Dermatology presentation on scabies it's manifestation and management

Dermatology presentation on scabies it's manifestation and management

• 1.
  SCABIES “SEVEN YEARS ITCH”
• 2.
  Etiology : Human scabiesis a pruritic condition caused by infestation with the mite Sarcoptes scabiei var. hominis, which lives its entire life within the epidermis Epidemiology • Disease of the poor and underprivileged. • Spreads by close personal contact • Crowded living conditions and poor personal hygiene • History of similar complaints in family or contacts often present. • Also sexually transmitted. • Epidemics occur every 30 years according to studies with smaller epidemics occurring every 7 years
• 3.
  Clinical Manifestations Morphology • Intenselyitchy (more pronounced at night) • Generalized papular eruption • Presents within 2-6wks of infestation but reinfestation can provoke symptoms within 48hrs • Pathognomonic lesion a burrow (1-10mm), an irregularly linear skin colored ridge, produced by female mite tunneling through stratum corneum.
• 5.
  Sites of Predilection •Burrows present in interdigital clefts of hands, flexors of wrists, elbows, anterior axillary folds, t he ‘belt’ area and buttocks. • And in children, additionally on the palms and soles. • Male genitalia. • And in females, the areolae of the breast. • Head and neck conspicuously spared except in infants
• 7.
  Types of scabies •Classical scabies: itching which worsens at night - burrows can be present- in severe cases, deep seated nodules are seen • Scabies in clean: Seen in individuals who keep their body clean • Nodular scabies : Persistent nodules may develop on the male genitals • Scabies incognito: Local applications of corticosteroids may make scabies unrecognizable • Animal transmitted scabies: it is acquired from animals like dogs, horses, etc
• 8.
  Norwegian Crusted Scabies • Seenin patients with compromised cell mediated immune status (e.g. AIDS) Or in mentally challenged. • Manifests as hyperkeratotic and crusted lesions on the hands and feet. • occasionally as generalized erythroderma. • Itching minimal. • Highly contagious condition, since there are numerous mites in the scales.
• 9.
  Complications •Excoriations •Secondary infection •Eczematization (common). •Acute glomerulonephritis, an occasional but serious complication of secondary streptococcal infection.
• 10.
  Investigations • Diagnosis clinical. •Skin Scrapings : Done to demonstrate mite done by paring burrows from hands and wrists
• 11.
  Biopsy Shows mite instratum corneum. And acanthosis and a perivascular infiltrate of lymphocytes and eosinophils
• 12.
  Treatment Patient’s education • Allpersons in the household, whether itching or non itching should be treated. • The clothes should be disinfected. - Woolen blankets, etc. should be kept locked inside the cupboard, as the mites die off if they do not come in contact with humans for 3-5 days • The topical preparation is applied overnight to the entire body surface, from head to toe, in infants and the elderly. Special attention should be paid to the interdigital spaces, intergluteal cleft, umbilicus, and subungual areas. • Following successful treatment, pruritus and skin lesions can persist for 2–4 weeks or longer. This is referred to as “postscabetic” pruritus or dermatitis.
• 13.
  Specific Treatment •Antiscabitics, topicaland systemic. Topical treatment Include permethrin, 5% cream, lindane (gamma benzene hexachloride, GBH), 1% lotion/cream and benzyl benzoate, 10–25% lotion/emulsion. • Intralesional steroids used in nodular scabies. • Systemic treatment : Ivermectin (200 ug/kg), the only systemic agent. Used for Norwegian scabies and scabies epidemics in institutions (orphanages, old age homes)