Scabies

Scabies
Mohammad Asifuzzaman
Professor & Head, Dermatology
Green Life Medical College Hospital
Agent
• Caused by Sarcoptes scabiei which is also
called itch mite is a parasite (arthropod)
Sarcoptes scabiei
About the disease…..
• Estimated global prevalence is 200 million at any
given time
• It is highly contagious and infects family, friends and
close contacts
• Transmits through direct and close physical contact,
infected clothes, linens, other shared domestic
usable.
• It does not survive more than three days on
substance outside human body
• Can also transmit through sexual contacts.
Pathogenesis
Parasite
infestation Multiplication
of organism
Burrow
Clinical Delayed
lesion hypersensitivity
Types
• Classical
• Nodular scabies
• Crusted (Norwegian) scabies
• Bullous scabies
Predisposing factors
• Lack of hygiene
• Low socioeconomic conditions
• Close physical contacts
• Old age
• Immunocompromise
• Hospital stay
• Down syndrome
• Organ transplant
• Leprosy
• AIDS
Clinical features (classical)
• It takes 4 to 6 weeks for features to develop after infestation
of mite
• Pathognomonic lesion is burrow which is slightly elevated,
greyish and tortuous lines.
• A vesicle or pustule containing the mite are found at the end
of the burrow
• Other lesions are papules, excoriations,
• Pruritus is the only symptom which is severe and usually
more intense in the night. Family members are also infected
• In case of secondary bacterial infection, there will be
pustule, abscess, cellulitis
How does scabies look
Clinical features (other forms)
• In nodular scabies, there will be nodules
• In bullous scabies, there will be bulla formation
• Crusted scabies occurs in immunocompromised
individuals and presents with widespread crusts
specially in scabies specific areas or can involve
whole body. There can be widespread scale and
exfoliation. It can cause fatal complications if not
treated properly.
Nodular scabies
Bullous scabies
Crusted scabies
Sites
• Finger webs
• Wrists
• Axilla
• Nipple and Areola Circle of
• Umbilicus hebra
• Lower abdomen
• Buttock
• Scrotum and penis
• Perineal area
• Foot
• Toe web
• Face and scalp in children only
• Around and underneath nails
Investigations
• Normally no investigation is required to
diagnose scabies
• However, theoretically, Burrow is detected
with gentian violet and then the organism is
isolated with needle or scalpel and visualized
under microscope
• Investigations can be done to assess any
suspected underlying immunosuppression or
associated complication.
Treatment
• General measures
1. Maintenance of hygiene
2. Treatment of family members and close contacts
3. In case of suspected sexually transmitted set up,
treatment of the partner
continued
• Specific measures
1. Topical therapy
1. 5% Permethrin cream – apply all over the body (except
head and face in adults) and keep it for 8 to 12 hours. Then
wash off and reapply after a week. All members of family
and close contacts need to apply in the same way
2.Lindane
3.Benzyl benzoate
4.Crotamiton 10% cream
Used in
5.6 – 10% precipitated sulphur
6.Monosulfirum
pregnancy
7.Malathion
Continued
• Topical steroid is given to cure inflammation
and inflammatory lesions
– Choice of topical steroid depends on the site,
severity, age
– Ointment is preferred to cream as lesions are
generally dry
– 2 to 3 weeks may be needed but sometimes given
for longer duration if eczematization develops
Systemic therapy
• Ivermectin(200 mcg/kg)
– It is safe for children above 15 kg body weight
– Not recommended in pregnancy & lactation
– Repeat dosing may be needed at a week or two
weeks interval
– Diarrhoea, nausea, vomiting, tachycardia,
hypotension are known adverse effects but very
rare
– Best to use in combination with topical permethrin
Continued
• Antihistamines
– Should be chosen according to the level of itching
– Mild to moderate itching can be managed with
nonsedative antihistamine at night or twice daily
– Severe itching needs sedative antihistamine at
night alone or in combination with nonsedatives
during day time
– Antihistamine needs to be continued as long as
itching present as sometimes patients complain
itching after lesions heal as a complication
Continued
• Antibiotics if there is secondary bacterial
infection
Treatment of nodular & crusted scabies
• Nodular scabies if not getting cured by the
treatment, can be treated with intralesional
triamcinolone acetonide injection.
• Crusted scabies is treated with oral ivermectin
on two consecutive days each week for 4 to 6
weeks with topical permethrin for same
duration. Sometimes topical antibiotic,
systemic antibiotic, topical steroid and topical
keratolytic agents like salicylic acid is required.
Complications
• Secondary bacterial infections – impetigo, folliculitis,
furunculosis, abscess, cellulitis
• AGN – when scabies is secondarily infected by beta
haemolytic streptococcal strains of 49, 55, 57, 60 and M
type 2, then there is deposition of Ag-Ab in the glomerular
basement membrane causing inflammation
• Eczematization
• Lichenification
• Urticaria
• Acarophobia
• Exfoliative dermatitis
Eczematization Urticaria
Lichenification Exfoliative dermatitis
Impetigo Cellulitis
Furuncle
Things that look like scabies, but….
Papular Urticaria
• Finger and toe web genitalia not involved

• Could be associated with asthma, rhinitis
• Long relapsing history
• Family members not affected
• Itching throughout the day
• Mostly arms and legs involved
Miliaria
MILIARIA
• Finger & toe web, genitalia spared

• Associated with sweating
• Occurs in summer
• Back and chest mostly involved
• Associated with burning
• Family history absent
Viral exanthem
• Finger & toe web, genitalia spared

• Associated with viral fever
• Can occur all over
• No burning or itching
Drug reaction
• Finger & toe web,

genitalia spared
• History of drug intake
• Can occur all over
• Itching could be severe
Seborrheic folliculitis
Finger & toe web, genitalia spared

Mostly in chest and back
Scalp and beard involved
Itching could be severe
Family history absent
Can be worse in winter
THANK YOU ALL

Scabies

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Scabies

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Scabies

• Finger and toe web genitalia not involved

• Finger & toe web, genitalia spared

• Finger & toe web, genitalia spared

• Finger & toe web,

Finger & toe web, genitalia spared

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