Scabies SRU Rev 06

Scabies
Sitti Rahmah Umniyati
Learning objective
Explain the etiology, life cycle,
pathogenesis, signs and symptoms. diagnosis, prognosis, treatment, epidemiology and control of scabies.
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
Sarcoptes scabiei (itch mites)

Phylum: Arthropoda Class: Arachnida Order: Acarina Family: Sarcoptidae Genus: Sarcoptes Species: Sarcoptes scabiei
Morphology
Capitulum and body
saclike Legs 4 pairs, short (2 forward and 2 backward) The anterior legs terminate in delicate sucking pads (pulvilli) The posterior legs both end in longhair bristle in the female While in the male the third pair has bristles and the fourth pair pulvilli
Sarcoptes scabiei Sixe of the body

+ 0.34 mm (female) + 0.20 mm (male)
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
With primary infection, itching and

skin eruption are usually delayed for several weeks. As sensitization develops, the typical scabies rash appears on various part of the body that do not necessarily correspond to the location of active adult female mites but represent a generalized response to the allergen. Minute vesicular swelling , possibly produce by the irritating fecal deposits or excretions
The intense itching , aggragated by

warmth and precipitation , 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. At first clinical manifestation may be mild, but after some weeks the skins becomes sensitized , resulting in an itching erythematous eruption.
Life Cycle
3 days
Form a lateral branch
First nymph
male
Burrows Into the skin 2to3 mm at night
Female
2nd nymph
The male excavates lateral pockets

in the burrows The female during her life span 0f 45 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.
Clinical features
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
A patient who was infested with scabies

shows the typical pruritic red papules in the interdigital spaces of hand shows the typical pruritic red papules in the finger
A nursing home patient who was infested with scabies

shows the typical pruritic red papules in the axilla.
these papules on the flexural wrist are secondary to scabies infestation.
Scabies burrows
between the fingers
Scabies rash on the

hands. Burrows are visible.
Scabies with inflamed lesions in periumbilical distribution
Scabies with flexural

wrist involvement
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
demonstration of the mites, eggs, or scybala (fecal pellets). Because the mites are located under the surface of the skin, scrapings must be made from the infected area.
Skin Scraping Technique

1.Place a drop of mineral oil on a sterile
scalpel blade. (Mineral oil is preferred over potassium hydroxide solution or water. Mites will adhere to the oil, skin scales will mix with mineral oil, refractility of differences will be greater between mite and oil, and oil will not dissolve fecal pellets.) 2.Allow some of oil to flow onto the papule. 3.Scrape vigorously six or seven times to remove the top of the papule. (There should be tiny flecks of blood in the oil).
4. Transfer the oil and scraped material to a glass slide (can use an applicator stick). 5. Add 1 or 2 extra drops of mineral oil to the slide, and stir the mixture. Any large clumps can be crushed to expose hidden mites. 6. Place a coverslip on the slide and examine (first on low power). The adult mites range from approximately 215 to 390 microns in length, depending on sex. The eggs are 170 microns long by 92 microns wide, and the fecal pellets are about 30 by 15 microns. The fecal pellets will be yellow-brown.
Plastic Box or Petri Dish Method

If mineral oil preparations of skin scrapings
fail to demonstrate the mites, the encrusted skin scrapings, etc., can be placed in a small plastic box or small petri dish. The container should be left undisturbed at room temperature for 12 to 24 h. Away from the living host, the mites will drop down onto the bottom of the box or dish and can be seen with a magnifying glass or with a dissecting microscope.
This demonstrates the application of mineral oil to suspected scabies lesions prior to scraping.
The scale and mineral oil

are applied to a slide after scraping the skin looking for scabies mites. The scraping is viewed under the microscope at low magnification. The scabies mite measures about 0.1 to 0.3 mm in diameter, and is not visible with the naked eye, but very slight magnification will make it visible.
Differential diagnosis
Impetigo Scabies
Scarlet Fever
Scabies
Prognosis
Prognosis is good with persistence
treatment
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
Control
Prevention of scabies requires the
treatment of infected individuals, the sterilizations of garments and bedding, and personal cleanliness

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Scabies

Sitti Rahmah Umniyati

Scabies is a skin disease

Sarcoptes scabiei (itch mites)

Sarcoptes scabiei Sixe of the body

With primary infection, itching and

The intense itching , aggragated by

Form a lateral branch

Burrows Into the skin 2to3 mm at night

The male excavates lateral pockets

A patient who was infested with scabies

A nursing home patient who was infested with scabies

these papules on the flexural wrist are secondary to scabies infestation.

Scabies rash on the

Scabies with inflamed lesions in periumbilical distribution

Scabies with flexural

Skin Scraping Technique

Plastic Box or Petri Dish Method

The scale and mineral oil

For pediatric use, 10 per cent concentration ,

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