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PubMed2005

The incidence of molluscum contagiosum, scabies and lichen planus.

We aimed to describe the incidence of new episodes of molluscum contagiosum, scabies and lichen planus presenting to general practitioners in England and Wales. We examined data collected in a sentinel practice network (the Weekly Returns Service of the Royal College of General Practitioners) in which about half a million persons were observed each year over the period 1994-2003. The incidence of molluscum contagiosum in males was 243/100,000 person-years and in females 231; of scabies, males 351, females 437; of lichen planus, males 32, females 37. Incidence varied by year and age. Ninety per cent of molluscum contagiosum episodes were reported in children aged 0-14 years, where incidence in 2000 (midpoint of a 6-year period of stable incidence) was 1265/100,000 (95% CI 1240-1290). Scabies affected all ages and annual incidence ranged between 233 (95% CI 220-246) in 2003 and 470 (95% CI 452-488) in 2000. Lichen planus occurred chiefly in persons aged over 45 years: incidence (all ages) ranged between 27 (95% CI 23-31) in 2003 and 43 (95% CI 37-49) in 1998. The relative risk of female to male incidence (all ages) of molluscum contagiosum was 0.95 (95% CI 0.91-0.99); of scabies 1.25 (95% CI 1.21-1.28); and of lichen planus 1.19 (95% CI 1.08-1.13).

Adolescent↗
PubMed1999

The epidemiology of head lice and scabies in the UK.

Anecdotal evidence suggests that the prevalence of both scabies and head lice is increasing and also that both conditions are becoming refractory to pesticide treatment. Using information obtained from the Office of National Statistics, Royal College of General Practitioners Weekly Returns Service, Department of Health, local surveys of school children from Bristol and drug sales of insecticides, we have confirmed that there has been a rise in the prevalence of both conditions. We have shown that scabies is significantly more prevalent in urbanized areas (P < 0.00001), north of the country (P < 0.000001), in children and women (P < 0.000001) and commoner in the winter compared to the summer. Scabies was also shown to have a cyclical rise in incidence roughly every 20 years. Head lice were shown to be significantly more prevalent in children and mothers (P < 0.000001) though both conditions were seen in all age groups. Head lice were also less common during the summer. Host behaviour patterns, asymptomatic carriage, drug resistance and tourism from countries or districts with a higher incidence may be important factors in the currently high prevalence of both scabies and head lice.

Adolescent↗
PubMed1999

Oral ivermectin in the treatment of scabies.

One hundred and twenty scabietic patients attending the outpatient clinic of the Department of Dermatology, Mansoura University Hospital, voluntarily participated in this uncontrolled, open label study to evaluate ivermectin 20 microg/kg as a scabietic after they had given their consent. The scabietic subjects included in this study were otherwise healthy, mentally competent, aged more than 18 years, and used no topical antiscabietic treatment in the week before ivermectin treatment, or during the 4-week study period. Patients were also required to show clinical evidence of scabies, and the microscopically demonstrated presence of Sarcoptes scabiei, their eggs, or their fecal pellets (scybala). A thorough history was taken, and a physical examination was conducted that included measurement of the pulse, blood pressure, temperature, and weight. For each participant, the distribution of scabies lesions was plotted on a body diagram, and the severity of disease was recorded as mild (10 or fewer lesions), moderate (11-49 lesions), or severe (50 or more lesions). Skin scrapings were examined for mites, eggs, or scybala. Urinalysis, stool analysis, a complete blood count, prothrombin time, and serum chemistry studies (serum creatinine, alanine aminotransferase (ALT), and total bilirubin) were performed before treatment, and 2 and 4 weeks after the drug was given. Ivermectin was administered as scored 6-mg tablets with water, and the dose was designed to provide 200 micrograms/kg (ivermectin was provided by Delta Pharma, Tenth of Ramadan City, Egypt). The patients were instructed to have recently worn clothing, sheets, and towels washed in a hot cycle the day after treatment. The patients were interviewed 3 days after treatment about any symptoms or subjective evidence of adverse reactions. Follow-up examinations were carried out 2 and 4 weeks after intake of ivermectin, and all examination procedures and laboratory investigations were repeated. Cure criteria included absence of nocturnal itching as well as dermatologic evidence of scabies, and negative skin scraping. Patients showing evidence of active scabies or having new lesions during the follow-up visits were given a second dose of ivermectin. All members of the household and immediate family were treated with either topical 5% permethrin cream or 1% gamma benzene hexachloride to reduce the chance of reinfestation.

