Introduction

Epidemiology Etiopathogenesis Clinical Features Complications

Investigations & Diagnosis

Treatment

INTRODUCTION
Scabies (from Latin: scabere, "to scratch"), known colloquially as the 7 year itch It is caused by a tiny and usually not directly visible parasite, the mite Sarcoptes scabiei, derived from the Greek words sarx (the flesh) koptein (to smite or cut)

The infection in animals (caused by different but related mite species) is called sarcoptic mange. Scabies -one of the first diseases with a known cause.

HISTORY
Scabies is an ancient diseaseReported for more than 2500 yrs.
The ancient Greek philosopher Aristotle reported on "lice" that "escape from little pimples if they are pricked"; scholars believe this was actually a reference to scabies Roman physician Celsus named the disease "scabies" and describing its characteristic features. Italian physician Giovanni Cosimo Bonomo documented the parasitic etiology of scabies in his famous 1687 letter, "Observations concerning the fleshworms of the human body

EPIDEMIOLOGY
Age: In any age group essentially in children Decreasing prevalance with advancing age Sex: No gender predilection Predisposing factors: Low SES, Crowding , Poor hygiene Immunosuppression

ETIOPATHOGENESIS
Human scabies is caused by an infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis).

Morphology: Like other aranchnids, the scabies mite is an eight-legged arthropod with round body. It is barely visible to the human eye, and females (larger than males) are less than 0.5 mm in length. Reservoir: Domesticated animals, but usually different strains have distinct host preferences so infections that are contracted from animals may cause irritation and itching, but are usually short-lived. Incubation period: Usually between 2 to 6 weeks; can be as little as 1 to 4 days in people that have been sensitized by prior exposure.

MODE OF TRANSMISSION

I Direct skin to skin contact (common)

COMMON SYMPTOMS
Itching & Skin rash Severe itching (pruritus), especially at night, is the earliest and most common symptom of scabies. A pimple-like (papular) itchy (pruritic) scabies rash is also common Lesions: 1 & 2

1 Lesions Burrows

Papules & Papulovesicular

2 Lesions
Pustules Eczematized Lesions

Nodular Lesions

Itching and rash may affect much of the body or be limited to common sites such as: Between the fingers Wrist Elbow Armpit Genitalia Nipple Waist

CIRCLE OF HEBRA
Buttocks Shoulder blades The head, face, neck, palms, and soles often are involved in infants and very young children, but usually not adults and older children.

Tiny burrows sometimes are seen on the skin; these are caused by the female scabies mite tunneling just beneath the surface of the skin. These burrows appear as tiny raised and crooked (serpiginous) grayish-white or skin-colored lines on the skin surface. Because mites are often few in number (only 10-15 mites per person), these burrows may be difficult to find.
They are found most often in the webbing between the fingers, in the skin folds on the wrist, elbow, or knee, and on the penis, breast, or shoulder blades.

VARIANTS
Scabies Incognito Nodular Scabies

Bullous scabies
Scabies in clean persons Norwegian Scabies

Scabies Incognito Glucocorticoid adm masks signs & symptoms of scabies although infestation remains freely transmissible Nodular: Firm, red itchy nodules Due to hypersensitivity reaction to the mite Bullous Scabies Vesicles in children & in adults may mimic bullous pemphigoid Atypical/ Clean Scabies:Itching with few scattered papules

Crusted (Norwegian) Scabies

thick crusts of skin that contain large numbers of scabies mites and eggs.
The mites in crusted scabies are not more virulent than in non-crusted scabies; however, they are much more numerous (up to 2 million per patient); persons with crusted scabies are very contagious to other persons. persons with crusted scabies can transmit scabies indirectly by shedding mites that contaminate items such as their clothing, bedding, and furniture.

INVESTIGATIONS:
a. Diagnostic test: i.Identification of the mites, eggs,eggshell fragments and mite pellets( Scybala) ii. Drop of mineral oil over the burrow Longitudinal and lateral scrapping of skin with scalpel blade Study under microscope iii. Avoid using KOH as it can dissolve the pellets iv. Failure of the identification of eggs or mites does not rule

b.Localizing the burrow: i.Application of topical tetracyclineWashing off the excess study under the Wood Lamp Fluorescence

ii.Application of the washable ink

iv.Skin biopsy

COMPLICATIONS
skin sores infected with bacteria on the skin, such as Staphylococcus aureus or beta-hemolytic streptococci. post-streptococcal glomerulonephritis.

Eczema particularly in atopics

DIAGNOSIS
Diagnosis of a scabies infestation usually is made based upon: Intensely itchy eruption itching being worse at night. H/O of similar itchy eruption in close contacts
Presence of burrow espcly in web spaces & on penis. Nodular lesions on scrotum & penile shaft. Distribution of lesions The diagnosis of scabies should be confirmed by by taking skin scrapings from burrows and identifying the mites, their eggs or faeces by microscopy.

DIFFERENTIAL DIAGNOSES
Atopic Dermatitis

Animal scabies
Insect bite HS Pediculosis corparis Dermatitis herpetiformis

ATOPIC DERMATITIS
Palms & soles spared

SCABIES
Papulovesicultion on palms & soles

H/o of atopy
Fly H/o of atopy

Not relevant
Close contacts have typical lesions of scabies

ANIMAL SCABIES Burrows: Absent Fly H/o : Absent H/o of contact w/ animals

HUMAN SCABIES Present Close contacts Not relevant

IBH Age: Children If adults rule out underlying neoplastic disease or HIV Morpho: Papule with vesicle or hemorrhagic crust Distribution: Exposed parts Fly H/O: Absent PEDICULOSIS CORPORIS Morph: Linear excoriations often covered with hemorrhagic crusts. Distribution: Trunk

SCABIES Any age

Burrows; papules vesicles Webs of fingers, genitalia, thighs Present SCABIES Burrows; papules vesicles Webs of fingers, genitalia, thighs

DERMATITIS HERPETIFORMIS Morph: Grouped excoriations & vesicles Distribution: Extensors of extremities & Trunk Associations: Gluten sensitive enteropathy Response: Dramatic response to dapsone

SCABIES Burrows; papules vesicles Webs of fingers, genitalia, thighs Fly H/O present To antiscabetic therapy

TREATMENT
General Principles Treatment is precede by a tepid bath or shower followed by drying with a towel
Scabicides should be applied thinly but thoroughly in all areas Medication should be left for hrs prescribed & thoroughly rinsed off. At the conclusive therapy undergarments, bed linens, towels should be machine washed & dried using hot cycles.

Specific Scabicides
SCABICIDE Permethrin 5% METHOD OF USE COMMENTS 1 Application of 8-12 Scabicide of choice hrs

Benzyl Benzoate 25% 3 App at 12 hourly intervals Gamma Benzene 1 App Hexachloride 1% Crotamiton 10% 2 App daily X 14d
Pptd Sulphur 10% 2 app daily X 14d

Irritation
C/I in epilepsy, infants. Useful in children Mild antipruritic Useful in children

Ivermectin

Single oral dose 200g/kg body wt. Repeat after 2 weeks.

Indicated in Epidemics in orphanages Norwegian scabies