Scabies

introduction
Mite: Sarcoptes scabiei
scabies
 Scabies is a parasitic infection of the skin caused
by the burrowing of the ectoparasitic itch mite
Sarcoptes scabiei.
 Mites burrow into the skin where they lay eggs.
The resulting offspring crawl out
onto the skin and make new burrows
 Any part of the body may be affected,
and transmission is by skin-to-skin contact
 The absorption of mite excrement into skin
capillaries generates a hypersensitivity reaction.
 The itching of scabies results from our body's
allergic reaction to the mites, their eggs and their
waste.
Clinical feature
 itchy papular, papular crusted, or vesicular
lesions may present.
 Classic sites include the interdigital folds, the
wrists and elbows, and around breast nipples
in women
 An individual was defined to have scabies if at
least two of the following 3 requirements were
fulfilled:
 Presence of one or more typical lesions for longer
than 2 weeks,
 pruritus that intensified at night, or at least
 one more family member with similar lesions
Complications

Secondary infection of the skin lesions can occur

following repeated scratching
Vigorous scratching can break your skin and allow a
secondary bacterial infection such as impetigo to occur
A more severe form of scabies may develop called
crusted scabies. This type tends to be crusty and scaly,
and covers large areas of the body. It's very contagious
and can be hard to treat.
Prevention & control
 To prevent re-infection
Clean all clothes and linen
○ Potentially contaminated clothes and bedding
should be washed at high temperature (>50°C) if
possible
Starve the mites
○ Mites separated from the human host die within 72
hours
○ Consider placing items you can't wash in a sealed
plastic bag and leaving it in an out-of-the-way
place for a couple of weeks
Current sexual partners as well as other
members of the household should be examined
and treated
treatment
 These should be applied to the whole
body from the neck downwards, and
washed off after 12 hours, usually
overnight
 Itch may persist for several weeks.
Application of crotamiton cream may
give symptomatic relief, and
antihistamines may also be helpful
Follow up
 The appearance of new burrows at any
stage post-treatment is indicative of a need
for further therapy, although in re-infection
symptoms of pruritus may recur before
typical burrows have developed
 Pruritus persisting more than 2 weeks after
treatment may reflect treatment failure,
reinfection or drug allergy to anti-scabetics
medications
Benzyl benzoate
 Irritant & should be avoided in children
 Less effective compared to malathion &
permethrin
 Side effects:
Skin irritation, burning sensation, rashes
 Counseling points:
Applied to the neck downwards, and washed off
after 12 hours, usually overnight
Up to 3 application on consecutive days
Reapply treatment to the hand if they are
washed
Permethrin
 Permethrin cream 5%
 Permethrin is approved by the US Food and Drug
Administration (FDA) for the treatment of scabies in
persons who are at least 2 months of age.
 Permethrin is safe and effective when used as
directed. Permethrin kills the scabies mite and eggs.
 Permethrin is the drug of choice for the treatment of
scabies.
 Two (or more) applications, each about a week
apart, may be necessary to eliminate all mites,
particularly when treating crusted (Norwegian)
scabies
Crotamiton
 Crotamiton
lotion 10% and Crotamiton
cream 10%;
Crotamiton is approved by the US Food and
Drug Administration (FDA) for the treatment
of scabies in adults;
it is considered safe when used as directed
 Crotamiton is not FDA-approved for use in
children. Frequent treatment failure has
been reported with crotamiton
Lindane
 Lindane lotion 1%;
 Although FDA-approved for the treatment of scabies,
lindane is not recommended as a first-line therapy.
 Overuse, misuse, or accidentally swallowing lindane
can be toxic to the brain and other parts of the
nervous system; its use should be restricted to
patients who have failed treatment with or cannot
tolerate other medications that pose less risk
 Lindane should not be used to treat premature
infants, persons with a seizure disorder, women who
are pregnant or breast-feeding, persons who have
very irritated skin or sores where the lindane will be
applied, infants, children, the elderly
Ivermectin
 Ivermectin
 Ivermectin is an oral antiparasitic agent approved for
the treatment of worm infestations
 Evidence suggests that oral ivermectin may be a safe
and effective treatment for scabies; however, ivermectin
is not FDA-approved for this use.
 Oral ivermectin has been reported effective in the
treatment of crusted (Norwegian) scabies; its use
should be considered for patients who have failed
treatment with or who cannot tolerate FDA-approved
topical medications for the treatment of scabies.
 A total of two or more doses of ivermectin may be
necessary to eliminate a scabies infestation
Lifestyle and home
remedies
 Cool and soak your skin. Soaking in cool
water or applying a cool, wet washcloth to
irritated areas of your skin may minimize itching.
 Apply soothing lotion. Calamine lotion,
available without a prescription, can effectively
relieve the pain and itching of minor skin
irritations.
 Take antihistamines. At your doctor's
suggestion, you may find that over-the-counter
antihistamines relieve the allergic symptoms
caused by scabies.

Ref: http://www.mayoclinic.com/health/scabies
references
1. Feldmeier et. al. 2009. The epidemiology of scabies in an impoverished community in
rural Brazil: Presence and severity of disease are associated with poor living
conditions and illiteracy. J AM ACAD DERMATOL. (6) 436-444.
2. Scott, G. 2008. United Kingdom National Guideline on the Management of
Scabies infestation (2007) .
3. Centers for Disease Control and Prevention. National Center for Zoonotic, Vector-
Borne, and Enteric Diseases (NCZVED).
4. British National Formulary. 50th Edition. 2005.
5. Anderson,P., Knoben, J. & Troutman, W. Handbook of clinical drug data. 10th edition.
Mcgraw-Hill.