Scabies

Dr Athar Khan

1. SCABIES & ITS PREVENTION
PROF. DR ATHAR KHAN
Department of Community Medicine
Liaquat College of Medicine & Dentistry,
Karachi
[email protected]

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12. LEARNING OBJECTIVES
•DescribetheetiologyandepidemiologyofScabies
•Describetheclinicalfeatures,assessmentand
diagnosticcriteriaofScabies
•Discusstheprocessofcontrolandpreventionof
Scabies
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13. DEFINITIONS
•ENTOMOLOGY:
•ABranchofzoologywhichisconcernedwith
thestudyofinsects.
•ANTHROPODS:
•Aninvertebrateanimalwhichhasexoskeleton,
asegmentedbody,andjoinedappendages.
•INFESTATION:Itisastateofhavingaparasite
inoronthebodywhichincludesanthropods
oranimalparasites.
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14. •Anthropods:Itchmite
•Diseasetransmitted:Scabies
•Scabiesisaninfestationbytheitchmite
(SarcoptesScabiei)
•Scabiesreferstotheskinlesionsproducedby
thismite.
•Phrase"7yearitch"
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15. •Mitesaresmalleight-leggedparasites(in
contrasttoinsects,whichhavesixlegs)
•Theyaretiny,just1/3millimeter(.32inches)
long,andburrowintotheskin
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INFECTIOUS AGENT

16. •Thefemalemitesthatcausescabiescanbe
seenbynakedeyebutmalecanbeseenwith
amagnifyingglassormicroscope.
•Lifehistory:incompletemetamorphosis,the
entirelifehistorytakesabout17days.
•Aftermating,themalemitedies.
•Thefemalemiteburrowsintotheepidermis
(stratumcorneum)ofthehost
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INFECTIOUS AGENT

17. •Themite,Sscabieispreadsdiseasethrough
directandprolongedcontactbetweenhosts.
•Themiteremainsviablefor2-5dayson
inanimateobjects;therefore,transmission
throughformites,suchasinfectedbeddingor
clothing,ispossible,butlesslikely.
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INFECTIOUS AGENT

18. EPIDEMIOLOGY
•Mostvulnerablegroups-youngchildrenandthe
elderlyinresource-poorcommunities
•Hotandtropicalclimates
•Unhygienicconditions
•Overcrowding
•Poverty&illiteracy
•Limitedaccesstotreatment
•Scabiesinadultsfrequentlyissexuallyacquired
•Nursinghomes,prisons,andchildcarefacilities
•Sharingclothesandtowels
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19. EPIDEMIOLOGY
•RouteofTransmission:
–Directcontactwithinfectedperson
–Indirectcontactwithsoiledbedlinen,clothingand
othercontaminatedobjects
•IncubationPeriod:Itching
–1to5daysinindividualspreviouslyexposed
–2to6weeksnotpreviouslyexposed
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2-3 eggs per day
3 to 4 days

22. •Beforeandafterthesymptomsappear.
•Symptomsmayappeartwotosixweeksafter
contactinpeoplewhohavenotpreviously
beenexposedtoscabiesinfestations.
•Peoplewhohavehadapreviousboutwith
scabiesmitesmayshowsymptomswithinone
tofourdaysaftersubsequentre-exposures.
•
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PERIOD OF COMMUNICABILITY

23. •Itching and a skin rashis the most common
symptom.
•A pimple-like (papular) itchy (pruritic) “scabies
rash”.
•Itch usually worse at night.
•Telltale lesions is the burrow
•
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SIGNS & SYMPTOMS

24. •Symptomsmayappeartwotosixweeksafter
contactinpeoplewhohavenotpreviously
beenexposedtoscabiesinfestations.
•Peoplewhohavehadapreviousboutwith
scabiesmitesmayshowsymptomswithinone
tofourdaysaftersubsequentre-exposures.
•Itching and a skin rashis the most common
symptom.
•Itch usually worse at night.
•
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SIGNS & SYMPTOMS

