Understanding scabies.
Increased incidence of scabies in older people has highlighted difficulties of diagnosis and treatment. Ian Burgess describes the life cycle of the scabies mite, transmission of the infection, diagnosis and treatment.
Animals↗
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Epidemic Norwegian scabies.
Norwegian scabies is an ectoparasitic infestation by Sarcoptes scabiei, characterized by hyperkeratotic lesions of the hands, feet, ears, and scalp, which contain many mites. An epidemic of Norwegian scabies involved 22 patients in a 25-patient ward of mentally and physically handicapped persons (mostly mongoloids). The pathogenesis of the prolific mite population is unclear, but either a specific immunologic deficit or the inability to effectively eliminate the mites by scratching is a plausible possibility.
Adolescent↗
Cutaneous alternariosis in association with scabies or iatrogenic Cushing's syndrome.
Cutaneous alternariosis is rare. Most infections occur in immunocompromised hosts. We report the first three cases in Taiwan. The patients were elderly farmers residing in Tainan. They developed indolent, erythematous, ulcerated or crusted papules, plaques or pustules over the extensor aspect of the forearms or hands. Pure colonies of Alternaria sp were isolated from biopsy specimens in each case. The diagnosis was confirmed by detecting pleomorphic fungal elements in the dermis within suppurative, granulomatous infiltrates. All three patients were immunocompromised. They showed a negative reaction to an intradermal test of seven common antigens. Cases 2 and 3 had iatrogenic Cushing's syndrome. Cases 1 and 3 had extensive scabies, which in Case 1 was of the Norwegian type. To the best of our knowledge, scabies associated with alternariosis has not been reported previously. The infection showed spontaneous regression in Case 1; in Case 2, it resolved after seven weeks of intralesional amphotericin B at a dose of 1 mg/mL twice a week.
Aged↗
The use and efficacy of Azadirachta indica ADR ('Neem') and Curcuma longa ('Turmeric') in scabies. A pilot study.
In the Ayurvedha and Sidha system of medicine (Indian system of medicine) Azadirachta indica ADR ('Neem') and Curcuma longa ('Turmeric') has been used for healing chronic ulcers and scabies. The 'Neem' and 'Turmeric' was used as a paste for the treatment of scabies in 814 people. In 97% of cases cure was obtained within 3 to 15 days of treatment. We find that this is a very cheap, easily available, effective and acceptable mode of treatment for the villagers in the developing countries. We have noticed no toxic or adverse reaction so far. However, further research is needed.
Administration, Topical↗
Sepsis associated with Norwegian scabies in patients with acquired immunodeficiency syndrome.
A review of the literature reveals that of the eight reported cases of patients with acquired immunodeficiency syndrome acquiring Norwegian scabies, three of these have been complicated by sepsis. We describe such a patient who contracted sepsis from Pseudomonas aeruginosa. We propose that the fissures often seen in severe cases of Norwegian scabies may serve as a port of entry for bacteria, thus placing these patients at a high risk for sepsis. We also believe that empiric antibiotic treatment is justified in these patients and that the choice of agent should be based on the institution's bacterial flora profile.
Acquired Immunodeficiency Syndrome↗
[Efficacy, safety and acceptability of precipitated sulphur petrolatum for topical treatment of scabies at the city of Coro, Falcon State, Venezuela].
INTRODUCTION: In spite of sulphur ointment has been applied during centuries in the treatment of human scabies, nevertheless, its clinical efficacy, as well as safety and acceptability has not been clearly demonstrated. AIM: During September 2001-March 2002, attempts have been made to assess the efficacy, safety and acceptability of a mixture of precipitated sulphur 2-8% petrolatum for the treatment of 40 ambulatory consultant patients, of all age groups, including children under 1 year of age, pregnant and lacting women, with suggestive sarcoptic cutaneous lesions from Coro, Falcon State, Venezuela. METHODS: The diagnosis was made by clinical examination and microscope observation (KOH 10%) of scrapings of cutaneous lesions. The acceptability were quantified using visual analogue scale (VAS) and other two behavioral (BS) scores. Enrolled patients applied ointment 1 daily dose for 6 days, 1 week rest, repeated for 2 days, thoroughly washing off with neutral soap and applying lubricant cream. Differential schedule concentrations were: 2% for children below 2 years and up to 6 years old; 2-5% for scholars, adolescents and pregnant; 5-8% for adults and elderly; being exposition time to the ointment of 3 hours for children under 2 years old, and overnight for reminding age-groups. Efficacy was evaluated 7-30 days post-treatment by clinic observation, quantification and scraping of the sarcoptic lesions. A safety assessment was based on adverse effects reported by patients or observed by the physician. RESULTS: 38 (95%) out of 40 patients were clinical and ectoparasitologically cured 7-30 days after cessation of ointment application, with no relapses or relevant adverse effects, producing a significant (t = 9.26; p < 0.0001) decrease at the end of evaluation period in the median values of number of lesions (28.08-9.18 vs. 0.00). Only 2 (5%) patients developed a mild dermatitis reaction, and subsequently no completed the follow up. CONCLUSION: It's proven highly therapeutic effectiveness as well as widely availability, low costs with no serious side effects and satisfactory acceptability (X; VAS = 1.14 +/- 1.67; BS: 0.25 +/- 0.38, 0.53 +/- 0.43), allows us to recommend the topical use of the ointment sulfur-petrolatum for the treatment of human scabies, especially in children under 5 years of age, pregnant and lactating women and elderly, in which other drugs are not recommended by its potential toxicity.
