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PubMedDate not supplied

Care and treatment of scabies.

In these days of Universal Precautions, the staff nurse can and should work with all patients as if they had a potentially infectious disease. A case in point is scabies which mimics many dermatological conditions and is transmitted by direct contact. Scabies is caused by infestation with the mite Sarcoptes scabiei, and can be a problem in nursing homes and hospitals, particularly among patients who are debilitated and require extensive hands-on care. A scabies outbreak need not result in chaos or epidemic. If nursing staff are well trained in Universal Precautions, especially handwashing, much transmission could be prevented. Moreover, if scabies is recognized early, accurately documented, and quickly treated, a scabies outbreak could be readily contained.

Cross Infection↗
PubMed1995

Scabies: the diagnosis of atypical cases.

In the current scabies pandemic, classic scabies is seen less frequently and special forms are becoming more common. The diagnosis of scabies has become, therefore, a challenge for clinicians. The well-known scabietic burrow is seen only very rarely today and, therefore, pathognomonic as it is, the diagnosis of scabies should not rely on this clinical sign. In our experience, examination of skin scrapings mounted on a slide with saline is the most practical bedside method and ideal for screening patients with suspected scabies. It is easy to perform, requires neither sophisticated tools nor special skill, and can be done in less than five minutes by every practitioner.

Animals↗
PubMed1993

Crusted scabies in systematic lupus erythematosus: a case report.

Crusted scabies (Norwegian scabies) is uncommon in clinical practice and may present as papulosquamous dermatosis. A case of crusted scabies in systemic lupus erythematosus (SLE) is described. The skin lesions simulated those of subacute cutaneous lupus erythematosus of the papulosquamous type, and became the source of epidemic scabies in the hospital. The colonization with Staphylococcus aureus within crusted lesions may have contributed to the patient's sepsis. This case illustrates the pitfalls in recognition of crusted scabies and the importance of rapid diagnosis.

Humans↗
PubMed1993

[Control of scabies in the district of Ytre Nordhordland. An experiment within community medicine in the 1860's].

19th century Norway may be likened to the developing countries of today. Scabies was very prevalent, and traditional approaches to treatment were in vain. The poor peasant population would not spend money on such. Thomas Collett (1835-98), the local doctor in a rural district of western Norway, initiated a programme for community control of scabies. The local Board of Health agreed to purchase a large amount of sulphur ointment. 1/8 of a barrel of ointment was placed at the disposal of local teachers. The teachers were instructed to initiate treatment of school-children who were found to be infected with scabies. The household to which the child belonged was also to be treated, as well as the other children at the school. Gradually, the prevalence of scabies declined. Self-care increased, and eventually, the peasants ended up making their own sulphur ointment. Experiences and recommendations from developing countries of today agree with the strategy adopted by Collett. Individual medical treatment of cases and their contacts is too costly, and fails to reduce the total prevalence of scabies.

Community Medicine↗
PubMed2006

Evidence that scabies mites (Acari: Sarcoptidae) influence production of interleukin-10 and the function of T-regulatory cells (Tr1) in humans.

We performed experiments to determine whether an extract of Sarcoptes scabiei (De Geer) influenced cytokine expression by human T-lymphocytes. Peripheral blood mononuclear cells from five sensitized donors and four donors without sensitization to scabies mites were challenged with a T-cell mitogen alone, with scabies extract (SS) alone, or with mitogen and SS together. Supernatants were analyzed for the cytokines interferon-gamma (IFNgamma), interleukin (IL)-2, IL-4, and IL-10. No IL-2 or IL-4 was produced in response to scabies extract. Cells from both naive and sensitized donors produced large amounts of IFNgamma and IL-10. The lack of IL-4 but high levels of IL-10 suggests that IL-10 was likely secreted by type 1 T-regulatory cells, which were activated by something in the scabies extract. IL-10 has anti-inflammatory and immune-suppressive effects. It may play a key role in depressing the inflammatory and immune responses in humans so that clinical symptoms are not seen until 4-6 wk after a person becomes infested with scabies mites.

Adult↗
PubMed1999

Equivalent therapeutic efficacy and safety of ivermectin and lindane in the treatment of human scabies.