25. •Telltalelesionsistheburrow(serpentinelines-S-
shapedcurvedlinethataregrayishorskin-colored)
foundin:
•Mostcommonlywebsbetweenthefingers
•Wristsandbackoftheelbowsandknees
•Areasaroundthewaistandumbilicus
•Areasaroundthenipples
•Sidesandbacksofthefeet
•Genitalareaandthebuttocks
•Face,scalp,palmandsoles–infants&children
SIGNS & SYMPTOMS
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26. •Forthefirstweeks,itchissubtleandgradually
becomesmoreintense.
•Burrows are tiny thread-like projections, thin
gray, brown, or red lines in affected areas.
•Scabies produce small red bumps and blisters
and affect specific areas of the body.
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SIGNS & SYMPTOMS

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29. •Distributionoftherashandthepresenceof
burrows
•Definitivediagnosisofscabiesismadeby
directvisualizationofthemite,eggs,orfeces.
DIAGNOSIS
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30. •Especiallyinchildren:
–Furunculosis
–Impetigo
–Paronychia
–Pyoderma
COMPLICATIONS
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31. •Precipitatedsulfur6%inpetrolatum:
•Thisistheoldestknowntreatmentofscabies.
•Itissafeandeffectiveandthetreatmentof
choiceininfants<2monthsandpregnantor
lactatingwomen.
TREATMENT
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32. •Lindane1%
•Previousstandardtreatmentforscabies,but
itisnotverysafeinchildrenbecauseof
transcutaneousabsorptionleadingto
neurotoxicity.
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TREATMENT

33. •Permethrin5%(Elimite,Nix)
•Permethrinisaneurotoxinthatcauses
paralysisanddeathinectoparasites.
•Itisthemostcommonchoiceoftreatment
usedtodayforscabies,particularlyforinfants,
youngchildren,andpregnantorbreastfeeding
women.
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TREATMENT

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35. •Washlinensandbedclothesinhotwater.
•Excludepeoplewithscabiesfromchildcare,
preschool,schoolandworkuntilonedayafter
treatmentcommences..
•Treatsexualcontactsorrelevantfamilymembers
•Improvepersonalhygiene
•Avoidsharingoftowelsandclothes
PREVENTIONANDCONTROL
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36. •Thoroughlyvacuumrugs,furniture,bedding,
andcarinteriorandthrowthevacuum-
cleanerbagawaywhenfinished
•Trytoavoidscratchingandkeepanyopen
soresclean
PREVENTIONANDCONTROL
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37. •Promotegoodsurveillanceofnewresidents
•Observeforrashesonarrivalatthehome,thenat3
weeksandat6weeks
•Maintainahighlevelofsuspicionifpatientspresent
withundiagnosedskinrashes
•Familiesaretreatedallatthesametime.
•Massdrugadministration(MDA)strategiesappear
promisinginachievingcommunitycontrol
OUTBREAKPREVENTION
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38. Crusted or Norwegian Scabies
•Crustedscabiesisararemanifestationof
scabiescharacterizedbyuncontrolled
proliferationofmitesintheskin.
•Crustedscabiesischaracterizedby
hyperkeratosisandcrustingoftheskindueto
theprofuseproliferationofmitesresulting
fromanalteredhostresponsetothe
infestation.
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39. Crusted or Norwegian Scabies
•ClinicalFeatures:
•Thecrustsarecreamy,grey,yellowbrownor
yellowgreenincolorandareadherentand
firmbut,whenremoved,theyhaveaporous
appearanceresemblingapumicestone.The
lesionsfoundovertheextensorsurfaceshow
fissuring.
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Crusted plaque over the shoulder

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43. Crusted or Norwegian Scabies
•Diagnosis:
•Microscopicexaminationoftheskinscrapings
fromthepatientisessentialtodemonstrate
themites.
•Demonstrationofmites,eggsandmitefeces
(scybala)isdiagnosticofscabies.
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44. Crusted or Norwegian Scabies
•Combinationtreatmentregimensusedinclude
useoftopicalagentssuchaspermethrin5%
creamwithoralivermectin.
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45. Crusted or Norwegian Scabies
•PreventionandControl:
•Itisimportanttostrictlyisolatepatientswith
crustedscabiesasthesepatientscaneasily
triggeranoutbreakofscabies.
•Thehouseholdcontactsorhospitalstaff
shouldbeinstructedtotakeadequate
precautionstoavoidgettinginfested.
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46. Crusted or Norwegian Scabies
•Thenailsofthepatientsshouldbeclippedand
scabicidalsshouldbeappliedasnailsarethe
frequentsourceofrelapse.
•Adequatecareshouldbegiventomoribundor
paralysedpatientstopreventrelapse.Their
clothesshouldbelaundered..
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What type of organism causes scabies?
Mite
Mouse
Fungus
Bacteria
Achildhasmultipleitchypopularlesionsonthegenitalia
andfingers.similarlesionsarealsoseeninyoungerbrother.
Whichofthefollowingisthemostpossiblediagnosis?
a.popularurticaria
b.scabies
c.atopicdermatitis
d.allergiccontactdermatitis

