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Scabies and pediculosis, two commonly encountered infestations both having an incidence that is on the rise, are discussed in detail in this article with special emphasis given to their symptomatology, pathogenesis, and treatment.
Cases of scabies crop up from time to time in Nursing Homes and similar closed communities. It is of prime importance that such instances should be dealt with appropriately and control measures undertaken to effect a speedy therapy and prevention of further spread.
BACKGROUND: The conventional antiscabietics have poor compliance. Ivermectin, an oral antiparasitic drug, has been shown to be an effective scabicide and could be a useful substitute. OBJECTIVE: This study compares the efficacy of oral ivermectin with topical permethrin cream in the treatment of scabies. METHODS: Eighty-five consecutive patients were randomized into 2 groups. Forty patients and their family contacts received 200 microg/kg body weight of ivermectin, and another 45 patients and their family contacts received a single overnight topical application of 5% permethrin cream. Patients were followed up at intervals of 1, 2, 4, and 8 weeks. RESULTS: A single dose of ivermectin provided a cure rate of 70%, which increased to 95% with 2 doses at a 2-week interval. A single application of permethrin was effective in 97.8% of patients. One (2.2%) patient responded to 2 applications at a 2-week interval. Permethrin-treated patients recovered earlier. CONCLUSION: A single application of permethrin is superior to a single dose of ivermectin. Two doses of ivermectin is as effective as a single application of permethrin. The temporal dissociation in clinical response suggests that ivermectin may not be effective against all the stages in the life cycle of the parasite.
A superficial shave biopsy is described as a simple, essentially painless, more reliable method for the demonstration of the scabies mite, eggs, and feces in human skin.
Direct immunofluorescence of scabies lesions revealed IgM, IgA, C3, and fibrin in the cornified layer of the epidermis, dermoepidermal junction, and papillary dermal vessels. The granular deposits of IgM and IgG in the dermoepidermal junction had a pattern similar to that found in lupus erythematosus. These findings support a humoral immune response secondary to scabetic infestation.
Adult female Sarcoptes scabiei var. canis mites were applied to human skin for 96 hours in an experimental chamber. Clinical lesions produced during this period were studied histologically. The organisms burrowed, defecated, and laid up to nine eggs that developed normally. Two eggs hatched after removal from the host. A life cycle was not completed during this short experiment, but these results suggest canine scabies are capable of such activities on human skin.
Five cases of an atypical form of crusted (or Norwegian) scabies are described. Three cases occurred in patients who suffered from a malignant tumor, and two additional cases occurred in mentally retarded and physically debilitated patients. These cases should draw attention to the possibility of a scabietic infestation whenever a widespread, scaly, itchy dermatosis develops in a debilitated immunosuppressed patient.
We describe a patient with scabies who had an associated bullous pemphigoid-like eruption. Previous reports of this association have appeared in the literature. However, most case reports have described negative or nonspecific findings with direct immunofluorescence in contrast to the intense linear homogenous band of IgG and C3 found in our patient.
A case of unusual crusted (Norwegian) scabies involving the entire skin of a 26 year old Brazilian patient with lepromatous leprosy is reported. The more prominent histopathological findings were acanthosis, hyperkeratosis and crusting with many mites of Sarcoptes scabiei. In the dermis, numerous foamy histiocytes filled with abundant acid-fast bacilli were seen.
Although scabies and pediculosis are difficult and widespread problems, there are many effective treatments available. Dermatologists play a major role in educating the public in prevention and diagnosis. Although patients are more aware and well informed of the infections because of the Internet and other sources, practitioners are often the most important source of information and treatment in helping to eradicate this worldwide problem.
Scabies mites are only distantly related to human lice. Nevertheless, the two groups have much in common as regards to structure and life-style. These similarities result from the two groups using parallel adaptations in order to solve some of the problems of being parasites. Understanding these adaptations may help us give better advice.
Scabies-a small word that can, and often does, impart great anxiety and apprehension among health care workers (HCWs). Yet the epidemiology associated with this human parasitic infestation is well understood, as are the mechanisms for both its treatment and control.
A 75-year-old man presented with a progressive eruption of 6 weeks' duration. Purpura and focal areas of cutaneous infarction were present on the legs. There were scabies burrows on the wrists and hands, and a mite was extracted. Histology of a skin biopsy showed a necrotizing leucocytoclastic vasculitis. Circulating lupus anticoagulant was detected. Treatment consisted of topical 5% permethrin cream and systemic steroids.
Oral treatment with ivermectin of crusted (Norwegian) scabies in two immunosuppressed patients is reported. There was resolution of symptoms and signs of the cutaneous parasitosis on administration of 18-36 mg ivermectin (total doses) in 2- and 3-week periods of treatment, with remission periods of 3 and 4 months, respectively.
A study of 100 children suspected of having scabies was carried out using high-magnification (HM) videodermatoscopy as the only diagnostic tool. HM videodermatoscopy reaches magnifications of up to 600x and allows a detailed inspection of the skin. Rapid and clear identification of mites, migration burrows, eggs, and feces was obtained in 62 of 100 patients. None of the 38 patients with negative findings showed any sign of infestation 2 weeks later. HM videodermatoscopy is rapid, effective, and sensitive, especially in those cases with nonspecific clinical features, and allows clear detection of diagnostic details usually not appreciable at lower magnifications. It has high specificity, with no chance of false-positive results, and being noninvasive, it eliminates the risk of accidental infections. Finally, the most important advantage in children is its high compliance rate, as it does not cause pain or physical or psychological discomfort. It may be used for primary diagnosis as well as for posttherapeutic follow-up and for screening of family members, thus reducing the risk of persistence and diffusion of the infestation.
Scabies outbreaks occurred in two large orphanages in Chiang Mai, Thailand. Since we were concerned about the availability, safety, and cost of scabicides in Thailand, sulfur in petrolatum was our choice for mass treatment of the children. We studied the efficacy of sulfur in children 2 months to 6 years of age. After the treatment, 47% and 71% of the 102 patients were cured in 2 weeks and 4 weeks, respectively. Only three preschool children developed a mild facial irritation after the first application. This agent is a safe and cheap choice for mass therapy.
A 15 year old boy with scabies has been treated with local form of therapy for 3 month without effect. He was then admitted to our pediatric clinic with pyrexia and restricted movement of the right knee. The med. history, the consequent laboratory findings, positive bloodcultures, skin swabs and bone scintigraphy lead to diagnosis of acute haem. osteomyelitis. The early antibiotic therapy assured uneventful recovery.
Some patients with scabies develop bullae concomitantly with, or subsequently after, the occurrence of scabetic lesions. Although several immunofluorescence studies have demonstrated immunoglobulin deposition in the basement membrane zone of bullous lesions, it remained unclear whether these antibodies are directed to bullous pemphigoid antigens. We clearly show that two scabetic patients with bullous eruptions had circulating antibodies against BP180 and/or BP230 as determined by Western blotting analysis. This is the first report to demonstrate that at least some of the bullous eruptions occurring in scabetics are true bullous pemphigoid.