phylum: Arthropoda
• Class: Arachnida
• Order: Acarina
• Family: Sarcoptidae
• Genus: Sarcoptes
• Species: Sarcoptes scabiei
• Impetigo • Scabies
Impetigo
• Impetigo, a contagious skin infection that
usually produces blisters or sores on the face
and hands, is one of the most common skin
infections among kids.
• It is generally caused by one of two bacteria:
group A streptococcus or staphylococcus
aureus. Impetigo usually affects preschool
and school-age children, especially in the
summer months. A child may be more likely
to develop impetigo if the skin has already
been irritated or injured by other skin
problems, such as eczema, poison ivy, insect
bites, or a skin allergy to soap or makeup.
• Good hygiene can help prevent
impetigo, which often develops when
there is a sore or a rash that has been
scratched repetitively (for example,
poison ivy can get infected and turn
into impetigo). Impetigo is typically
treated with antibiotics.
• Scarlet Fever • Scabies skin lesion
What is scarlet fever?

• Scarlet fever is a disease caused by a

bacteria called group A streptococcus,
the same bacteria that causes strep
throat. Scarlet fever is a rash that
sometimes occurs in people that have
strep throat. The rash of scarlet fever is
usually seen in children under the age
of 18.
What should I do if I think my child
has scarlet fever?
•
The best thing to do if you think your
child may be ill is to call your doctor or
health care provider.
How is scarlet fever diagnosed?
•
Your doctor or health care provider will
examine your child and swab the back
of the throat with a cotton swab to see
if there is a streptococcus infection.
Other less common symptoms include:
Nausea and vomiting Headache Body
aches
What is the treatment for scarlet
fever?
•
If the swab test (throat culture) shows that
there is streptococcus, you will be given an
antibiotic prescription for your child. Give this
medicine exactly as you are told. It is very
important to finish all of the medicine. Never
share any of this medicine with family or
friends. Ask your doctor or health care
provider about over-the-counter medicine to
lessen sore throat pain.
What are the symptoms of scarlet
fever?
• The most common symptoms of scarlet fever are: A rash first
appears as tiny red bumps on the chest and abdomen. This rash
may then spread all over the body.
• It looks like a sunburn and feels like a rough piece of
sandpaper. It is usually redder in the arm pits and groin areas.
The rash lasts about 2-5 days.
• After the rash is gone, often the skin on the tips of the fingers
and toes begins to peel. The face is flushed with a pale area
around the lips. The throat is very red and sore. It can have
white or yellow patches.
• A fever of 101 degrees Fahrenheit (38.3 degrees Celsius) or
higher is common. Chills are often seen with the fever. Glands
in the neck are often swollen.
• A whitish coating can appear on the surface of the tongue. The
tongue itself looks like a strawberry because the normal bumps
on the tongue look bigger.
Is there anything else I can do to
make my child feel better?

• Warm liquids like soup or cold foods like

popsicles or milkshakes help to ease the pain
of the sore throat. Offer these to your child
often, especially when he/she has a fever
since the body needs a lot of fluid when it is
sick with a fever. A cool mist humidifier will
help to keep the air in your child's room moist
which will keep the throat from getting too
dry and more sore. Rest is important.
• Scabies diagnosis • This demonstrates
the application of
mineral oil to
suspected scabies
lesions prior to
scraping.
• Scale and mineral oil • Scabies mite
are applied to a slide magnification
Typical distribution of inflammatory papules in
adults who contract scabies

