Scabies

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Scabies

Scabies– a parasitic infection that occurs with severe itching (especially at night), epidermal lesions caused by the formation of pathogen passages in the stratum corneum and secondary infection of the skin. Etiology. The causative agent is the scabies mite (itch) Sarcoptes (Acarus) scabiei var. hominis of the Sarcoptidae family. Epidemiology. Scabies is common in countries with a low hygienic culture of the population; At least 300 million cases are registered annually in the world. The increase in the incidence is facilitated by wars, natural disasters and mass migrations of the population. The disease develops as a result of ticks getting on the skin. Infection occurs through contact with the patient, through objects belonging to him (especially clothing and bedding). Much less often, the source of infection is all kinds of domestic animals (dogs, cows, goats, pigs, etc.).

Clinical picture

    • The appearance of sinuous grayish-white passages of scabies mites, lesions are especially pronounced in areas with a delicate and thin stratum corneum – in the interdigital spaces, on the extensor surfaces of the hands, penis, scrotum, buttocks, on the nipples of the mammary glands (in women).
    • In babies, especially infants, the process does not often capture the soles, palms, face and scalp.
    • Along with scabies, discrete vesicles and papules, secondary erosions (caused by scratching), erythema, crusts and desquamation are found.
    • Nodules are found on closed areas of the body (buttocks, perineum, armpits).
    • With secondary infection of scratches (staphylococci and streptococci), pustules are formed with the likely development of pyoderma and eczematization.
    • In patients with immunodeficiency, scabies proceeds atypically, with mild clinical manifestations.

Research methods

    • Examination of the skin under a magnifying glass: they detect the passages of parasites. Also visible are dark dots (accumulations of dirt), transparent or cloudy thickenings at the end of the passages (the location of the ticks).
    • For diagnostics, mineral oil is used, applying a drop to the outlet of the stroke. Then the material containing the parasite is removed, applied to a glass slide and microscoped. Initially, the mites are not very mobile, but then they become more active (to increase the mobility, you can slightly warm the glass). Moves, papules and vesicles can be opened with a spear-shaped needle.
    • With microscopy, you can detect all kinds of stages of tick development: eggs, larvae, adults, as well as their metabolic products. Often, studies of scrapings from under the nails can be positive.
    • You can use 10% solution of KOH, which dissolves the scales of the epidermis (scraping is placed on a glass slide, a drop of KOH is applied and covered with a coverslip). If the microscopy result is negative, the epidermis should be separated and the study repeated.
    • In the absence of visible passages, an ink test is performed: blue ink is applied to the lesion, then the excess ink is washed off

alcohol. The moves are colored and become visible. Then they make an application of mineral oil, scraping and conduct research using the above method.

Differential Diagnosis

    • Dermatitis (atonic, seborrheic, herpetiform)
    • Eczema
    • Insect bites
    • pink lichen
    • Syphilis.

Treatment:

    • 5% ointment with permethrin (nittifor) is applied to the skin for 12-24 hours (30 g of ointment is traditionally enough for an adult), then washed off. In some cases, it is recommended to reapply the ointment after 48 hours.
    • Lindane is used as a cream and shampoo. Cream or lotion is applied to the entire surface of the skin and washed off after 8-12 hours. Some dermatologists recommend repeating after 7 days. Use with caution in premature, dystrophic babies, as well as in patients with severe skin lesions or a history of epileptic seizures.
    • Benzyl benzoate nbsp; – in the form of a water-soap suspension (2 g of green or laundry soap is diluted in 78 ml of warm water and 20 ml of benzyl benzoate is added, then it is thoroughly shaken) rubbed with a moistened swab into the skin (except for the scalp, face and neck) arms, torso, then legs. Apply only under the supervision of medical personnel. Possible skin irritation.
    • Spregal (aerosol) is sprayed at a distance of 20-30 cm throughout the body, except for the face and hair, the most affected areas are especially carefully treated. After 12 hours (but not before), the skin should be washed with soap and rinsed well. For treatment, it is enough to treat the surface of the body once. The drug is not contraindicated in pregnancy and newborns.
    • Crotamiton in the form of an ointment is applied for 8-14 hours, then washed off.
    • Repeated applications of products (except Permitin) are carried out only as directed by a doctor.
    • 5-10% sulfur liniment is applied to the body, starting from the skin of the neck.
    • During pregnancy, lindane is used sparingly and no more than 2 times during pregnancy, because. it is neurotoxic and can cause seizures.
    • For children under 2 years of age, the appointment of permethrin or sulfur liniment is preferable.

Complications

    • Eczema
    • pyoderma
    • Pruritus after mites
    • Tick ​​knots.

Current and forecast. Against the background of treatment, the symptoms regress after 1-2 days. Itching and dermatitis are present for 10-14 days and can be treated with antihistamine products or glucocorticoids (by mouth or topically). Nodules may persist for several weeks. ICD. B86 Scabies See also fig. 3-28 Literature. Scabies. Sv limitsva TV, Fedorovskaya RF, Lange AB. M.: Medicine, 1989