Dr.

Shamim Ara
Associate professor
Dermatology and Venereology
CIMCH
Definition
A common parasitic skin disease caused by sarcoptes scabiei.
Incidence: children are more affected (0—5years). M=F.

Precipitating factors:
 Overcrowding
 Unhygienic condition
 Winter season
 Close contact (close, intimate personal contact for 15-20 minutes
with an infected person is adequate for the transmission of the
disease)
clothings, beddings
 Immunocompromized patients—AIDS, DM, Psychiatric disorders
Clinical features:
Symptoms
1. Itching—worse at night
Other family members may be affected
continuous in nature
scratch marks
secondary pyogenic infection
2. Boils, abscess, pustules
3. Fever
4. With complications--
Signs
Papule
Vesicle
Pustule
Scratch mark
Eczematization.
Sites of predilection
1.Circle of Hebra
-web space of fingers
-wrists (anterior aspects)
-ulnar border of forearm
-elbow—antecubital fossa
-axillary fold
-areola of nipple
-umbilicus
2. Genitalia
3. Crural region
4. Thighs (medial more)
5. Popliteal fossa
6. Palms & soles
Face & scalp is usually spared in adults. Why?
The density of hair follicles is 16 times greater here
than on the limbs, so there is increased sebaceous
activity—increased androgen receptor activity. Sebum
is acidic in nature. So, sarcoptes scabieie can not
localize.
Types of Scabies:
Classical scabies
Scabies in clean
Scabies incognito
Infantile scabies
Crusted scabies
Nodular scabies
Bullous scabies
Classical scabies:
Crusted scabies:
Infantile scabies:
Scabies incognito:
Nodular scabies:
Bullous scabies:
Diagnosis
The confirmatory evidence of scabies is
demonstration of s. scabieie in burrow.
There are 4 cardinal features in the clinical
diagnosis are:
1.Intense pruritus, which tends to be worse at night.
2.The characteristic distribution pattern of lesions.
3.The presence of burrow, especially on the hands
or penis.
4.Presence or history of similar illness in other
members of the house.
Complications
Secondary pyogenic infection.
Eczematization.
AGN.
(streptococcusβ-hemolyticus (nephritogenic
strain—4,12,49,57) → Ag-Ab(IgG) → immune
complex deposition in glomeruli→ AGN → type
iii reaction.)
D/d of Scabies:
Atopic dermatitis
Contact dermatitis
Insect bite hypersensitivity
Drug eruption
Management
General—
1.Antihistamines
2.Antibiotics—if pyogenic infection
3.Mild topical steroid-antibiotic combination—if
eczematization.
4.Personal hygiene maintenance
5.Mass treatment
6.Washing of cloths
Treatment:
Drug Dose

 Topical:
 5% Permethrin cream  Apply for 8 hrs,repeat in 7days.
 Gamma benzene hexachloride1%  Apply for 8 hrs,repeat in 7days.
 Benzyl Benzoate Lotion (BBL)  apply for 3 consecutive nights &
25% repeat it after 1 week.
 Tetra ethyl monosulfiram  Apply for 8 hrs,repeat in 3days.
 Crotamiton 10%  Apply for 8 hrs ,on days 1,2,3
 Precipited sulfur 5% + 10% and 8.
 Apply for 8 hrs ,on days 1,2,3 .
 Systemic:
Ivermactin200  Taken orally on day1 and 8.
microgram/Kg
Instruction to parents/patients:
Medication should be rubbed into the skin and all
body parts.
Topical agent should applied on clean and dry skin.
Treatment is best done at night before going to Bed.
Change your under clothing and sheet next day and
launder them(i.e. wash out, dry, and should be iron.)
Everyone in the house should be treated at same
time.
Itching may persist for few days after treatment ,but
never re-apply the medication without doctor’s advice.