Administration, Oral↗
PubMedDate not supplied

Infantile acropustulosis revisited: history of scabies and response to topical corticosteroids.

Infantile acropustulosis (IA) is a condition of young children characterized by recurrent episodes of pruritic vesicles and pustules in an acral distribution. Several reports describe patients with scabies infestation prior to the diagnosis of IA, although the relationship between the two remains unclear. Furthermore, optimal therapy is controversial. We reviewed the history of scabies and response to therapy in 21 patients diagnosed with IA at two institutions between 1983 and 1997. A history of prior treatment for scabies was noted in 14 patients, although only two had mites, feces, or ova detected on microscopic examination for diagnostic verification. All patients were treated with topical corticosteroids (4 with class I, 12 with class II, 3 with class III, 1 with class IV, and 1 with class VI). All 18 patients who returned for follow-up experienced significant improvement or cleared completely with treatment. There were no observed cutaneous or systemic side effects from corticosteroid therapy. We conclude that a history of preceding scabies is common in patients with IA, but often this diagnosis is made without microscopic confirmation. We also demonstrate that mid- to high-potency topical corticosteroids are a safe and effective first-line therapy for patients with IA.

Administration, Topical↗
PubMedDate not supplied

Scabies incognito presenting as urticaria pigmentosa in an infant.

Misdiagnosis is frequent in scabies of infants and children because of a low index of suspicion, secondary eczematous changes, and inappropriate therapy. Topical or systemic corticosteroids may modify the clinical presentation of scabies and that situation is referred to as scabies incognito. We describe a 10-month-old infant with scabies incognito mimicking urticaria pigmentosa.

Biopsy↗
PubMed1999

Crusted scabies: A molecular analysis of Sarcoptes scabiei variety hominis populations from patients with repeated infestations.

Crusted scabies is a severe debilitating disease due to hyperinfestation with the ectoparasite Sarcoptes scabiei. Treatment protocols include oral ivermectin and topical scabicides. After single-dose ivermectin, there may be early recrudescence, whereas after 3 doses at 14-day intervals, there is an apparent cure. However, such patients often present again after 6-12 months. To clarify the biology of recurrence, we studied genetic markers in sequential populations of S. scabiei mites from treated patients with multiple episodes of crusted scabies. Individual mites were genotyped at hypervariable microsatellite loci by a fluorescence-based polymerase chain reaction. Results indicated that sequential populations of mites were genetically more similar to each other than to mites from other patients. Although the majority of recurrent scabies is probably due to reinfestation from inadequately treated contacts, there was evidence that in very severe crusted scabies, treatment with even 3 doses of ivermectin 14 days apart may be inadequate and relapse may occur.

Alleles↗
PubMed1997

Is crusted (Norwegian) scabies a marker of adult T cell leukemia/lymphoma in human T lymphotropic virus type I-seropositive patients?

Human T cell lymphotropic virus type I (HTLV-I)-induced immunosuppression has been suggested to explain the occurrence of crusted scabies in HTLV-I-infected patients. HTLV-I is the etiologic agent of adult T cell leukemia/lymphoma (ATL). Crusted scabies diagnosed in 6 HTLV-I-seropositive patients was studied to look for an association with ATL. Four of the 6 either had concomitant ATL when crusted scabies was diagnosed or developed ATL a few months later. These findings suggest that the occurrence of crusted scabies in patients seropositive for HTLV-I could represent a sign of marked immunosuppression related to ATL.

Adult↗
PubMed1994

Scabies epidemic: price and prejudice.

Scabies epidemics are not unusual, and the recommended way of stopping them is by simultaneous treatment of everybody in the facility; this has been known since the last century, when Norwegian scabies was a problem in Norway. When this is not done, scabies epidemics can smolder for months. Scabies should not spread with good infection control measures, but we learned that a good infection control service is not enough. Efforts have to be done to educate everybody in the hospital, including laundry workers, and to improve work conditions.

