Definition: It is an infectious disease contagious in nature and caused by sarcoptes scabiei (it has got another name acarus) and characterized by follicular popular or vesicular eruption with intense itching specially at night.The presence of the eggs often produces a massive allergic response which, in turn, produces more itching. Scabies is transmitted readily, often throughout an entire household, by prolonged skin-to-skin contact with an infected person (e.g. bed partners).
Etiology:
Some predisposing factors are responsible for scabies :
i) Age : Children and older people are more sufferer
ii) Season : Winter predispose the disease
iii) Overcrowding : It is an institutional disease
iv) Habit: Unhygienic persons are more affected
Often the disease of poverty and poor housing, scabies and skin sores is rife in many remote indigenous communities. Recent research conducted in East Arnhem found a previously unrecognised level of scabies and skin sores in the first year of life, with six out of every ten babies having contracted scabies at least once by their first birthday. A similarly high rate (seven out of ten) had contracted skin sores.
Large numbers of displaced people are at increased risk of infectious diseases, such as chicken pox, gastroenteritis, scabies and influenza, which can spread quickly in disaster shelters.Crowded and poor sanitary conditions, including limited access to clean water and insufficient numbers of toilets, help spread disease from person to person.
Scabies and skin sores in childhood have been linked with high rates of kidney disease in later life. There is also strong evidence to suggest that skin infections are closely linked to the world-record rates of rheumatic heart disease found in some remote indigenous communities.
Insect-bite skin rashes mimic the symptoms of a variety of conditions, ranging from fungal infections, scabies, allergies and environmental contacts, to HIV-associated dermatoses. Reactions to a bite are often delayed, making it difficult to trace exposure.
Sites of affection: The acarus penetrates the soft skin very easily.
Common sites in adults :
i) Interdigital space ii) Front of the wrist iii) Ulnar border of the hand iv) Ant. border of the axilla
v) Umbilicus vi) Genitaliavii) Buttock vii) In case of female nipple of breast ix) In case of children, skin of the palm and sole.
At first the infection is localized and later on it may occur throughout the body.
CLINICAL FEATURES:
Symptoms:
i) Follicular or vesicular eruption to the above mentioned sites.
ii) Nocturnal itching, because worm environment of the bed stimulate the movement of the Scrcoptes scabiei.
iii) There may be a history of itching of other family members.
Signs :
i) As like symptoms mentioned above.
ii) Burrows : It is a thin fine linear track formed by female acarus while going from surface to granular layer of skin. It forms a black line and is filled up with eggs and faces of the acarus and present on the above mentioned sites.
iii) Nail scratching.
Investigations:
1) Blood for sugar.
2) Urine for sugar.
3) Stool for ova of worms.
4) Examination of the skin scraping from the burrow may reveal the eggs of female acarus.
Complications:
i) Impetigo due to secondary infection ii) Boil iii) Urticaria iv) Exfoliative dermatitis. v) Acute glomerubnephritis.
Management:
i) Take a scrape with warm water and soap that the skin is thoroughly rubbed to remove the crusts and to open the burows.
ii) Apply any one of the following drugs throughout the body except lace and scalp for 3 consecutive days without any bath:
a) 10% Unguentum sulphuris in case of adult and 5% in case of children.
b) 25% Benzyl benzoate in case of adult and 12.5% in case of children.
c) 5% Emulsion of tetraethyl thiauracii monosulphide.
d) 0.5% Gamaxane.
e) Gamma benzene-hexachloride 1% in liquid paraffin. After clean both only one application is sufficient.
iii) Take soap water bath on the 4th day.
iv) Tab. Chlorpheniramine maleate, 5-10 mg t.d.s.
v) If secondary infection give antibiotic before scabicidal drugs, e.g. Ampicillin, Inj. C. penicillin,
vi) All other family members having the disease should be treated properly and simultaneously.
vii) All clothes should be boiled.
New Zealander; Paul Balvert reports his first peaceful sleep in two years after doctors found an infestation of mites in his ears. Balvert went to a specialist who was amazed to discover very active, tiny, semi-transparent mites moving around in a moist layer and white eggs present all over the canal ands eardrum.After using suction to remove all visible mites and eggs and soaking Balvert's ears in a liquid used for scabies and head lice, he finally was cured.
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