Adolescent↗
[Place of ivermectin in the treatment of scabies].
Ivermectin is the first oral treatment available for scabies. It is however not licensed for use in Belgium. In this article, we review its mechanism of action, its preferential indications among which crusted scabies and institutional outbreaks, its contra-indications and its advantages in comparison with topical treatments.
Antiparasitic Agents↗
[Scabies triggering Darier's disease].
An increased incidence of scabies has been noted in many countries. Difficulties may arise when unrecognized infestations trigger or aggravate other dermatological disorders. We present an instructive case of Darier's disease, which did not respond to appropriate therapy regimens due to constant triggering by an undetected underlying scabies infestation. In this case, a 44-year-old Italian man presented with typical symptoms of Darier's disease. In addition, the patient reported massive pruritus, which is rather uncommon in this disorder. The disease proved recalcitrant to established treatment regimens resulting in excessive treatment costs. We confirmed the diagnosis of Darier's disease by histopathological analysis, and, in addition, detected arthropod fragments in the upper epidermis. Systemic ivermectin and topical allethrin followed by acitretin and PUVA-bath therapy resulted in rapid improvement of the debilitating pruritus as well as alleviation of the symptoms of Darier's disease.
Administration, Topical↗
[Scabies among the Zoo mammals].
Scabies was observed in 9 species of mammals at the Zoological Garden of Lódź in years 1957-1989. Sarcoptes scabiei spp. was found in capybaras, tapirs and camelids. Notoedres cati was recorded from the siberian tiger, but Notoedres sp. from the Erinaceus europaeus. Scabies was also found in a wild dead Tapla europaea at the Zoo area.
Animals↗
[Infantile acropustolosis: unusual manifestation of scabies in the infant?].
Three pediatric cases of vesiculopustules persisting for several months or years after eradication of Sarcoptes scabiei are reported. This particular course of scabies in infants is underrecognized although probably common. Its clinical manifestations, natural history and histologic features are identical to those seen in infantile acropustulosis, a recently individualized syndrome whose pathogenesis is unelucidated. In the light of these cases and a review of the literature, the possible relationship between scabies and infantile acropustulosis is discussed.
Acrodermatitis↗
Histocompatibility (HLA) antigens in Egyptians with two parasitic skin diseases (scabies and leishmaniasis).
The frequency of human leucocytic antigens (HLA) were studied in 62 patients with scabies and 27 patients with cutaneous leishmaniasis to evaluate the role of HLA antigens as genetic markers in the pathogenesis of these parasitic skin diseases. A significant statistical association was proved between HLA-A11 antigen and scabies and between HLA-A11, -B5 and -B7 antigens and diffuse cutaneous leishmaniasis.
Adolescent↗
Norwegian scabies in a patient with acquired immune deficiency syndrome.
A rare, severe form of scabies called Norwegian or keratotic scabies is described in a patient with acquired immune deficiency syndrome (AIDS). This is the first known description of this disease in an AIDS patient. The occurrence of secondary staphylococcal sepsis illustrates the importance of early correct diagnosis and treatment. Cutaneous hydration followed by aggressive application of gamma benzene hexachloride was safe and effective.
Acquired Immunodeficiency Syndrome↗
Treatment of scabies with permethrin versus lindane and benzyl benzoate.
