A short guide to scabies treatment 2016
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Scabies is caused by infestation of the tiny burrowing mite called Sarcoptes scabiei. They enter your skin, form burrows and leads to intense itching. Moreover, the urge to scratch turns stronger at night. It is highly contagious and can spreads easily through close physical contact. Regardless of age, gender and race, it can happen to anyone. However, it can be treated by right medication. A number of natural, homeopathic and several other medicines are available, which are capable of curing this itchy skin disorder
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A short guide to scabies treatment 2016
- 1. A Short Guide to Scabies Treatment
- 2. Presentation Objectives Provide an overview of scabies Description Transmission Symptoms Diagnosis and treatment Control measures
- 3. Scabies Searches Worldwide Cases of Scabies has been increased rapidly in decade
- 5. Scabies Description Contagious infestation of the skin Caused by human mites (Sarcoptes scabiei subsp. hominis) Distributed worldwide Reported incidence increasing in US since 1970’s Humans are the reservoir
- 6. Scabies Infestation: Mites burrow underMites burrow under skin to feed and layskin to feed and lay eggseggs Can burrow beneathCan burrow beneath skin in 2.5 minutesskin in 2.5 minutes Adult female miteAdult female mite .3 - .4 mm long.3 - .4 mm long
- 7. Scabies Transmission Direct, prolonged, skin–to-skin contact Sexual contact Household contact Indirect transfer from clothing, towels and bedding, only if contaminated immediately before contact Communicable while infested and untreated during incubation period
- 8. Scabies Symptoms Symptoms caused by reaction to mites Pimple-like rash or burrows between fingers, on wrist, elbows, armpits, belt line, navel, abdomen, and/or buttocks Intense itching over most of the body, especially at night Sores on the body caused by scratching Incubation period: 2-6 weeks without previous exposure 1-4 days after re-infestation (usually milder)
- 9. Scabies Rash
- 10. Scabies Diagnosis Confirmed by skin scrapings of papules or intact burrows Burrows and mites may be few in number (only 10-12) and difficult to find
- 11. Scabies Treatment Application of scabicides over entire body below head: Dr. Scabies lotion or cream (wash after 8-14 hrs) 5% permethrin cream (wash after 8-14 hrs) 1% lindane cream (wash after 8-12 hrs) Ivermectin, single dose, orally Itching may continue for several weeks despite successful treatment In ~5% of cases, 2nd treatment may be necessary after 7-10 days.
- 12. Applying Prescription Creams Follow package insert Apply thin layer over whole body from neck down, paying particular attention to folds in skin Trim fingernails and toenails, apply under nails Reapply after handwashing Leave on for at least 8 hours, but not longer than maximum time recommended for product Wash off with warm, soapy water and dry skin
- 13. Scabies Control Prompt diagnosis and treatment of patients Simultaneous, prophylactic therapy: household members sexual contacts caregivers with prolonged skin-to skin contact Launder all clothing worn within 48-72 hrs. of treatment in hot water and dry in hot dryer Thorough vacuuming of carpets and upholstered furniture
- 14. Prevention and Handwashing Germs are everywhere: People carry millions of germs on their hands. Germs are on also on objects that we touch every day (doorknobs, handrails) “30 second solution” Least expensive way to stay healthy Forming good habits early in life keeps us healthy Biggest factor in preventing spread of infectious diseases!
- 15. How to Wash Your Hands Use warm running water Lather with soap (liquid preferred) Scrub, including between fingers, for 20 seconds Rinse with water Dry thoroughly with a clean dry towel or paper towel Turn off faucet with towel
- 16. References American Academy of Pediatrics. Summaries of Infectious Diseases. Heymann, DL, Control of Communicable Diseases Manual. Washington DC: American Public Health Association; 2004:473-476. Isada, C. et al. Infectious Diseases Handbook. 6th ed. Hudson, Ohio: Lexi-Comp, Inc.; 2006:293-294. http://www.cdc.gov/ncidod/dpd/parasites/scabies/def ault.htm Dr. Scabies - http://www.drscabies.com/scabies-wiki
Editor's Notes
- Sarcoptes scabiei subsp. canis acquired from dogs with clinical mange – causes a self-limited and mild infestation, usually in area in direct contact with animal; resolves without specific treatment; these mites do not replicate in humans Mites are distributed worldwide; affects all races and socioeconomic classes in all climates Scabies is endemic in many countries; seems to occur in 15 – 30 year cycles
- Scabies mite cannot fly or jump. Females deposit eggs at 2-3 day intervals as they burrow through the skin Eggs are oval and .1 to .15 mm in length; incubation time for eggs to hatch is 3-8 days. Larvae migrate to skin surface and burrow into the skin or hair follicles forming short burrows, called molting pouches. Larvae have 3 pairs of legs and last only 2 to 3 days before turning into nymphs. Nymphs have 4 pairs of legs, and become adults weeks later. Sarcoptes scabei mite is round, sac-like and eyeless. Females are 0.3 to 0.4 mm long and 0.25 to 0.35 mm wide. Males are slightly more than half that size. Mating occurs when male mite penetrates the molting pouch of the female mite. Impregnated females extend their molting pouches into characteristic serpentine burrows, laying eggs in the process; survive 1-2 months in tunnels under the skin.