OBJECTIVE: To compare the therapeutic efficacy and safety of ivermectin and lindane for the treatment of human scabies. DESIGN: Randomized, prospective, controlled, double-blind, "double-dummy," and parallel clinical study. SETTING: A single department of dermatology at a hospital in Buenos Aires, Argentina. PATIENTS: Patients were outpatients, hospitalized patients, and those referred to our hospital from nursing homes and asylums. Fifty-three patients had clinical signs and symptoms compatible with scabies. INTERVENTION: Patients received either a single oral dose of ivermectin (150-200 microg/kg of body weight) or a topical application of 1% lindane solution. Treatment was repeated after 15 days if clinical cure had not occurred. MAIN OUTCOME MEASURES: Clinical healing and adverse effects. RESULTS: Of 53 patients, 43 (81%) completed the study, 19 in the group treated with ivermectin and 24 in the group treated with lindane. At day 15, 14 patients (74%; 95% confidence interval, 48.8%-90.8%) in the group receiving ivermectin showed healing of their scabies and 13 patients (54%; 95% confidence interval, 32.8%-74.4%) in the group treated with lindane were healed. At 29 days, both treatments resulted in statistically equivalent therapeutic efficacy: 18 patients (95%; 95% confidence interval, 74.0%-99.9%) were healed with ivermectin and 23 patients (96%; 95% confidence interval, 78.9%, 99.9%) were healed with lindane (P<.02). Adverse effects from the treatments were few, mild, and transient. Results from laboratory tests showed no major abnormalities and no difference between treatments. CONCLUSIONS: Ivermectin is as effective as lindane for the treatment of scabies. Ivermectin is simpler to use and, therefore, is a promising tool to improve compliance and to control infestations.

Adult↗
PubMedDate not supplied

Scabies outbreak on a spinal cord injury unit.

This article describes an outbreak of scabies on a 30-bed acute spinal cord injury unit and the measures taken to eradicate the infestation. Because spinal cord injury patients have sensorimotor deficits, the sensation of itching often is absent, making an infestation of scabies more difficult to identify. A total of 30 patients and 38 employees were exposed and treated for scabies. Educational programs about scabies were instituted immediately for all employees. Routine daily activities and therapy schedules were severely hampered by the outbreak. Despite the efforts of staff to solve the problems associated with the outbreak, frustration and anger were sometimes displayed by many of the staff, patients, and families because of the difficulties they encountered. The outbreak was halted, however, and no further cases were reported, although several employees had to be treated twice.

Cross Infection↗
PubMed2000

[Treatment of scabies with special consideration of the approach in infancy, pregnancy and while nursing].

Infestation of human skin with scabies mites remains an persistent problem in daily dermatological practice. There are several therapeutic regiments against scabies which have been proven effective and without major side effects. Because of known neurotoxicity of lindane as well as intoxication/problems following systemic absorption of benzyl alcohol (the metabolite of benzyl benzoate), these two compounds have to be considered with caution in early childhood scabies as well as during pregnancy and nursing. The pharmacology and spectrum of clinical side effects of the approved anti-scabies preparations (lindane, benzyl benzoate, crotamiton) as well as permethrin (not available in Germany) are reviewed.

Breast Feeding↗
PubMed2004

Scabies by Kenneth Mellanby.

BACKGROUND: Epidemics of scabies are often associated with wars or other times of social upheaval. This was particularly evident during the Second World War when it was estimated that there were one to two million patients with scabies in Great Britain. OBJECTIVE: This article reviews the work of the zoologist Kenneth Mellanby of England and evaluates his contribution to our knowledge of the diagnosis and treatment of scabies in the Second World War. CONCLUSION: Using humans, Mellanby studied the transmission and treatment of this disease. Among his contributions were knowledge of how many mites the average patient had, and where they were located. He clearly noted and described that the scabies rash was not limited to the location of the mites on the body; he attributed the rash in areas with no mites to "a true sensitization." He found that "fomites were not the major method of transmissions.

England↗
PubMed1991

Community control of scabies: a model based on use of permethrin cream.

