Scabies

Human scabies is an intensely pruritic skin infestation caused by the host-specific mite Sarcoptes scabiei hominis. This mite can travel from the infected person to another person. Most people get scabies from direct, skin-to-skin contact. Less often, people pick up mites from infested items such as bedding, clothes, and furniture. The mite can survive for about 48 to 72 hours without human contact.

Signs and symptoms

Burrows are a pathognomonic sign and represent the intraepidermal tunnel created by the moving female mite. They appear as serpiginous, grayish, threadlike elevations in the superficial epidermis, ranging from 2-10 mm long.

Scabies can develop anywhere on the skin. The mites, however, prefer to burrow in certain parts of the body. High-yield locations for burrows include the following:

• Webbed spaces of the fingers
• Flexor surfaces of the wrists
• Elbows
• Axillae
• Belt line
• Feet
• Scrotum (men)
• Areolae (women) Scabies in children

Diagnosis

The diagnosis of scabies can often be made clinically in patients with a pruritic rash and characteristic linear burrows.

Treatment: In all cases

• Close contacts of the patient are treated simultaneously, even in the absence of symptoms.
• Wash the whole body with soap ( better if sulphur containing or scabfree lotion to the whole body except face and allow to dry medicated soap is used ) and water. Then apply benzoyl benzoate on skin. Wash after 12-24 hours. Repeat the same after a week
• Clothing and bedding ( including that of contacts ) are changed after each treatment . They are washed at 2 60 ° C then dried in the sun , or exposed to sunlight for 72 hours , or sealed in a plastic bag for 72 hours.
• Tab / Syp- Kestine ( ebastine ) 10mg or any other anti - histaminic tab PO x OD at night

Topical Treatment

• Topical scabicides are applied over the entire body (including the scalp, post - auricular areas, umbilicus, palms and soles), avoiding mucous membranes and face, and the breasts in breastfeeding women. Particular attention should be paid to common infestation sites. The recommended contact time should not be shortened or exceeded; the patient must not wash his hands while the product is in use ( or the product should be reapplied if the hands are washed). In infants, the hands wrapped prevent accidental ingestion of the product.
• The preferred is Scabfree / Scabiderm (5 % The preferred treatment permethrin) lotion or cream: Child 2 months and adult: one application, with a contact time of 8 hours, then rinse off Permethrin is easier to use ( no dilution required ) , and preferred over benzyl benzoate in children , and pregnant / lactating women . One application may be sufficient, but a second application 7 days later reduces the risk of treatment failure. If not available, use Scabica / Scabicure (benzyl benzoate 25 %) lotion.
• A second application of benzyl benzoate (e.g. after 24 hours, with a rinse between the 2 applications; or two successive applications, 10 minutes apart , when the first application has dried with a rinse after 24 hours ) reduces the risk of treatment failure . Second applications are not recommended in pregnant women and children < 2 years

Oral treatment

• Treatment with Ivermite / Scabimac (ivermectin) as a single dose is an alternative: it is more practical than topical treatment (e.g. in the case of an epidemic or for treating contacts) and can be started right away in the case of secondary infection. A single dose may be sufficient; a second dose 7 days later reduces the risk of treatment failure.
• Ivermectin is not recommended for children < 15 kg or pregnant women (safety not established).
• In immunocompetent individuals, 200 mcg / kg orally is effective in about 75 % of cases with a single dose and 95 % of cases with two doses 2 weeks apart.
• Ivermectin is often used in combination with permethrin.
• In immunosuppressed persons and those with crusted hyperkeratotic) scabies, multiple doses of ivermectin (every 2 weeks for 2 or 3 doses) plus topical therapy with permethrin every 3 days to once weekly, depending on degree of involvement, may be effective when topical treatment and oral therapy alone fail.
• Crusts should be softened (with salicylic acid ointment) and removed before applying local treatment (otherwise, local treatment is ineffective). As exfoliated skin scales may spread the parasite, the patient should be isolated during the treatment staff should use protection (gloves, gowns and hand washing after contact), and environment (bedding, floors and surfaces should be decontaminated.
• A topical keratolytic (urea) can also be used to help remove the scale of Hyperkeratotic scabies, thereby decreasing the mite load.
• Persistent pruritic post - scabietic papules may be treated with mid- to high - potency corticosteroids or with Intralesional triamcinolone acetonide ( 2.5-5 mg / mL ).
• Treatment effectiveness is judged on clinical grounds. Itching may persist for 1 to 3 weeks after elimination of the parasite