- Scabies is usually transmitted by intimate interpersonal contact, often sexual in nature, but transmission through casual contact can occur as well. Exposure is most common in nursing homes, hospitals, institutions, and daycare settings; can also be spread in households and through sexual contact Because of large number of mites in exfoliating scales, only minimal contact with a person with Norwegian scabies may result in transmission Transmission occurs as long as person is infested and untreated, including incubation period
- Symptoms of scabies includes the following: Pruritic (itchy), erythematous (red), papular (pimple-like) eruption burrows or rash of the skin Severe itching, especially at night and frequently over much of the body, including areas where mites are undetectable. Occurs on webbing between the fingers; the skin folds on the wrist, elbow, or knee; the penis, the breast, or shoulder blades; Additional areas are common in children, including hands and face (head, neck, palms, and soles) Skin eruptions are caused by hypersensitivity to proteins in parasite Burrows are gray or white, thread-like lines up to several centimeters long Sores can sometimes become infected with bacteria. Secondary bacterial infections may occur in all forms of scabies (usually streptococcus pyogenes or staphylococcus aureas) In children under 2 yrs of age, eruption is generally vesicular (filled with fluid or pus) and often occurs in areas usually spared in older children and adults, such as the head, neck, palms, and soles. Atypical presentations: vesicles and bullae in infants; eczematous eruptions, and urticaria (eruption of itching wheals) Nodular scabies: small, red-brown, intensely pruritic nodules; usually on penis, scrotum, groin and axilla; respoinse to dead mite antigens and feces; can persist for weeks and months after effective treatment. Norwegian scabies: Unusual; severe scabies; highly contagious skin is diffusely scaling and thickened from infestation of 1000’s of mites, but with only slight itching; usually occurs in debilitated, developmentally disabled, immuno-compromised individuals, and patients with Down Syndrome
- Differential diagnosis: impetigo, insect bites, drug eruptions, varicella, and eczema Linear burrows should be visible; applying ink to burrows and washing or wiping the skin with sterile pad reveals burrows (ink remains in burrow) Most diagnoses of scabies infestation are made based upon the appearance and distribution of the rash and the presence of burrows. Whenever possible scabies should be confirmed by isolating the mites, ova or feces in a skin scraping. Apply mineral oil to burrow, scrape with sterile #15 scalpel blade, and examine under microscope If a skin scraping or biopsy is taken and returns negative, it is possible that a person may still be infested. Typically, there are fewer than 10 mites on the entire body of an infested person; this makes it easy for an infestation to be missed. Most burrows are obliterated by scratching before a patient is seen by a physician
- Cream should be reapplied to hands after routine handwashing, since hands are often infected Contraindications for lindane cream: patients with crusted scabies (Norwegian scabies), premature infants, young infants, women who are pregnant or breastfeeding people with known seizure disorders, people with hypersensitivity to product, and patients with extensive dermititis Lindane should not be used immediately after bath or shower. Lindane has been associated with central nervous system disorder, particularly when an underlying skin disorder exists Oral antihistamines and topical corticosteroids can be prescribed to relieve itching (due to hypersensitivity to mite) Topical or systemic antimicrobial therapy is indicated for secondary bacterial infections of excoriated lesions. Occasionally, 2 – 5 mm red-brown nodules appear (response to dead mite antigens and feces) can persist for weeks or months after effective treatment. No new burrows or rashes should appear 24-48 hours after effective treatment.
- Mites do not survive more than 3 -4 days without skin contact. Placed items that cannot be washed, such as stuffed toys and pillows in tightly closed plastic bags for 14 days to kill any mites Localized outbreaks may require more stringent and consistent measures to treat contacts. Environmental disinfestation is not necessary, although thorough vacuuming of environmental surfaces is recommended after use of a room by a person with crusted (Norwegian) scabies People with crusted (Norwegian) scabies and their close contacts must be treated promptly and agressively to avoid outbreaks.
- As you are all aware, when handwashing is done properly it is the most effective way to prevent the spread of infections diseases. 30 second solution- maybe over simplified- but it has been proven through history beginning with Semmelweiss, who demonstrated that handwashing between patients saved the lives of women in the maternity ward during the 1800’s. Regular handwashing is the fastest and least expensive route to staying healthy.
- So, how should you wash your hands: By rubbing your hands together with soapy water, you pull the dirt and oily soils free from your skin. The soap lather suspends both the dirt and germs trapped inside, and then they are washed off your skin with the running water. You can use the same towel to wash your hands to turn off the faucet. Plain soaps work just as well as antibacterial soaps. The hardest thing is to get people to wash their hands routinely. You can also use hand lotions to keep hands healthy especially during the winter months. If hands are chapped and sore, people are less likely to wash. Chapped hands also provide harborage for bacteria. Alcohol based hand sanitizers are also effective in preventing transmission of germs but they do not remove dirt. If you cannot get to a sink – hand sanitizers are an alternative.