For 18 years treatment with lindane or crotamiton products has failed to stem the epidemic of scabies among the Kuna Indians in the San Blas islands of the Republic of Panama. Permethrin 5% cream was introduced as the only treatment in a programme to control scabies on an island of 756 inhabitants and involving workers recruited locally. Prevalence fell from 33% to less than 1% after every person was treated. As long as continued surveillance and treatment of newly introduced cases was maintained, prevalence of scabies remained below 1.5% for over 3 years. When supply of medication was interrupted for 3 weeks, prevalence rose to 3.6%. When control was lost after the US invasion of Panama, prevalence rose to 12% within 3 months. Bacterial skin infections decreased dramatically when scabies was controlled. Permethrin is safe and effective even in areas where this disease has become resistant to lindane.

Administration, Topical↗
PubMed1990

Scabies in nursing homes: an eradication program with permethrin 5% cream.

Permethrin 5% cream was used to treat scabies in three large nursing homes under a compassionate-plea protocol for chronic, therapy-resistant infestations. All residents, staff, and frequent visitors were treated whether or not symptomatic. Family members of these groups were treated either when symptomatic or directly exposed to scabies. Nine hundred ninety-five persons were treated, 202 of whom were diagnosed with scabies. Approximately 35% (111 of 313) of nursing home residents were diagnosed with scabies. These were patients in whom multiple treatments with other scabicides were unsuccessful. At the completion of the study, 195 patients were examined for efficacy of treatment. Of these, 91 (46.7%) had clearing of lesions with one medication application, 77 (39.5%) with two treatments, and 23 (11.8%) with three or more treatments. The overall cure rate was 98%. Adverse experiences occurred in 2.4% of cases and were mild (i.e., pruritus and rash).

Adolescent↗
PubMed1996

The development of protective immunity in canine scabies.

Seven of eight dogs that had been previously infested with Sarcoptes scabiei var. canis and then cured, expressed protective immunity when experimentally reinfested with scabies. All seven dogs that expressed resistance were spontaneously cleared of scabies by 64 days after they were experimentally reinfested. Five of the eight dogs were free of scabies by 24 days. The sequential changes in the inflammatory/immune cellular infiltrate in the scabietic lesions of each dog were determined during the sensitizing infestation, cure and the subsequent experimental reinfestation (challenge). During the initial infestation and in the subsequent challenge reinfestation, dogs developed mixed cellular infiltrates in their scabietic lesions that contained mononuclear cells, neutrophils, plasma cells and mast cells. Reinfestation induced more rapid increases in the densities of these cells than had occurred during the sensitizing infestation. Mononuclear and mast cells were the most numerous infiltrating cells during the sensitizing phase. During the challenge phase the most numerous infiltrating cells were mononuclear cells and neutrophils. The sensitizing and challenge infestations induced circulating scabies-specific antibody responses, but the response was more rapid during the reinfestation challenge. Both the cell-mediated response in the skin and the circulating antibody response waned in parallel with clearing of the mites following reinfestation.

Animals↗
PubMed2006

Crusted scabies (sarcoptic mange) in four cats due to Sarcoptes scabiei infestation.

Four new cases of sarcoptic mange in cats are described. Two cats resided in areas known to be frequented by foxes, another cohabited with a dog recently diagnosed with sarcoptic mange, while the final cat lived with a mixed breed dog that had been treated for sarcoptic mange 7 months previously. Three cases were diagnosed on the basis of characteristic mite size and morphology in skin scraping from representative lesions, situated on the head (two cases) or head and distal hind limbs (one case). Mites were highly mobile and abundant in all instances, and easily detected also in skin biopsy specimens procured from two cases. Eosinophilic inflammation, hyperkeratosis and parakeratosis were prominent in the tissue sections. In the remaining case, the diagnosis was presumptive, based on characteristic lesions, cohabitation with a canine scabies patient and positive response to scabicide therapy. Pruritus was not a prominent clinical feature in any patient and was considered to be absent in three of the four cases. Lesions in three cats with long-standing disease were reminiscent of crusted scabies (synonym: Norwegian scabies, parakeratotic scabies) as seen in human patients. In three cases, in-contact human carriers developed itchy cutaneous papular lesions. Two cases responded promptly to therapy with systemic avermectin drugs, while one responded to topical treatment with lime sulphur and the remaining cat received both a lime sulphur rinse and ivermectin. Sarcoptic mange should be considered in the differential diagnosis of cats with non-pruritic crusting skin diseases, especially when there is contact with foxes or dogs, and when owners have itchy papular lesions.