•
• The scraping is viewed • Sarcoptes scabiei
under the microscope at
low magnification.
• The scabies mite
measures about 0.1 to
0.3 mm in diameter,
and
• is not visible with the
naked eye, but very
slight magnification will
make it visible.
Treatment of scabies
• Treatment of choice for
scabies is to apply
permethrin (Elimite)
overnight from the neck
down, and to ensure that
everyone in the patient's
family is treated at the same
time.
• The bedding and clothing
from the past week should
be washed or dry cleaned, or
it can be placed in plastic
bags and set aside for a
week until any scabies mites
within the bags die.
• Some suggest that the
Elimite should be
applied again overnight
to all persons five days
after the initial therapy
to ensure that any adult
mites that are hatching
from eggs that are not
killed by the first
application can be
destroyed by the
second application.
• Primary syphilis • Secondary syphilis
What is Syphilis?
• is a sexually transmitted disease (STD)
caused by the bacterium Treponema
pallidum. It has often been called “the
great imitator” because so many of the
signs and symptoms are
indistinguishable from those of other
diseases.
How do people get syphilis?
• Syphilis is passed from person to person
through direct contact with a syphilis sore.
Sores occur mainly on the external genitals,
vagina, anus, or in the rectum. Sores also can
occur on the lips and in the mouth.
Transmission of the organism occurs during
vaginal, anal, or oral sex. Pregnant women
with the disease can pass it to the babies
they are carrying. Syphilis cannot be spread
through contact with toilet seats, doorknobs,
swimming pools, hot tubs, bathtubs, shared
clothing, or eating utensils.
Primary Stage
• The primary stage of syphilis is usually
marked by the appearance of a single sore
(called a chancre), but there may be multiple
sores. The time between infection with
syphilis and the start of the first symptom can
range from 10 to 90 days (average 21 days).
The chancre is usually firm, round, small, and
painless. It appears at the spot where syphilis
entered the body. The chancre lasts 3 to 6
weeks, and it heals without treatment.
However, if adequate treatment is not
administered, the infection progresses to the
secondary stage.
Secondary Stage
• Skin rash and mucous membrane lesions characterize the
secondary stage. This stage typically starts with the
development of a rash on one or more areas of the body. The
rash usually does not cause itching. Rashes associated with
secondary syphilis can appear as the chancre is healing or
several weeks after the chancre has healed. The characteristic
rash of secondary syphilis may appear as rough, red, or reddish
brown spots both on the palms of the hands and the bottoms of
the feet. However, rashes with a different appearance may
occur on other parts of the body, sometimes resembling rashes
caused by other diseases. Sometimes rashes associated with
secondary syphilis are so faint that they are not noticed. In
addition to rashes, symptoms of secondary syphilis may include
fever, swollen lymph glands, sore throat, patchy hair loss,
headaches, weight loss, muscle aches, and fatigue. The signs
and symptoms of secondary syphilis will resolve with or without
treatment, but without treatment, the infection will progress to
the latent and late stages of disease.
Habits
• Copulation
• the male
• female, usually at night , burrows into
the skin, progressing at the rate of
about 2-3 mm per day.
• The female during her life span 0f 4-5
weeks deposits up to40-50 eggs, 2-4
at a time, in the burrow.
• The female may survive off the host
for 2-3 days at room temperature.
Life Cycle of Sarcoptes scabiei 8 to 15 days
Form
3 days a lateral branch

First nymph
male

Burrows
Into the
skin 2nd nymph
Female
2to3 mm
at night
Pathogenicity
• The preferential sites are the interdigital
spaces, the flexor surfaces of the wrist and
forarms, elbows, axillae, back, inguinal
region, and genitalia.
• The lesions appear as slightly reddish,
elevated tracts in the skin.
• Minute vesicular swelling , posibbly produce
by the iritating fecal deposits or excretions,
from beneath the gallery a short distance
behind the mite.
• The intense itching , aggragated by warmth
and precipitation , causes scratching, which
spreads the infestation, iritates the lesions,
and induces secondary bacterial infection.
• As a result multiple papular vesicular, and
pustular lesions may be produced.
• At first clinical manifestation may be mild, but
after some weeks the skins becomes
sensitized , resulting in an itching
erythematous eruption.
Diagnosis
• The type of lesion and an itching rash
are suggestive. Conclusive evidence is
obtained by removing the mite from its
burrow with a needle. The mites are not
always easy to find, since the number
of females, in spite of the high rate of
reproduction, in small.
• Prognosis is good with persistence
treatment
Scabies caused by Sarcoptes scabiei
Identification
• Identification requires that skin
scrapings be taken from the suspected
infested area and examined
microscopically.
• There has been much debate over
whether the scabies mite of man and
the scabies mites found in other
animals are one or several species.
• This is because mites from different
animals are morphologically
indistinguishable from S. scabiei.
Animal scabies
• The itch and mange mites of various domestic
animals (horses, pigs, dogs, cats, camels) can
infect humans.
• These mites are often morphologically in
distinguishable from human parasites and are
fully capable of penetrating human skin.
• The infection is usually self limited, however
because this mites do not form tunnels and
can not complete their life cycles.
• Nevertheless, human may react with severe
papular urticaria to these transitory infestations
Animal scabies
Treatment
• Infestation with the itch mites can be
eradicated by the use of 1% gamma benzene
hexachloride in a lotion BASE.
• The medicaton should be applied in the
evening after the lesions have been cleaned
and soften by soaking in a warm water and
should be left of overnight.
• One or two additional application, at weekly
intervals may be necessary to kill those mites
that hatch subsequent to the initial
treatment.
• For pediatric use, 10 per cent concentration ,
N-ethyl-o crotonotoluide (Eurax) in a cream
or lotion base, is prefered by many
physicians. It is applied to the skin of whole
body from the chin downs and a second
application is made after 24 hours
• A cleansing bath is given after another 24
hours.
• Allergic reactions and local irritation have
been reported.
Epidemiology
• Scabies is transmitted by personal
contact especially by person sleeping
together, less frequently by towels,
clothing and bed linens.
• Infectivity is low and the indication
tends to run a limited course in healthy
persons of cleanly habits
Control
• Prevention of scabies requires the
treatment of infected individuals, the
sterilizations of garments and bedding,
and personal cleanliness