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Disease Index » Scabies

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by Ashish Sharma

Scabies, a common cause of itching, is produced by infection with the mite Sarcoptes scabies varhominis.The patient presents with nocturnal itching, most marked when the person is warm in bed. It is associated with burrows, papules, papulo-vesicles, vesicles or pustules.Infested person can transmit scabies to other prior to the development of symptoms.

Scabies, a common cause of itching, is produced by infection with the mite Sarcoptes scabies varhominis. Poor hygienic conditions and overcrowding, permitting close body contact, favor the transmission of the disease.

Acarus scabiei has four pairs of legs. The male is appreciably smaller. Acarus scabiei undergoes its life cycle on the skin surface. The male mite fertilizes the female and dies.

The adult female, after impregnation, burrows into the skin and forms and a tunnel in the horny layer (stratum corneum). It burrows at the rate of 1 to 5 mm per day. Two days after fertilization, it starts laying eggs along her course in the burrow. Two to the three eggs are laid each day.

A female Acarus lays a total of 10 to 25 eggs during her life span of 30 days and then dies at the end of the burrow. The egg hatches in 3 to 4 days producing a larva that moves to the skin surface. It then moults through various stages of octopod nymph into an adult mite in 10 to 14 days.

Clinical features of scabies

In the first attack of scabies, the symptoms do not occur for three to four weeks, till the patient is sensitized to the products of the mite. In subsequent attacks the symptoms may develop within few hours of infestation.

The patient presents with nocturnal itching, most marked when the person is warm in bed. It is associated with burrows, papules, papulo-vesicles, vesicles or pustules. Burrows, though considered pathognomic of scabies, are not frequently encountered in Indian patients. This is because they present late for treatment and by this time the burrows have been excoriated and the secondary bacterial infection has often supervened, resulting in impetiginization.

The distribution of lesions is characteristic and the sites of predilection are the inter-digital spaces of the fingers, palms, wrists, elbows, anterior axillary folds, lower abdomen, buttocks, nipple area in females, and external genitalia in the males. In infants and small children the scalp, face, palms, and the soles may also be involved. Very often, more than one member of the family may affected.

Diagnosis of scabies

It may take up to 6 weeks following exposure before symptoms of scabies infestation develop. In those who have been previously infected, symptoms can develop much sooner, sometimes within several days. Infested person can transmit scabies to other prior to the development of symptoms. In those who are infected, pruritus eventually develops secondary to a hypersensitivity reaction to the mites and their secretion, eggs, and feces.

Lesions are most commonly found on the inter-digital web spaces, wrists, elbows, axillae, female breasts, and male genital areas. In typical scabies, patients usually develop red, raised papules.

Scabies is commonly misdiagnosed as other common skin conditions, such as eczema, drug reaction, impetigo, Folliculitis, atopic dermatitis, insect bites, and contact dermatitis. During scratching, skin lesions can become colonized and then infected with bacteria, such as staphylococcus or streptococci.

Burrows are often difficult to visualize because of excoriation. Skin scrapings should be done in all suspected cases, although the sensitivity of this test depends greatly on the experience of the examiner. Mineral oil should be placed upon a popular lesion or a burrow. The involved skin is the scalpel blade and placed and placed on a glass slide. Under low power on the microscope, the examiner should search for mites, eggs, and fecal matter.

Treatment of Typical Scabies

Because of resistance and neurotoxicity, lindane is no longer routinely recommended for the treatment of scabies. The currently recommended treatment for scabies is 5 % permethrin cream. When applied as directed this product is approximately 90% effective after one application for the treatment of typical scabies.

For atypical scabies, two applications are often recommended to increase the likelihood of eradication of all parasites. Permethrin is well tolerated but may cause burning stinging, or itching following application. Because of a lack of safety data, permethrin should not be used on those who are pregnant unless the diagnosis has been confirmed. The following plan should be followed when treating scabies:

Isolation of Patients with Typical Scabies

For a typical case of scabies, the infected inmate should be placed on contact isolation precautions in his or her assigned cell for the duration of the first treatment period (8 to 12 hours).

Isolation precautions can be discontinued after permethrin has been washed off. Patients who are being treated prophylactically need not be isolated.

Treatment of Crusted or Keratotic Scabies

Those with crusted scabies should be placed in contact isolation precautions in a private room until at least three negative skin scrapings have been documented and symptoms have resolved. This may take weeks, depending upon the severity of the infestation. If permethrin is used, multiple treatments may be required for successful treatment of crusted or keratotic scabies. Crusts may need to be debrided to hasten eradication of infestation.

Homeopathic treatment of Scabies – Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat scabies but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to cure scabies that can be selected on the basis of cause, sensations and modalities of the complaints. For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following remedies which are helpful in the treatment of scabies:

Sulphur, Causticum, Sepia, Psorinum, Dulcamara, Calcaria Carb, Selenium, Hepar Sulph, Carbo Veg, Graphites, Pulsatilla, Lycopodium, Arsenic Album and many other medicines.

Medication should not contact the mucous membrane of the eyes, nose, or mouth.

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