Scabies and Pediculosis
12
SCABIES
Scabies, a common cause of itching, is produced
by infestation with the mite Sarcoptes scabiei var
hominis. Poor hygeinic conditions and over-
crowding, permitting close body contact, favor
the transmission of the disease.
Acarus scabiei has four pairs of legs. The female
measures 400 µ by 300 µ in size (Fig. 12.1).
The male is appreciably smaller. Acarus scabiei
undergoes its life cycle on the skin surface. The
Figure 12.1: Sarcoptes scabiei
male mite fertilizes the female and dies. The
adult female, after impregnation, burrows into
the skin and forms a tunnel in the horny layer
(stratum corneum). It burrows at the rate of 1
to 5 mm per day. Two days after fertilization,
it starts laying eggs along her course in the
burrow. Two to three eggs are laid each day.
A female Acarus lays a total of 10 to 25 eggs
during her lifespan of 30 days and then dies at
the end of the burrow. The egg hatches in 3 to
4 days producing a larva that moves to the skin
surface. It then moults through various stages
of octopod nymph into an adult mite in 10 to
14 days.
CLINICAL FEATURES
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not occur for three to four weeks, till the patient
is sensitized to the products of the mite. In
subsequent attacks the symptoms may develop
within few hours of infestation.
The patient presents with nocturnal itching,
most marked when the person is warm in bed.
It is associated with burrows, papules, papulo-
vesicles, vesicles or pustules (Figs 12.2A to C).
Burrows, though considered pathognomic
of scabies, are not frequently encountered in
Indian patients. This is because they present late
for treatment and by this time the burrows have
been excoriated and the secondary bacterial
 Scabies and Pediculosis 51

Figure 12.3: Scabies: Papular, pustular lesions

affecting the genitals
infection has often supervened, resulting in
impetiginization. The distribution of lesions is
characteristic and the sites of predilection are the
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elbows, anterior axillary folds, lower abdomen,
buttocks, nipple area in females, and external
B genitalia in the males (Fig. 12.3). In infants and
small children the scalp, face, palms, and the
soles may also be involved. Very often, more
than one member of the family may be affected.

Clinical Variants
A number of clinical variants may be encoun-
tered such as the following.

Classical Scabies (vide supra)

C myriads of mites. There may be associated
Figures 12.2A to C: Scabies depicting papules and
pustules affecting the interdigital spaces and the wrist
of the hand
Norwegian scabies (crusted scabies): It is en-
countered in mentally retarded, physically
debilitated or immunosuppressed patients.
It is characterized by erythematous, scaly
eruptions on the hands and feet, harbo ring
dystrophy of the nails. It is highly contagious
and even a casual contact may transmit the
disease.
 52 Textbook of Clinical Dermatology
Scabies in clean patients: One or two sites of
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bathing.
Scabies in infants and children: It is charac-
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the head, neck, palms, and soles. The itching
is severe resulting in excoriations. Secondary
bacterial infection results in pustules, impetigo,
ecthyma, and crusting.
Scabies in the elderly: It is characterized by
severe itching which is frequently attributed to
dry skin, anxiety or passed off as senile pruritus.
Elderly patients, when bed ridden for a prolon-
ged period, may have involvement of the back.
Nodular scabies: Nodules develop as a part of
hypersensitivity reaction. They are reddish brown
and pruritic and are distributed on covered parts
especially male genitalia, groins, and axillae.
Scabies incognito: Systemic and topical corti-
costeroids may mask the signs and symptoms
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sites of predilection (vide supra)
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TREATMENT
The treatment should be formed around as
detailed in Table 12.1.
PEDICULOSIS
Pediculosis results from infestation with the lice,
of which there are two types: (1) Pediculus huma-
nus with its two varieties: Pediculus humanus
corporis and Pediculus humanus capitis, (Fig. 12.4)
and (2) Phthirus pubis. These infest the body,
scalp, and the pubic area, respectively.
The gravid female louse lays a few eggs daily.
These eggs are called nits. They are small,
oval, greyish white, and 0.5 mm in length
of scabies. However, the infestation persists and
may show atypical distribution and unusual
extent of involvement.
Animal scabies: Close contact with the infested
animals is responsible for transmission of scabies
from animals to man. The eruption is less severe
and the characteristic burrows are not formed.
Various complications may ensue in a case of
untreated scabies, such as the following:
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in children due to secondary infection with
streptococci.
DIAGNOSIS
It is based on the following:
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a period of 2 to 3 weeks, to attain maturity. Its
entire life cycle is of 1 month.
Pediculosis capitis: It is the infestation of scalp
by P. capitis. It localizes in the scalp, favoring the
occiput and temporal areas. The adult louse is
rarely observed. However, the nits along the hair
shafts are easily seen. They are laid close to the
scalp surface, at the bottom of the hair. They are
carried higher along with the growth of the hair.
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sheath and cannot be moved along the shaft.
Itching is the usual presenting complaint.
Scratching causes trauma with resultant oozing.
Secondary infection usually supervenes resul-
ting in pustulation and abscess formation.
Occipital and cervical lymph nodes are
frequently enlarged. A recurrent pyoderma

