SCABIESTeaching Bangsal

CASE

• Name : Kartini Mene• Sex : Woman• Age: 42 years• Job : Housewife• Address : Kamp. Majen Kel.Bontonompo Gowa• Status : Married• Religion : Islam• Diagnosis : Scabies DD/ Folliculitis, Nodular

prurigo, Insect bites.

ANAMNESIS

• Autoanamnesis• Chief Complaints : the patient complaint an

itchy over her body.• Itch felt since 1 months ago and it is almost

be felt almost in all parts of body. The itchy accompanied with red fleck which in this time become black because scratched. Itch is especially felt at the night.

• Additional Complaints : -• Previous Disease History : none

Physical Examination

• Blood Pressure : 120/80• Heart rate : 88x/m• Respiratory Rate : 18x/m• Temperature : 36.5 ºC

Skin Clinical Feature

• Location : Regio Generalisata• Distribution : General• Effloresce : papule eritema,

hyperpigmented, erotion.

DEFINITIONScabies is a human skin disease caused by the infestation and sensitation by sarcoptes scabiei

var, hominis and its products

Synonim : The itch, pruritic agogo , gudig, kudil

Transmition : direct and indirect contact

ETIOLOGY

Sarcoptes scabiei var, hominis

- Obligat parasite, phylum arthropods, class arachnida, ordo accarima, family sarcoptes.- ♂ : 0,2 mm long by 0,15 mm broad ♀ : 0,4 mm long by 0,3 mm broad.

- cannot fly or jump but crawl at the rate 2,5 cm/minute.

EPIDEMIOLOGY

The worldwide prevalence has been estimated at about 300 million, it is estimated being epidemic in every 30 years

Indonesiadr.Sutomo hospital 1983 – 1984 is 2,7%.Dadi hospital 1987 – 1988 is 0,67%

Many factors caused the scabies

RISK FACTOR

Poor sanitation

Densely populated and

social disruption

Low economic

Transmitted

DirectSkin to skin /

sexualSensitation

and infestation on

skin

IndirectBed cover, clothes, etcSensitation

and infestation on

skin

PATHOGENESIS

- Secreta- Excreta

Clinical finding

“Itch”- Papul, vesicle,

Urticaria- erotion,

excoriation, crust + secondary infection)

4 – 6 weeks

8 – 12 days

EFFLORESENCE OF SCABIES

Papules, erithematous

CLINICAL FINDING

Cardinal Sign

• Nocturnal pruritic

• Attack to group of people

• Find burrow/tunnel

• Find mite

Additional test

•Skin scrapping•Burrow ink test•Take with neddle•Epidermal shave biopsy•Biopsy with Hematoxylin eosin•Tetracyclin test

ANOTHER FORM OF ATYPICAL

1. Cultivated scabies2. Nodular scabies3. Incognito scabies4. Animal scabies5. Norwegian/crust scabies6. Infants and children scabies7. Bed ridden scabies

DIAGNOSIS

2 from 4 cardinal sign

Additional test

DIFFERENTIAL DIAGNOSIS

Insect bites

• Papules urticaria erithematous

folliculitis

•Macula erithema papule pustule emerge with hair

Nodular prurigo

• Pruritic nodule

TREATMENT

Education

• Warm bath and dry• Medication to all part•Treatment is best done at night before going to bed•Avoid touching mouth/eyes•Change underclothing and launder them•May itch for few days/don’t repeat treatment•Everyone in the house should be treated•Report to doctor after one week

DRUGS AND TOPICAL AGENTSDRUG DOSE COMMENT

Permethrin 5% cream

Applied for 8-14 h; often repeated in 7 days.

First-line treatment in the United States; pregnancy category B

Lindane 1%lotion

Applied for 8 h then washed off, Second applicationrecommended after 1 wk.

Not recommended for Children under 2 months, during pregnancy, or lactation;resistance has been increasing; banned in california

Crotamiton 10% cream

Applied on 2 consecutive days; repeated once within5 days.

Antipruritic Qualities; may not be as effective as other topicals

DRUG DOSE COMMENT

Precipitated sulfur 5%-10%

Applied for 3 days and then washed off.

safe in children under 2mo and during pregnancy, but messy toapply and limited efficacy data

Benzyl benzoate 10% lotion

Applied for 24 h then washed off.

Not available in United States

lvermectin, 200 ug/kg

Single oral dose, can be repeated in 10-14 days,

Highly effective with a good safety profile; can be used along withtopical agents, particularly in crusted or resistant cases

SPECIAL TREATMENT

Form TreatmentNorwegian/Crust scabies

-permethrin/+ lindane and sulphur- keratolytic

Nodular scabies -Anti scabitic- Steroid

Complication -Anti biotic (eritromycin)Symtomatic -Anti histamine

- Hydrocortison 1%- Emolient- Triamsinolon 0,1%

PREVENTION

Individual in close contact with the infected person Should be treated

Re-infection with fomites, bed sheet etc should be washed and dried in the hot cycle

The mite can be live up to 3 days of the skin Vacuum cleaner

COMPLICATION

Secondary

impetiginization

Lymphangitis

septicemia

Post streptococc

al glumerulonephr

itis

PROGNOSIS

If left untreated persist for many years

Immunocompetent individual the number of mite decrease over time

Correctly treated good prognosis

THANK YOU

LITERATURE

1. Handoko,PR. Skabies. In: Prof.Dr.dr.Adi Djuanda, editor. Ilmu penyakit kulit dan kelamin. Ed 6. Jakarta. FK UI; 2010.p.122-123

2. Stone SP, Goldfarb JN, Bacelieri RE. Scabies, other mites, and pediculosis In: Wolff K, Lowell A, Katz GSI, Paller GAS, Leffell DJ, editors. Fitzpatrick’s dermatology in general medicine. 7th ed. United state of America. McGraw-Hill; 2008. p. 2029-2032.

3. Burns DA. Diseases caused by arthropods and other noxious animals. In: Rook’s textbook of dermatology. 8th ed. United kingdom. Willey-blackwell; 2010. p. 38.36 – 38.38.

4. Amiruddin MD. Skabies. In. Amiruddin MD, editor. Ilmu Penyakit Kulit. Ed 1. Makassar: Bagian ilmu penyakit kulit dan kelamin fakultas kedokteran universitas hasanuddin; 2003. p. 5-10.