1. Scabies
Sitti Rahmah Umniyati

2. 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

3. Learning objective
Explain the signs and symptoms. etiology, life cycle, pathogenesis, diagnosis, prognosis, treatment, epidemiology and control of scabies.

4. Scabies burrows between the fingers
Scabies rash on the hands. Burrows are visible.

5. 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

6. A nursing home patient who was infested with scabies
shows the typical pruritic red papules in the axilla.
shows scabies infestation on the flexural wrist

7. Scabies with inflamed lesions in periumbilical distribution
Scabies with flexural wrist involvement

8. Sarcoptes scabiei (itch mites)
Phylum: Arthropoda
Class: Arachnida
Order: Acarina
Family: Sarcoptidae
Genus: Sarcoptes
Species: Sarcoptes scabiei

9. Life Cycle Form a lateral branch 3 days First nymph male Burrows
Into the skin
2to3 mm at night
2nd nymph
Female

10. The life cycle is completed in 8-15 days
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.

11. 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.

12. 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.

13. 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.

14. 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.

15. Differential diagnosis
Impetigo
Scabies

16. Differential diagnosis
Scarlet Fever
Scabies

17. 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

18. 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

19. 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.

20. 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.

21. 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.

22. 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

23. 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

24. 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

25. Control
Prevention of scabies requires the treatment of infected individuals, the sterilizations of garments and bedding, and personal cleanliness

26. Reference
Markell, E.K., Voge, M., John, D.T 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 Parasitic Diseases, 3rd ed. Springer Verlag, New York, Belgia, Heidelberg, London, Paris, Tokyo, Hongkong, Barcelona, Budapest

27. Alhamdulillaahi rabbil `aalamiin