Dr. Dietrich luhaga

1. Learning Objectives
● Define scabies and dermatomycosis
● Describe mode of transmission of scabies and
dermatomycosis
● Mention clinical features scabies and
dermatomycosis
● List diagnostic methods of scabies and
dermatomycosis
● Describe treatment of scabies and dermatomycosis
● Describe preventive and control measure of scabies
and dermatomycosis

2. Definition of Scabies
• Scabies: A parasitic infection of the skin characterised by an
intense itching with typical distribution caused by the mite
Sarcoptes scabei

3. Epidemiology of Scabies
• Scabies is common in rural Africa
• Prevalence is high in areas with shortage of water and is uncommon in people who bathe regularly
• Low socio-economic conditions favour the spread of the disease
• Transmission is by direct close body contact from infected person and indirectly through bedclothes and
clothing
• The female mite enters the skin and makes a small tunnel or burrow
• The burrow is always superficial
• The skin selected for burrow is always thin and wrinkled giving scabies rash a typical distribution • In the
burrows, eggs and faeces are produced
• The eggs hatch in 4-5 days
• The larvae leave the parent tunnel and bury in the skin in other places, but they do not make tunnels

4. Clinical Features
● Intensive itching, especially at night
● Eczema-like signs
○ The itching leading to scratching causing secondary bacterial infection
● In immunosuppression patients the infestation is intensive
● Typical distribution of severe itch nad rash are
○ Anterior axillary fold
○ Nipples ,lower abdomen in women
○ Belt line
○ Thighs and buttocks
○ External genitalia
● Secondary bacterial infection scabies may complicate
○ Septicaemia
○ Glomerulonephritis
● Patients with sensational defects e.g leprose cause scabies to be intensive and
leading the formation of thick crusts

7. Diagnosis
● Physical examination or clinical findings
○ Pruritus and symmetric polymorphic skin lesion
○ Burrows presence
● Microscopic examination
○ Mites
○ Eggs
○ Faecal pellets

8. Treatment
● 10% Benzyl benzoate emulsion (BBE) - drug of choice
○ After warm bath apply BBE,not on face
○ After 24 agin bath, wear clean clothes
○ Kills larvae and not eggs, repeat after 4-7 days
● Others
○ Tetmosol solution or soap
○ Permethrin cream 5% (neck to downaward ,wash after 8-14 hrs)
○ Ivermectin (repeat after 2wks)
○ Lindane (1%) lotion or cream
● Antibiotics used when sign of secondary infection (penicillin prefered)

9. Other Management Considerations
● Decontamination of bedding materials and clothing
● Wash in hot water and aired or removed from body contact for at least 72 hours
● Treat the whole family
● The itching will not disappear immediately, if necessary treat it symptomatically
with calamine lotion
● The treatment should not be repeated so soon in infant
● The scalp should also be treated for scabies but remember to protect the eyes
carefully

10. Prevention
● Regular bathing with soap
● Washing of clothes and frequent use of soap will control the disease
● Give health education to stress the use of soap
● Treat the whole family.

12. Definition
Dermatomycosis:term applied to fungal infection of the skin and its appendages e.g.
hair and nails
● Several types are identified according to causative organism, site and clinical
appearance.
● They are sometimes indicators of immunosuppression as occurs in AIDS, cancer,
diabetes and tuberculosis.

13. Mode of Transmission of Dermatomycosis
● All fungi may be transmitted to humans by direct skin contact from their
habitat in the soil, vegetation, animals or other individuals.
● Genital infection (balanitis and vulvo-vaginitis) may spread during sexual
intercourse but most candida infections are not sexually transmitted.
● Local conditions on the skin such as moist and hot environment are
predisposing factors and therefore the infections are highly prevalent in
tropical climates.

14. Types of Dermatomycosis
● Tinea capitis (ringworm of the scalp)
● Tinea corporis (ringworm of the body)
● Tinea pedis (Ringworm of the foot or ‘athlete’s foot’)
● Tinea unguium (Ringworm of the nails)
● Tinea versicolor or pityriasis

15. Clinical Features of Different Dermatomycosis
Tinea Capitis (Ringworm of the Scalp)
● Begins as a small papule which spreads to involve a larger area. • Hairs in the
affected skin become brittle and break off easily.
● It occurs mainly in children under 10 years and often disappears after puberty.
Tinea Corporis (Ringworm of the body)
● This is characterised by flat ring shaped spreading lesions.
● The ring lesions are reddish, vesicular or pastula, and may be dry and scaly,
or moist and crusted.
● The central area often clears leaving apparently normal skin.

16. Tinea Pedis (Ringworm of the foot or athlete’s foot)
• Characterised by scaling and cracking of the skin between the toes, particularly
the fourth and fifth toes.
Tinea Unguium (Ringworm of the nails)
• This is characterised by a thickening, discolouration and brittleness of the nails.
• There is accumulation of caseous materials beneath the nail which becomes
chalky and disintegrates.
Tinea Versicolor or Pityriasis
• This is a very superficial infection.
• The skin on the side of the face, neck and chest shows many irregular, round and
light coloured areas.

17. Diagnosis of Dermatomycosis
● Clinical diagnosis is unreliable
● Confirmed by laboratory investigations
○ Microscopic examination of scrapings after KOH preparation
○ Results - branching filaments crossing borders of cells are seen
● The technique is easy and materials needed are simple to collect

18. Treatment
Tinea Capitis
• Griseofulvin is the drug of choice, although oral therapy with itraconazole and
terbinafine are effective alternatives
• Oral fluconazole seems to have similar efficacy to Griseofulvin
• Give Griseofulvin at a dosage of 250mg twice a day or 500mg once a day in
adults and 20-25mg/kg for children for 6-12 weeks
• Whitefield’s ointment applied twice daily for 3 – 6 weeks has also been used in
areas where the above drugs are not available.

19. Tinea Corporis
• This responds well with topical application of topical antifungals such as
Clotrimazole 1% cream, lotion or solution (use twice daily), and Ketoconazole 2%
cream (used once daily).
• Severe disease and disease in immunocompromised patients should be treated
with systemic agents.
Tinea Cruris
• Topical antifungal treatment should be used (just as in tinea corporis)
• Resistant lesions can be treated with Griseofulvin or other systemic agents.
• Patients should be advised to dry the area completely after bath and not to wear
tight clothing

20. Tinea Pedis
• Topical agents applied for duration of 4 weeks are usually effective.
• Chronic or extensive disease may require
o Griseofulvin 250 – 500mg twice daily for 6 – 12 weeks, or
o Terbinafine 250mg daily, or
o Itraconazole 200mg daily
Tinea Unguium
• Systemic antifungal are indicated.
• Terbinafine and itraconazole have been show to be more effective than other
agents.

21. Prevention and Control
• Early diagnosis and treatment of infected person.
• Improve personal hygiene – regular bathing with water and soap
• Dry skin well (especially feet).