Scabies
Scabies
Scabies
Definition Infestation caused by the mite Sarcoptes scabei. Any part of the body may be affected, and transmission is by skin to skin contact. Clinical features Symptoms mites burrow into the skin where they lay eggs. The resulting offspring crawl out onto the skin and makes new burrows. absorption of mite excrement into skin capillaries generates a hypersensitivity reaction. The main symptom, which takes 4-6 wks to develop, is generalised itch especially at night Signs characteristic silvery lines may be seen in the skin where mites have burrowed. classic sites: interdigital folds, wrists, elbows, umbilical area, genital area and feet Nodular Scabies- papules or nodules seen at the site of mite infestation often affect the scrotum, axillae, back, or feet of children. Crusted or Norwegian Scabies- seen in young infants or immunosuppressed patients. Widespread mite infestation causing a hyperkeratotic and/or crusted generalized rash. Diagnosis the clinical appearance is usually typical, but there is often diagnostic confusion with other itching conditions such as eczema scrapings taken from burrows examined under light microscopy may reveal mites Management General advice parents are given a detailed explanation of condition, and clear, accurate written information on applying the treatment treat everyone in the household or close contacts. Ignore pleas that someone does not itch; infected people can be asymptomatic and reinfect household members. change bedding, nightclothes & towels on night of treatment and clean them in a hot wash & hot iron after. Treatment Infants: 2 months onwards Prementrin 5% lotion - one application and repeat another application after 2 weeks - to be applied to the whole body (may include the face if lesions are found on the face), overnight (8-12 hours) and washed off the following morning Crotamiton cream - applied to all lesions 3 times a day for 2 weeks (anti-pruritic,symptomatic relief) Children: 6 years above Benzyl Benzoate Lotion (EBB) 12.5% (6-9 years); 25% (> 10 years) - applied to whole body from neck down; washed after 8-12 hrs; 3 consecutive nights Prementrin 5% lotion - one application and repeat another application after 2 weeks - applied to whole body overnight (8-12 hours); washed off the following morning. Sulpha (3-6%) with calamine - applied to all lesions 3 times a day for 5 days (anti-pruritic, symptomatic relief). antihistamine may also be helpful in relieving the itch. 280
DERMATOLOGY