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Scabies is a pruritic skin infestation caused by the itch mite Sarcoptes scabiei. Physical proximity allows the mite to move from one host to another. The diagnosis is made by identifying the mite or its eggs or excrement microscopically from a sample of skin scrapings. Treatment is achieved with topical application of a scabicide and elimination of the mite from the patient's surroundings.
Mineral oil scrapings from an infant with a persistent, puzzling, generalized eruption revealed the mite, Sarcoptes scabiei. Various diagnostic technics and treatment for scabies are discussed.
Sixty patients with scabies were typed for thirty-three antigens of the HLA-A, -B and -C series. A significantly increased frequency was found for HLA-AII (28.3%), compared to healthy controls (10.4%). This deviation was only found in those of the patients without signs of atopic disease.
Crusted scabies (CrS) is an uncommon occurrence among patients with AIDS. Indeed to date only five cases have been described, all with widespread lesions. A case of localized CrS appearing as a yellowish and crusted plaque on the second right toe is reported in a woman with AIDS. Scraping off the verrucous surface, as well as punch-biopsy revealed many mites within the horny layer. The infestation is related to the cutaneous immune response and thus CrS should be considered an opportunistic infestation in AIDS. The importance of the early diagnosis of CrS in order to prevent disseminated lesions and involvement of other health-care workers is underlined.
Five topical treatments for scabies compared for efficacy in 85 infants with scabetic infestation. Preliminary results during the six-month study period showed lindane to be the most effective, with furacin the least effective.
Forty-eight human contacts with cats infested with Notoedres cati were investigated; 30 (62.5%) of the contacts showed symptoms of notoedric scabies, and N. cati mites were recovered from 15 (50%) skin specimens. Intense pruritus without any mite burrows developed within a few hours of initial contact with the infested cats. People within the age group of 26-35 years were frequently infested. Hands and legs were the most common sites of lesions. Prolonged association with the infested cats was responsible for this cutaneous disease. The lesions in infested people subsided when the cats were segregated from humans.
Reactive perforating collagenosis (RPC) in adults commonly manifests in patients with diabetes mellitus. Pruritus and consequent induced scratching have been identified as the bases for the evolution of this skin disease. We present the unusual case of a 55-year-old female diabetic with characteristic umbilicated skin lesions and a long history of scabies. Histology from a crusty nodule revealed transepidermal elimination of collagen. Following antiscabietic treatment, two courses of oral doxycycline demonstrated beneficial effects in controlling the perforating skin disorder.
Two children with acute lymphoblastic leukemia undergoing chemotherapy had a special form of scabies characterized by fine scaling of the scalp simulating seborrheic dermatitis. Pruritus was mild or absent. Immunocompromised children and adults should receive whole-body and scalp antiscabietic treatment.
Direct and indirect immunofluorescence investigations performed for 11 patients with scabies. All patients had punch biopsies taken from (1) a lesion containing Sarcoptes scabiei, (2) an inflammatory papule which did not contain a mite, and (3) normal skin. In four patients IgE deposits were found in the vessel walls of the upper dermis both in biopsies containing mits and biopsies of inflammatory papules with no mites. No IgE deposits were found in biopsies of normal skin from the same patients. Two patients had IgM and/or C3 deposits along the basal membrane in biopsies containing mites and one of them also had C3 in this area in the biopsy from a papule with no mite, as well as normal skin.
A localised epidemic of scabies lasting nearly a year occurred among crews on river pleasure craft. There was a sharp contrast between the paucity of scabietic lesions, especially burrows, and an unusually high infectivity. Scarcely a crew member was free from itching, yet individually diagnosis proved extremely difficult.
Each month in the UK, typically, around 100 cases of scabies are reported per 100,000 people in general practice. Here we discuss how to recognise and treat this often debilitating parasitic skin infestation.
We report the case of a 42-year-old man with symptomatic HIV infection (C3 CDC stage) who presented widespread hyperkeratotic skin lesions diagnosed as Norwegian scabies. The CD4 count was 87 cells/mm3. The patient has been the source of a nosocomial outbreak (20 individuals affected). He was treated successfully with combined topical treatment (permethrin 5% cream plus keratolytic agents) and oral ivermectin.
A 73-year-old man had scabies with formation of bullae resembling bullous pemphigoid clinically that recurred and persisted despite systemic corticosteroids. Treatment with topical permethrin was successful for up to 12 months of follow-up.
Thirty-eight patients with scabies (21 males and 17 females) received oral ivermectin in two doses of 200 microg/kg at 7 days interval. Excellent results were achieved in 29 cases (76.34%), improvement in 6 (15.78%) and poor responses in 3 (7.88%). Tolerance was satisfactory-excellent in 32 patients (84.2%). The effectiveness and safety of the drug described in previous studies are confirmed by the present results.
A child with systemic lupus erythematosus who has been treated with prednisone for three years, developed crusted scabies. Scrapings from lesions revealed Sarcoptes scabiei adult mites mad eggs. The patient died with septicemia and renal failure soon after starting topical 20% sulfur. A marked improvement was observed in the cutaneous lesions.
We report the first case of an elderly patient suffering from Norwegian scabies who died after treatment with gammaBHC. GammaBHC (60 mg) was applied over the entire body except for the head of a 91-year-old female in our geriatric ward. This chemical was used in a smaller dose than previously reported, and it proved to be effective except for its effect on the head. Six days after the initial application, gammaBHC (40 mg) was also applied to the patient's head, but she died 5 days later. We propose that application of gammaBHC to the head of such patients should be done with great caution.
Infestations of head lice, body lice, scabies, and chiggers are common causes of rash and pruritus in children. Concern has arisen about development of resistance to often-used treatments, but a comprehensive approach to eradication is usually very effective. In this article, Dr Potts describes the presentation of ectoparasites and discusses conservative treatment and the safe use of pediculicides.
The challenge for nurses in hospital and community settings is to recognise scabies, deal with it appropriately and to help educate those who are most vulnerable.