Aged↗
PubMed1994

Crusted (Norwegian) scabies in patients with AIDS: the range of clinical presentations.

Crusted (Norwegian) scabies in AIDS patients can be manifested in both typical and atypical forms. Although the classic, hyperkeratotic, nonpruritic lesions are most common, reported cases have ranged in spectrum from crusting with pruritus to a pruritic, papular dermatitis to those resembling Darier's disease or psoriasis. We report two additional cases of crusted scabies in AIDS patients, one with typical crusted, hyperkeratotic though pruritic lesions and one with severe pruritus and rare papules, initially misdiagnosed as "pruritus of AIDS." Because of the extremely contagious nature of crusted scabies, as well as its potential for complete cure with appropriate therapy, a high degree of suspicion for this disorder should be maintained in AIDS patients, even when the lesions do not have the classical appearance. The discovery of crusted scabies, whether in its common or its atypical form should prompt testing for the human immunodeficiency virus (HIV).

Acquired Immunodeficiency Syndrome↗
PubMed2000

Crusted (Norwegian) scabies in a patient with smoldering adult T-cell leukemia.

Crusted (Norwegian) scabies is described in a patient with smoldering adult T-cell leukemia (ATL). The patient is an 84-year-old Japanese woman who presented with widespread scaling over the trunk and limbs and crusted lesions on the scalp and ears. Microscopical examination of scrapings from the scalp and ears showed extraordinarily large numbers of scabies mites. The white blood cell count was 5.1 x 10(9)/L with 6% abnormal lymphocytes with mature nuclei that showed convolution and lobulation. Anti-HTLV-I antibodies were positive. Southern blot analysis revealed that the cellular DNA extracted from this patient's peripheral blood cells, digested with Pst I, showed the same pattern of provirus genome as the DNA from ATL patients. A diagnosis of crusted scabies with smoldering ATL was made. It is possible that crusted scabies could be an opportunistic infection and a pre-diagnostic sign of ATL.

Aged↗
PubMed2001

Oral ivermectin in scabies patients: a comparison with 1% topical lindane lotion.

Scabies. which constitutes a significant proportion of the outpatient attendance in tropical dermatology clinics, has so far been treated with lindane, crotamiton, sulphur, permethrin, etc. Ivermectin, an orally administered drug, was tried in scabies patients and compared with 1% topical lindane lotion to evaluate its effects and toxicity profile. Two hundred scabies patients were randomly allocated to one of two groups. One group received oral invermectin in a single dose of 200 micrograms/kg body weight. The other received 1% lindane lotion for topical application overnight. Patients were assessed after 48 hours, two weeks and four weeks. After a period of four weeks, 82.6% of the patients in the ivermectin group showed marked improvement; only 44.44% of the patients in the lindance group showed a similar response. A side effects in the form of severe headache were noted in one patient in group A. Oral ivermectin is an easy drug to administer. It is given as a single oral dose, unlike lindane, which has to be applied topically. The compliance is accordingly increased. Moreover, ivermectin induces an early and effective improvement in signs and symptoms. Thus, it may be a better option for scabies than the traditional topical linlane lotion.

Administration, Oral↗
PubMed2006

Crusted scabies in an adult T-cell leukemia/lymphoma patient successfully treated with oral ivermectin.

We report an adult T-cell leukemia/lymphoma (ATL) patient whose crusted scabies was successfully treated with oral ivermectin. This 63-year-old man had previously been treated with oral prednisolone, sobuzoxane and etoposide for approximately 1 year. When he developed crusted scabies, he received two doses of oral ivermectin (200 microg/kg) 10 days apart and the concomitant topical application of crotamiton containing 30% benzyl benzoate. This produced remarkable results, suggesting that oral ivermectin should be considered for the treatment of crusted scabies even in immunocompromised patients. While ivermectin may be useful for treating intractable scabies, attention must be paid to the possible appearance of ivermectin-resistant mites.

