Scabies
Scabies
Disease due to Arthropod Parasite
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| (Parasitic infestation, Dermatozoonoses,खाज ) |
Scabies is a highly contagious disease. This is one of the most common dermatozoosis among humans and the causative organism is Sarcoptes scabeii, S hominis, and a few other species belonging to genus Sarcoptes. This parasite resembles a tortoise in appearance and looks like a pin head, when view with a naked eye. The female mite drills the skin of the victim with its strong chitin jaws and lays eggs in the burrows.
Common, more than one million cases per year in India. Treatable by a medical professional or dermatologist. Usually self diagnosable. Lab testing or imaging rarely required. Spreads by skin to skin contact. (handshakes or hugs) Short term resolves within days to weeks.
"See what can eat your skin and how you can protect it."
Introduction
Skin diseases may either be due to a pathological organism (infections and infestations) or non-infective (without the involvement of a pathogen) Those skin diseases which are due to a disease causing organism like bacteria, fungus or a virus are a infective diseases of the skin and those which are caused by an arthropod (small or primitive insects with joined legs) are termed infestations of the skin.
The examples of bacterial skin infections are cellulitis, erysipelas, impetigo, furuncles, folliculitis etc. The examples of fungal infections are Candidiasis, dermatomycosis etc. and the viral skin diseases include chicken pox, monkeypox, smallpox, warts etc. Certain skin diseases are not due to any pathogens and non infective in nature. The example of such skin disease are Psoriasis, hemangioma etc.
Dermatozoonoses is a skin disease which is caused mainly by the animal parasite. The important parasite which cause skin disease in humans are lice, fleas, bed begs, mosquitoes, mites, etc. These parasites spread through person to person contact, or by sharing the object of personal use belonging to the infested person, particularly clothes, bed linen etc. Improper washing of cloths, linen etc which were used by the affected person facilitate the spread of these diseases. The most common Dermatozoonoses among humans are Scabies and pediculosis.
Scabies is contagious and spreads quickly through close physical contact in a family, school or nursing home. The most common symptom of scabies is intense itching in the area where the mites burrow.
Scabies can be treated by killing the mites and their eggs with medication that's applied from the neck down and left on for eight hours. The mites can also be killed using oral medication
The skin infestation may occur during any part of the year, but is more frequent in autumn and winter. The infestation is charecterized by severe itching, particularly during evening or night and due to continuous itching, there may be pus formation.
A contagious, intensely itchy skin condition caused by a tiny, burrowing mite.
Etiology
Symptoms: Itch; Rash
Severe Itching
Severe itching is charecterized by the small pimples, which are slightly red in color and are charecterized by severe itching followed by the pus formation. The most common sites of this itching are the skin between the fingers, particularly the folds of the thigh, armpits, the breasts etc. Physician has classified this disease into wet and dry. The wet variety is caused by the seepage of pus and other fluids whereas the dry variety is without any seepage. Irrespective of the variety it is charecterized by severe itching The treatment is with systemic use of blood purifiers.
"Strict personal hygiene must be maintained."
Prevention
Practice of skin Hygiene for prevention of Parasitic skin diseases
The first and foremost step in prevention of parasitic skin disease as well as other infestations is the proper care of the skin and its hygiene upkeep. Dust, skin secretions (sebaceous and sweat secretions) should be cleaned periodically, for which soft water is employed as hard water is harmful to the skin owing to the inorganic salts present in it.
The Dermatozoonoses spread either by person to person contact or through cloths, bed linen, and other articles of personal use. Hence the prevention of the parasitic skin diseases is achieved by taking care of this mode of spread. A person to person contact is an important mode of spread. Special care should be taken at community centers, hostels, schools etc to see that any person suffering from parasitic infestation is immediately isolated and proper treatment is provided to him or her. Such person should be kept in isolation from his family members also till such time the infestation is totally eradicated. All the contact of the persons suffering from the parasites should be encouraged to use the insecticidal soap and adhere to the personal hygiene.
Sharing the articles of personal use which were used by the patient (bed linen, hosiery and other clothes, combs etc) should better be avoided and should be treated with permethrin or any suitable agent which destroys the parasite completely.
Other precautions include frequent washing of hands, keeping the skin moist, avoiding contact with overly used surfaces, sharing items of personal use etc. are helpful in avoiding many such pathogenic skin diseases.
Treatment
Allopathic
Locally
Permite (Permethrin) cream (Drug of Choice)
Gama Benzene Hydrochloride Solution (GABA) Lotion 1% or Cream.
Crotorex Ointment or Lotion
Ascabiol Lotion or Benzyl benzoate lotion 25% (12% in children)
To be used externally thus
Lotion or cream should be applied from neck down to toes, left overnight. And application repeated for three consecutive nights or left in skin for 48 hours.
Note : Gamma benzene Hydrochloride should be avoided in pregnancy, infants, young children or with history of seizure disorders.
Patient should have a bath with soap and hot water with rubbing and scrubbing to open all burrows and dry the skin before applying the medicine.
Bedding and clothing should be laundered and disinfected.
Or Ivermectin in a concentration of 0.8% can be applied overnight. Second application after 5 days.
Tab Ivermectin is the first effective systemic therapy. Dose 2 tabs of 6mg BD on empty stomach Dose can be repeated at interval of 2 weeks.
Note Ivermectin should be avoided in children weighing < 15 kg, old age , pregnancy and lactation.
Insecticide spray (Baygon) for room and furniture.
Unless treatment is aimed at all infected persons in the family reinfection will always almost occur.
All the family members and contact should be treated simultaneously.
Lesion complicated by secondary pyoderma :
Sepmax or Bactrim DS twice a day for five days.
Or Ampicillin 500 mg TDS 5-7 days
Or Amoxicillin + Cloxacillin 500mg TDS
Neosporin Cream
Crotorax cream
To be applied for 8 days followed by above treatment
Gentamycin (Lyramycin0cream
Fucidin cream.
If severe secondary infection
Tab Cephalexin 250mg TDS for 3-5 days.
In children 30-50mg/kg in 4 divided doses.
In neonates 125 mg BD for 3-5 days.
Cases resistant to treatment
Combination of treatment (a) and (b) or (b) and (c)
Tab Ivermectin 6mg BD
For Pruritus
Tab Cetrizine 10 OD
Tab Fexofenadine 120-180mg OD for 10 days
Tab Loratididine 10 mg OD
Betnovate N Cream mixed with Crotorax cream.
Zovate-GN cream+ Crotorax cream for 8-10 days, then stop the steroid cream.
For Severe Pruritis
Instrel gel (Paranodin HCL)
To use insecticidal soap
Ayurvedic
Clove oil is useful in scabies
Unani
Blood Purifiers
Locally Sulphur ointments
Or Blue vitriol with addition of ghee as a vehicle is very effective. The drug has to be applied after a hot water bath as the hot water opens up the burrows facilitating the locally applied medications to destroy the parasites. And after application of mentioned medicines locally, again a hot water bath should be given. Strict personal hygiene must be maintained and the bed linen, clothes etc should be properly treated with the insecticides (agents which kill the insects) followed by the treatment with hot water. Person to con contact with the infected person should be avoided to prevent reoccurrence as well as further spread of the parasites.
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