This open clinical study was designed to evaluate and compare the efficacy and side effects of lindane (1% and 0.3%), benzyl benzoate (20% and 10%) and permethrin (5% and 2.5%) after two, three, and one application at bedtime, in the treatment of scabies in 114 adults and 80 children aged between 0 and 5 years. Treatment failures were registered after lindane in 3 adults and 2 children, whereas benzyl benzoate and permethrin cured all patients as assessed after a 3-week follow-up. The number of irritations and post-scabious eczematous reactions was increased after benzyl benzoate treatment. Permethrin proved to be very reliable and exhibited few side effects when applied once at bedtime. Because of the percutaneous absorption and neurotoxicity of lindane, the application of permethrin can be recommended as a useful alternative in premature infants and small children, patients with seizures and neurological complications, in cases of therapeutic failure with lindane the treatment needs to be repeated, in scabies crustosa, as well as in children, pregnant women and nursing mothers.
Adult↗
[The treatment of scabies with permethrin in comparison with lindane and benzyl benzoate].
This open clinical study was designed to evaluate and compare the efficacy and side-effects of lindane (1% and 0.3%), benzyl benzoate (20% and 10%) and permethrin (5% and 2.5%) after twice-, three times- and once application at bedtime, respectively, in the treatment of scabies in 104 adults and 70 children aged between 0 and 5 years. Treatment failures were registered afer lindane in 3 adults and 2 children, while benzyl benzoate and permethrin cured all patients as assessed after 3 weeks follow-up. The number of irritations and postscabious eccematous reactions was increased after benzyl benzoate. Permethrin revealed to be very reliable and exhibited only a few side-effects when applied once at bedtime. Because of the risk of the percutaneous absorption and neurotoxicity of lindane, the application of permethrin can be recommended as an useful alternative in premature infants and small children, patients with seizures and neurological complications, in cases of treatment failures of lindane with the need to repeat the therapy, in scabies crustosa as well as in children, pregnant woman and nursing mothers.
Administration, Topical↗
[The seasonality of scabies morbidity and the fertility of the itch mite Sarcoptes scabiei de Geer as an index of the activity of a population of the causative agent].
The authors analyze the features of the epidemic process in scabies and review foreign and Soviet literature on the seasonal pattern of this condition. They have introduced the mite fertility index, that is determined by the number of eggs in the mite burrow, counted with the use of a new laboratory diagnostic technique with lactic acid. The studies have revealed that this index is high in September-December (11.5 +/- 1.0 - 12.6 +/- 1.3) and much lower in January-July (8.9 +/- 1.1 - 6.0 +/- 0.6). Another finding was that some females were in a latent state from December to July, when oogenesis was arrested and therefore the agent population activity dropped. The results have demonstrated regular seasonal changes in S. scabiei reproductivity, coinciding with the disease phenology; besides social and communal factors, these regularities also contribute to the epidemiology of scabies.
Animals↗
[The epidemiology of scabies].
Soviet and foreign literature data on scabies morbidity structure in families and organized collective bodies are reviewed. The authors' own data include an analysis of 88 clinical and epidemiological charts, developed and filled in by the authors. The notion of the disease focus in scabies is introduced for the first time. The foci are divided into potential (with an only patient) and irradiating ones (with two and more patients). Organized collective bodies predominate among the potential foci (85.7%), whereas families prevail among the irradiating foci (80.7%). The incidence rate of the condition in a focus depends not on the focus size, but on the time and intensity of the contacts of the patients with healthy subjects.
Adult↗
[Scabies in Poland 1966-1986].
In 1966-86 there were 1,675,213 cases of scabies in Poland. The highest incidence (580.5) per 100,000 inhabitants was noted in 1968, the lowest (41.7) in 1986. The highest morbidity falls on autumn and winter. The highest proportion of cases are children and teenagers (0-19 years old), the second group consists of people aged 20-64, the third--over 65 years old. Most frequent were single cases of scabies, but there occurred also group infections in families, schools, boarding schools and establishments. In the discussed period the losses brought about by this disease, in case of people 20-64 years old only, amount to 1,836,234 days of the sick leave, while the average absence in 1980 was 82,500 days.
Adolescent↗
[Childhood scabies: a different entity].
Epidemiological, clinical, diagnostic and therapeutic aspects that make scabies a clinical entity with a special personality in the pediatric field, are reviewed. On the epidemiological aspects, a special mention of its unsuspected frequency in this age is made. Scabies is an endemic disease in our country among the more deprived people. On the clinical aspects, the great importance of clinical history and distribution of skin lesions for the early diagnosis is pointed out. Some "alert pointers" are described for this early diagnosis. On the therapeutic field, the importance of the primary care prevention is discussed, and the drug approach for its relieve is commented.
Child↗