Administration, Oral↗
PubMed1981

Host-parasite relationships in hyperkeratotic (Norwegian) scabies: pathological and immunological findings.

The dynamics of intraepidermal penetration of the scabies mite and the host's responses to the invaders have been studied in hyperkeratotic scabies. Contrary to the generally accepted view, the mites progressed not only through the stratum corneum but also into the underlying epidermis and even occasionally to the dermo-epidermal interface. Morphological evidence of reactive processes included parakeratosis surrounding the burrows, psoriasiform hyperplasia with increased basal cell labelling indices and exocytosis of mononuclear cells. 3H-Thymidine labelling indices of immunocompetent cells of the dermal infiltrate reached levels found in allergic patch test reactions and were in both cases higher than in non-immune-specific inflammatory processes. The labelling index of peripheral blood lymphocytes showed an increased ratio of B cells to T cells as compared to controls or patients with allergic contact dermatitis. Serum CIq fixation was higher than in untreated patients with common scabies. These results support our previous findings of immunological activation in host infested by the scabies mite.

Aged↗
PubMedDate not supplied

The epidemiology of scabies in Turkey.

The epidemiology of scabies for the last twelve years has been studied in Turkey. Information was obtained from three regions (Istanbul, Ankara and Erzurum) having different climates. There has been an increase in scabies in the years following 1969 in Ankara and Erzurum and from 1967 on in Istanbul. It reached its maximum in 1978 in Erzurum, while this peak had been observed in early 1970s in other regions. Scabies incidence has significantly increased and decreased in winters and summers respectively, has been found to affect particularly the age group 15-44, and was observed more frequently in men than in women. Scabies seems to be moving to the eastern parts of Turkey.

Adolescent↗
PubMed2005

Treatment of scabies: newer perspectives.

Scabies is a common dermatological problem managed by general physicians, family physicians, and dermatologists. Scabies manifests itself in various forms in different individuals. The treatment of scabies has undergone developments with the evolution of new treatment strategies and antiectoparasitic drugs. The advent of drugs such as permethrin and ivermectin has revolutionised treatment. Management of scabies not only includes prescribing the drugs but also educating patients properly about the method of application of the drug. Treatment failures may result for various reasons and must be managed appropriately.

Administration, Cutaneous↗
PubMed1992

Factors associated with pediculosis pubis and scabies.

OBJECTIVE: To ascertain factors associated with genital pediculosis and scabies infestations among attenders at an STD clinic. DESIGN: Cross sectional assessment of potential risk factors by multiple logistic regression. SETTING: A central city sexually transmitted diseases (STD) clinic in Adelaide, South Australia. SUBJECTS: All men and women patients attending from 1988 to 1991. RESULTS: Pediculosis pubis was diagnosed in 205 of 12,170 (1.7%) men and 65 (1.1%) of 6125 women, and scabies in 56 (0.5%) men and 6 (0.1%) women attending an STD clinic from 1988-1991. Independent risk factors by multivariate analysis for pediculosis pubis in women were pregnancy (odds ratio (OR) = 2.3), sex outside the state (OR = 2.2) and age under 25 (OR = 2.0). Many factors were associated with pediculosis pubis in men, including no steady partner (OR = 1.4), multiple partners (OR = 1.6), being unmarried (OR = 2.0) and homosexual behaviour (OR = 1.6). None of these factors was associated with scabies infestation which was strongly associated with being Aboriginal (OR = 6.8) and being unemployed (OR = 2.5). CONCLUSION: In this setting scabies appears to be determined by socioeconomic factors and pediculosis pubis predominantly by sexual activity factors.

Australia↗
PubMed1976

Norwegian scabies in homozygous twins.

Norwegian scabies in two female homozygous twins, 12 years of age, was observed. Both children were in good psychosomatical condition. Clinical signs of Norwegian scabies with appearance of verrucous and keratotic papules on the dorsal aspect of hands, elbows and knees appeared after a year of persisting typical scabies in their family. Serum vitamin A concentration was lowered. The pathogenesis of the disease is discussed. The long-standing typical scabies is thought to be a promoting factor for manifestation of the latent and hereditary predisposition to keratotic reaction of the skin.

Child↗