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DEPARTMENT OF DERMATOVENEROLOGY MARCH 2013
MEDICAL FACULTY
HASANUDDIN UNIVERSITY
PRESENTING AS A TASK ON CLERKSHIP
DEPARTMENT OF DERMATOVENEROLOGY
MOSLEM UNIVERSITY OF INDONESIA
MAKASSAR2013
SCABIES
BY :
Andi Firman Mubarak 110 209 0088Rezky Putri Indarwati Abdullah 110 209 0116
Ade Irmasari 110 209 0120
ADVISOR :
dr. Ade Indrayani
SUPERVISOR :
Dr. dr. Anis Irawan Anwar, Sp.KK(K)
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DEFINITION
Scabies is a human skin infestation caused by the infestationand sensitation by sarcoptes scabiei var, hominis and itsproducts
Synonim : The itch, pruritic agogo , gudig, kudil
Transmition : direct and indirect contact
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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.
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EPIDEMIOLOGY
The worldwide prevalence has been estimatedat about 300 million, it is estimated beingepidemic in every 30 years
Indonesia
dr.Sutomo hospital 1983 1984 is 2,7%.
Dadi hospital 1987 1988 is 0,67%
Many factors caused the scabies
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RISK FACTOR
Poor sanitationDensely
populated and
social disruption
Low economic
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Transmitted
DirectSkin to skin / sexual
Sensitation andinfestation on
skin
IndirectBed cover, clothes, etc
Sensitation andinfestation on
skin
PATHOGENESIS
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- Secreta
-excreta
Clinical finding
Itch
- Papul, vesicle,
Urticaria- erotion, excoriation,
crust + secondary
infection)
4 6 weeks
8 12 days
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CLINICAL FINDING
Cardinal Sign
Nocturnal pruritic
Attack to group ofpeople
Find burrow/tunnel
Find mite
Additional test
Skin scrapping
Burrow ink test Take with neddle
Epidermal shave biopsy
Biopsy with
Hematoxylin eosin Tetracyclin test
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Another form of atypical
1. Cultivated scabies
2. Nodular scabies
3. Incognito scbies4. Animal scabies
5. Norwegian/crust scabies
6. Infants and children scabies
7. Bed ridden scabies
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DIFFERENTIAL DIAGNOSIS
Insect bites
Papules urticariaerithematous
folliculitis
Macula erithemapapule pustuleemerge with hair
Nodular prurigo
Pruritic nodule
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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/dont repeat treatment
Everyone in the house should be treated
Report to doctor after one week
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Drugs and topical agents
DRUG 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, Secondapplication
recommended after 1
wk.
Not recommended for Children
under 2, during pregnancy, orlactation;
resistance has been increasing;
banned in california
Crotamiton10% cream
Applied on 2consecutive days;
repeated once within
5 days.
Antipruritic Qualities; may not be aseffective as other topicals
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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 to
apply and limited efficacy
data
Benzylbenzoate 10%
lotion
Applied for 24 hthen 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 with
topical agents, particularly in
crusted or resistant cases
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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%
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PREVENTION
Individual in close contact with theinfected person Should be treated
Re-infection with fomites, bed sheetetc should be washed and dried inthe hot cycle
The mite can be llive up to 3 days of theskin Vacuum cleaner
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COMPLICATION
Secondaryimpetiginizati
on
Lymphangitis
septicemia
Post
streptococcalglumerulone
phritis
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PROGNOSIS
If left untreated persist for manyyears
Immunocompetent individual thenumber of mite decrease over time
Correctly treated good prognosis
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THANK YOU
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