Scabies

Sitti Rahmah Umniyati

 Scabies is a skin disease
caused by a mite called
Sarcoptes scabiei.
 It affects people of all ages.
 It is usually associated with
crowded living conditions,
and its outbreaks often
accompany wars, famine and
human migration
 Learning objective

 Explain the signs and symptoms.

etiology, life cycle, pathogenesis,
diagnosis, prognosis, treatment,
epidemiology and control of scabies.
 Scabies burrows  Scabies rash on the
between the fingers hands. Burrows are
visible.

 A patient who was infested with
scabies
shows the typical pruritic shows the typical pruritic
red papules in the red papules in the finger
interdigital spaces of
hand
 A nursing home patient who was
infested with scabies
shows the typical pruritic shows scabies
red papules in the axilla. infestation on the
flexural wrist
 Scabies with inflamed  Scabies with flexural
lesions in wrist involvement
periumbilical
distribution
 Sarcoptes scabiei (itch mites)
 Phylum: Arthropoda
 Class: Arachnida
 Order: Acarina
 Family: Sarcoptidae
 Genus: Sarcoptes
 Species: Sarcoptes scabiei
 Life Cycle
Form
3 days a lateral branch

First nymph
male

Burrows
Into the
skin 2nd nymph
Female
2to3 mm
at night
 The life cycle is completed in 8-15 days. The
female mite burrows into the skin, and tunnels
through the upper layers of the epidermis,
depositing fertile eggs.
 Six-legged larvae hatch from these eggs , leave
the tunnel, and form a lateral branch. Once in
place the larvae eat, molt, and transform into
eight-legged nymphs.
 The female has 2 nymphal stages, the male only
a single one.
 After fertilization, young adult female begin
construction of a new tunnel.
 The male excavates lateral pockets
in the burrows
 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.
 Mode of transmission

 Scabies usually spreads through

direct contact with an infected person.
 Clothing and bedding may also carry
the mite and transmit the disease.
 Incubation period

 For people without previous

exposure of the disease, incubation
period is around two to six weeks.
 People who have been previously
infested may develop symptoms
earlier, usually within 1-4 days after
re-exposure.
 Diagnosis

 Diagnosis can be confirmed by picking up adult

female mites at the ends of their borrows or by
scraping the affected skin lightly covered with
mineral oil.
 The srapings are then examined under a
microscope to search for immature or adult
mites or for eggs
 Other methods that have been proposed for
obtaining specimens are the use of cellophan
tape and various synthetic glues.
 Differential diagnosis
 Impetigo  Scabies
 Differential diagnosis
 Scarlet Fever  Scabies
 Pathogenesis
 Infection begin when fertile female mites are
transfered from infected individuals by direct
contact
 Female, usually at night , burrows into the skin,
progressing at the rate of about 2-3 mm per
day.
 The burrow is confined to the corneous layer of
the skin
 Lesions appear as short, sinous, or slightly
raised , cutaneous burrows
 Thread-like lesions or vesicles may be seen on
the skin
 Itching and skin eruption are usually
delayed for several weeks.
 The typical scabies rash appears on
various part of the body represent a
generalized response to the allergen.
 Minute vesicular swelling , posibbly
produce by the iritating fecal
deposits or excretions
 Warmth , 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.
 The face and scalp may be affected in
infants and children, whereas adults
seldom has lesions in these areas.
 Norwegian scabies
 A rare condition known as Norwegian, or
crusted scabies my result from hyperinfection
with thousands to millions of mites.
 The consequence is a crusted dermatoses of
the hands and feet and often much of the
body.
 This condition is characteristic of infected
individuals who cannot take care of
themselves and is often reported in mental
hospitals. It is also reported in individuals
treated with immunosusuppressive drugs.
 Treatment
 Infestation with the itch mites can be
eradicated by the use of 1% gamma benzene
hexachloride in a lotion BASE.
 The medication 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.
 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
 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
 Conclusion
 The main symptom is intensive itchiness which
is more severe at night.
 The common affected areas are finger webs and
the skin folds of wrists, armpits, buttocks, groins,
elbows, nipples and lower abdomen.
 The face and scalp are usually not affected,
except in small infants. Thread-like lesions or
vesicles may be seen on the skin
 Control

 Prevention of scabies requires the

treatment of infected individuals, the
sterilizations of garments and
bedding, and personal cleanliness
 Reference

 Markell, E.K., Voge, M., John, D.T. 1986

Medical Parasitology,6th edition, W.B.
Saunders Company, Philadelphia, London,
Toronto, Mexico City, Rio De Janeiro, Sydney,
Tokyo, Hongkong
 Despommier, D.D., Gwadz, R.W., Hotez, P.J.,
Karapelou J.W., Grave, E.V 1995. Parasitic
Diseases, 3rd ed. Springer Verlag, New York,
Belgia, Heidelberg, London, Paris, Tokyo,
Hongkong, Barcelona, Budapest