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Scabiesaninfectionoftheskincausedbysarcoptes
scabieisanexampleof?
a.waterbornedisease
b.waterwasheddisease
c.waterbaseddisease
d.waterrelateddisease
Ivermectin in indicated in the treatment of
a) Syphilis
b) Scabies
c) Tuberculosis
d) Dermatophytosis

49. 12/30/2019 PROF. DR. ATHAR KHAN LCMD 49
Which statement by a patient with scabies causes concern
and that they should be re-educated by the doctor?
"I'mgoingonvacationnextweekwithmybowlingteam."
"Iwillapplyanti-scabiesmedicationthicklytomyfaceand
scalp.
"Iwillwashmyclothingonlyincoldwaterwithbleach."
"Iwillavoidusingsoapandwaterwhileusinganti-scabies
treatment."
Apatientstatestheyarehavingintenseitchingbetween
theirfingerswithbrownlinearlinespresenting.Basedon
yourknowledgethisbestdescribeswhatcondition?
Scabies
Psorasis
Ecemza
Ringworm

50. •A6montholdinfanthaditchyerythematous
papulesandexudativelesionsonthescalp,
face,groinsandaxillaeforonemonth.She
alsohadvesicularlesionsonthepalms.The
mostlikelydiagnosisis:
•A.Congenitalshypilis
•B.Seborrheicdermatitis
•C.Scabies
•D.Psoriasis
12/30/2019 PROF. DR. ATHAR KHAN LCMD 50

51. •IvermectininindicatedinthetreatmentOR
Ivermectintheonlyorallyeffectivetreatment
of
•a)Syphilis
•b)Scabies
•c)Tuberculosis
•d)Dermatophytosis
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52. •Case1:
•Afamilyhadreturnedfromholidayand
collectedtheirgrandmotherfromrespitecare.
Aboutfourweekslater,thegrandmother
developedaveryitchy,widespread,
erythematous,vesicularrash.Onexamination,
theGPfoundasmall,greyish,serpiginous,
linearlesionwithaminuteblackspeckatthe
closedend,inaninterdigitalwebspace.
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53. •Case2:
•A26yearoldwomancomestoseeyouwitha
sevenweekhistoryofarashwhichisworseon
herhands.Itisextremelyitchy,particularlyat
night,andsheisworriedthatshecouldgive
“something”toher4yearoldson.
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Incubation period of scabies is
2 days
7 days
2 weeks
4 weeks
Adult scabies is characterized by all except
involve palm and soles
involve anterior abdomen
involve genitalia
involve genitalia

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Aninfantpresentedwithitchyeczematouscrustedlesions
withexudationonpalm,sole,glanspenisandface.true
statementincludes
family should be examined
distribution of lesion help in diagnosis making
all clothing and linen should be discarded or burnt
drug should be applied to affected areas for whole day
All of the following are used in treatment of scabies except
GBHC
Permethrin
Pyrimethos
Benzyl benzoate

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Scabiesinadultdifferfromthatinchildrenby
notinvolvingface
notinvolvinggenitals
notinvolvesareola
involvewholebody
Not a feature of scabies
burrows are seen in stratum corneum
itching is more severe at night
family history is found
fever is a common finding

57. 12/30/2019 PROF. DR. ATHAR KHAN LCMD 57
Characteristiclesionofscabiesis
burrow
fissure
vesicle
papule
The“circleofhebra”representsthemainsitesof
involvementin
Blisterbeettledermatitis
Pediculosiscorporis
Scabies
Toxoplasmosis

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levelofburrowinscabies
epidermis
dermis
stratumcorneum
stratumspinosum
Mostsevereformofscabiesis:
Norwegianscabies
Nebularscabies
Animalscabies
Genitalscabies

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Nodularscabiesisfoundin–
Webspaceoffinger
Axilla
Scrotum
Abdomen
Mostsevereformofscabiesis:
Norwegianscabies
Nebularscabies
Animalscabies
Genitalscabies