Scabicidal agents
1. 25% Benzyl benzoate
for adults
12.5% for children
(Ascabiol)
2. 1% Gamma benzene
hexachloride (Gab,
Scarab)
3. 0.5% Malathion solution
4. 10% Crotamiton
5. 10% Precipitate sulfur
in pertrolatum
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soap)
7. Topical thiabendazole
Figure 12.4: Pediculosa corporis
Scabies and Pediculosis 53
Table 12.1: Scabies treatment
Mode of applications Number of applications Other measures
Apply to the whole of 3 applications at 12 hours Clothes, bed clothes may
skin surface below the intervals followed by a bath be laundered. New
neck after a hot scrub washed set of clothes
bath should be worn after
treatment
-do- Single application. -do-
Bath after 8 hours. Avoid application on face
and in children as it is an
irritant
-do- -do- -do-
May be applied on Two applications at 12 Usually preferred in
whole body including hours interval followed infants and small children
the face by a bath
Rarely used — Irritant and it stains the
clothes
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prior to applying
other scabicidal agents
— — —
Figure 12.5: Nits
of scalp should always arouse a suspicion of
pediculosis.
Pediculosis corporis: The body louse inhabits
the seams of the clothings. The nits remain
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getting the warmth of the body.
The lice bites the skin to suck blood. During biting,
a mild toxin is released which is responsible for
producing a purpuric spot and evokes strong
itching. This results in excoriations, which are the
 54 Textbook of Clinical Dermatology

Table 12.2: Treatment of pediculosis

Site of infestations Pediculocidal agents
1. Pediculosis capitis 1. 1% Gammabenzene hexachloride (Gab)
2. 25% Benzyl benzoate (Ascabiol)
3. 0.5% malathion
2. Pediculosis corporis
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Modes of applications
Three applications on consecutive days
followed by tying a cloth on the scalp.
Shampoo after 7 days.
Laundering and ironing of clothes,
especially the seams.
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necessary, repeat after 3 days.

hallmark of the disease. They are distributed over
the shoulders, trunk, and buttocks. Other lesions
which may be encountered are wheals, papules,
and exanthematous rashes. Secondary bacterial
infection supervenes in neglected cases.
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neglect of pediculosis and is characterized by
dry, scaly, darkly pigmented skin associated
with excoriation, eczematization, bacterial
infections, and accumulation of crust.
Pediculosis pubis: This is the infestation of
pubic and perianal hairs by Phthirus pubis. It
is usually transmitted by sexual contact. The
adult louse clings to the hairs with its mouth
parts buried in the skin. The adult female lays
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pubic hair. The patient complains of itching,
which inevitably results in scratching. The
hairs may be matted in the thick crust of dried
pus, serum, and blood. The patient may also
notice tiny blood spots on the underwear.
Occassionally, bluish macules, 0.5 cm in
diameter may be noticed on the inner aspect
of thighs. These are maculae caerulae. They
result due to the altered blood pigments of the
infested person.
DIAGNOSIS
The diagnosis is usually suspected on clinical
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may be observed under the low power of the
microscope.
TREATMENT
Treatment should be formed around as shown
in Table 12.2.
RECOMMENDED READING
  0HOODQE\ . Scabies, 2nd edition. Hampton,
England: E.W. Classey 1972.
  2UNLQ 0 6FDELHV DQG 3HGLFXORVLV 0DMRU 3UREO
Clin 1977;19:209-221.
  6HKJDO915DR7/5HJH9/et al. Scabies: Study
of incidence and treatment methods. Int J Dermatol
1972;11:106-111.