Animals↗
PubMed2006

Nosocomial scabies.

Scabies is a parasitic dermatosis with a worldwide distribution. This infestation affects millions of people annually and may cause large nosocomial outbreaks with considerable morbidity among patients and healthcare workers. Immunocompromised or elderly institutionalized patients admitted with unrecognized crusted scabies are the main source of nosocomial transmission. Factors that facilitate the development of hospital-acquired scabies and nosocomial epidemics are: poor knowledge of scabies epidemiology, unfamiliarity of healthcare workers with atypical presentations, long incubation period, diagnostic delay and incomplete monitoring. Within hospitals, containment of an outbreak relies on the strict implementation of appropriate infection control measures and treatment administration to contacts. It is associated with a considerable working and economic burden.

Aged↗
PubMed1986

Permethrin 5% dermal cream: a new treatment for scabies.

Permethrin 5% dermal cream (Burroughs Wellcome Co.) was compared in an investigator-blinded, randomized study against lindane 1% lotion (Kwell) for the treatment of microscopically confirmed scabies. Eleven of twenty-three patients treated with permethrin cream were cured in 2 weeks (48%). Only two patients had scabies 1 month following a single treatment with this product, giving a cure rate of 91%. One of these two patients was considered to have a reinfestation. Only three of twenty-three (13%) patients treated with 1% lindane lotion (Kwell) were free of scabies 2 weeks after a single treatment and fifteen of twenty-three (65%) were cured at 1 month. The unusually high percentage of treatment failures (35%) following lindane therapy may have been related to extensive use of this agent for head lice and scabies in this village during the preceding 5 years. The higher cure rate at 1 month seen with permethrin cream was significant (p less than 0.025). Permethrin 5% dermal cream offers a new, cosmetically elegant alternative to lindane therapy and was effective in a community in which lindane demonstrated an unacceptable level of treatment failures.

Administration, Topical↗
PubMedDate not supplied

Management of chronic, resistive scabies: a case study.

It took about 9 months of diligent effort to resolve Mr. C's chronic, highly resistive case of scabies. In all, Mr. C. had a total of seven treatments with a scabicidal lotion or cream. In addition, other medications were prescribed in an attempt to resolve his skin condition. The treatment of scabies is costly to an institution, in medications, supplies, and additional nursing time required to treat the patient, as well as other patients prophylactically. Therefore it behooves nurses to do a thorough skin assessment on all nursing home care patients at least monthly, recognize early signs of scabies, and be cognizant of the fact that scabies in the elderly patient may have an atypical distribution.

Aged↗
PubMed2000

Detection of space-time clusters and epidemiological examinations of scabies in chamois.

In this paper some methodological approaches towards the detection of temporal, spatial and space-time clusters are presented and discussed in context with epidemiological factors of scabies in chamois. This presentation comprises in particular the use of the Scan Test (Wallenstein, 1980) for the detection of temporal clusters and the tests developed by Knox (1964) and Mantel (1967) for the testing of spatiotemporal interactions. Between 1952 and 1998 a total of 1689 cases of scabies in chamois and six cases in ibex were documented in 137 game preserves of the Austrian province of Styria. The evaluations indicate the presence of spatial and temporal clusters. Some possibilities for the spread of scabies in chamois are presented and reveal ibex as a probable vector for scabies transmission between chamois populations. The information may lead to strategies for controlling the spread of the disease.

Animals↗
PubMed1997

Treatment of HIV-related scabies with emphasis on the efficacy of ivermectin.

Since the mid-1980s, worldwide reports confirm that scabies in individuals infected with the human immunodeficiency virus (HIV) result in a wide range of-clinical manifestations which differ from those seen in immunocompetent patients. There is also general agreement that HIV-related scabies is more difficult to treat. Oral ivermectin has been shown in several countries to be a safe and effective therapy. In otherwise healthy persons, one dose of 200 microg/kg is usually curative. In HIV-related scabies, one treatment may be curative but repeated doses may be required. Crusted scabies in these individual requires a combination of oral ivermectin, total body treatments with 5% permethrin cream, and keratolytic agents to hasten removal of crusts.

AIDS-Related Opportunistic Infections↗