JNUH

Scabies

  • A very common but highly contagious ectoparasitic infestation of skin by human itch mite (Sarcoptes scabiei var hominis)
  • Predominantly though a disease of children it affects people of all races and social classes worldwide.
scabies
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  • Intense itching, predominantly at night.
  • In day time it is tolerable but persistent.
  • In a person who has never had scabies before, symptoms take 6 weeks to appear because sensitivity begins about that period.
  • In a person who was infected earlier before, symptoms appear sooner (1-4 days).
  • SIGNS: Pruritic, papular or papulo-vesicular lesions, excoriations and burrows.
  • “Burrow” is the pathognomonic lesion of scabies, a serpentine, thread like, greyish or dark line ranging from few mm to cm or more.
  • Predominantly involves finger webs, wrist, axillae, areola, umbilicus, lower abdomen, genitalia and buttocks
  • forming an imaginary circle –
  • “circle of Hebra”.
  • In adults usually spares face and scalp.
  • In infants it involves entire skin.
  • Ulcerations and impetiginization due to scratching.
  • Secondary infection of ulcers with bacteria, like Stapylococcus aureus or beta hemolytic streptococci.
  • Sometimes post - streptococcal gromerulonephitis
  • Close person to person contact (even for 15-20 minutes).
  • Occasionally via fomites (e.g bedding or clothing).
  • In adults scabies is frequently sexually acquired.
  • Cannot be transferred by pets and animals.
  • Simultaneous treatment of all contacts, even if they are asymptomatic.
  • Avoiding direct skin to skin contact with infected person.
  • Bedding, clothing wash used at anytime during the 3 days before treatment should be washed and air dried.
  • Rooms used should be thoroughly cleaned and vaccum cleaned after use.
  • Environmental disinfection not necessary.
  • High humidity, low temperature.
  • Infested member in family or sexual partner.
  • In crowded conditions like jail inmates, hostels, army barracks where close body and skin contact is common.

How is it diagnosed?

  • Mainly diagnosed clinically
  • Demonstration of egg/ scybala / mite under microcope
  • Serological Tests: Less than 50% accuracy
  • Quantification of specific IgE antibodies to a major scabies antigen recombinant rSar s14.3 is highly sensitive
  • PCR, Immunosorbent Assays
  • Dermatoscopy
Scabies

How is it treated?

  • Treat patient along with everyone who lives with him.
  • Recent sexual partner (if any).
  • Topicals to be applied whole body below neck in adults. In infants and children face and scalpe should be included.
  • All clothes worn along with bed sheet, pillow cover and bed linen should be washed and sundried in the morning.
  • Treatment not to exceed prescribed time limit.

Permethrin (5%)

Drug of choice at present

  • Most widely used, safe (even in children as young as 1 month old) and pregnant women.
  • Overnight application necessary.
  • Repeat the application after 7 days.
  • Cure rate of 89%-100%.
  • Insignificant irritant potential and adverse effects (2%).

LINDANE (GBHC 1%)

Benzoyl Benzoate 25%

Crotamiton 10% (Lotion / cream)

Ivermectin Solution

Precipitated Sulfur 5-10%

  • For secondary pyoderma.
  • Non irritant, non toxic antibacterial agents like Cetrimide / Chlorohexidine may help for topical use.

Ivermectin

  • Derivative of macrocyclic lactones.
  • Induces parasite paralysis by blocking neurotransmission.
  • Safety not established in children below 15 years and pregnant women.
  • Dose is 200 µg/kg/dose.
  • Two doses 2 weeks apart.
  • Neurotoxic.

Consult with experienced Doctors

JNU is home to some of the most eminent doctors in the world, most of whom are pioneers in their respective arenas and are renowned for developing innovative and revolutionary procedures
Gajanand Ojha

Dr. Gajanand Ojha

Professor

Qualification

MBBS, MD

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Priyanka Sharma

Dr. Priyanka Sharma

Associate Professor

Qualification

MBBS, MD

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Neha Agarwal

Dr. Neha Agarwal

Assistant Professor

Qualification

MBBS, MD

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Vikarn Garg

Dr. Vikarn Garg

Assistant Professor

Qualification

MBBS, MD

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Amit Kumar Malhotra

Dr. Amit Kumar Malhotra

Assistant Professor

Qualification

MBBS, MD

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