MED 704- BLOCK 2

PRESENTATION
NAME: DIVYANSHI KOMAL MAHARAJ

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SCABIES
IS AN INFESTATION OF
THE SKIN

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 EPIDEMIOLOGY
• Scabies- major public health problem
• Globally- affect more than 200 million people at any time.
• A recent study undertaken in Fiji found that the prevalence of scabies was 23.6%, and when
adjusted for age structure and geographic location based on census data, the estimated national
prevalence was 18.5%.
• The prevalence was highest in children aged 5-9years (43.7%), followed by children <5 YEARS
(36.5%).
• The prevalence of scabies was twice as high in iTaukei (indigenous) Fijians compared to Indo-
Fijians.

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 WHAT IS SCABIES?
• Human scabies is a parasitic infestation.

• Cause: Sarcoptes scabiei var hominis (tiny itch mites).

• Classic scabies typically manifests as an intensely pruritic eruption with a

characteristic distribution.

• Common sites of involvement-sides and webs of the fingers, wrists, axillae, areolae, and
genitalia are among the

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 LIFE CYCLE AND TRANSMISSION
S. scabiei var. hominis is a whitish-brown, eight-legged mite.

Female mites are larger than male mites. After mating, female mites burrow into the epidermis, a process
facilitated by secretion of proteolytic enzymes that cause keratinocyte damage.

Female mites continue to extend the burrow and lay two to three eggs per day before dying after four to six
weeks. Larvae hatch in three to four days and molt three times within the burrow to reach adulthood.

The mite burden in patients with classic scabies is generally low, limited to an average of 10 to 15 mites during an
initial episode and approximately half as many with subsequent infestations.

Transmission of scabies usually occurs through direct and prolonged skin-to-skin contact, as may occur among
family members or sexual partners.

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 CLINICAL MANIFESTATIONS

• Pruritusresults from a delayed-type hypersensitivity reaction to the mite, mite feces, and
mite eggs.
• severe and usually worse at night.
• Symptoms typically begin 3-6 weeks after primary infestation. However, in previously
infested patients, symptoms usually begin within 1-3 days after infestation, presumably
because of prior sensitization.
• Typical cutaneous findings are multiple small, erythematous papules, often excoriated.
• Burrows may be visible as 2 to 15 mm, thin, gray, red, or brown, serpiginous lines. Burrows
are a characteristic finding but often are not visible due to excoriation or secondary
infection.

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Scabies usually involves the sides and webs of the
fingers, the flexor aspects of the wrists, the extensor
aspects of the elbows, anterior and posterior axillary
folds, the skin immediately adjacent to the nipples
(especially in females), the periumbilical areas, waist,
male genitalia (scrotum, penile shaft, and glans), the
extensor surface of the knees, the lower half of the
buttocks and adjacent thighs, and the lateral and
posterior aspects of the feet. The back is relatively free
of involvement; the head is spared except in very young
children.

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Erythematous
papules, vesicles, and
pustules are present
on the sole of the foot
of this infant.

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Multiple erythematous
papules are present on
the wrist of this infant.

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 DIAGNOSIS

• The diagnosis of scabies is confirmed through the detection of the scabies mite, eggs, or fecal
pellets (also known as "scybala") through microscopic examination. However, since these
findings are not always readily detected given the low number of mites in patients with classic
scabies and microscopic examination is not always feasible, a presumptive diagnosis is
sometimes made based upon a consistent history and physical examination.
• Dermoscopy is a helpful adjunctive diagnostic tool.
• History and physical examination — The diagnosis of classic scabies should be suspected in
patients with one or more of the following :

 Widespread itching that is worse at night, spares the head (except in infants and young
children), and seems to be out of proportion to visible changes in the skin
 A pruritic eruption with characteristic lesions and distribution
 Other household members with similar symptoms

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SCABETIC BURROW

Burrows often are not evident on physical

examination but, when seen, strongly
support the diagnosis

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• Examination for mites — The definitive method to confirm diagnosis of scabies is a
scabies preparation.
1. Scabies preparations are used to detect mites, mite eggs, or mite fecal pellets. The
sensitivity of scabies preparation ranges from 46 to 90%; the specificity is 100%

2. Dermoscopic examination can identify sites of scabies mites or burrows and can facilitate
placement of the scraping. Because of the low mite burden in classic scabies, negative
results do not exclude the diagnosis.
The characteristic finding on dermoscopic examination is a dark, triangular shape that
represents the head of the mite within a burrow ("delta wing" sign) (picture 10A-B). In
addition, burrows are more easily visualized with dermoscopy.

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 MANAGEMENT OF SCABIES

The successful management of scabies involves:

• Eradication of the infestation

• Management of pruritus
• Management of complications
• Treatment of close personal contacts
• Implementation of environmental measures to minimize transmission
and recurrence of infestation

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It is very important to explain to the parent/care
giver the following points:
1. Provide an explanation of what scabies is
2. Explain the 3 points of the treatment of scabies
• Treat with the cream all over the body
• Wash the clothes and bedding
• Treat other members of the family with the
cream
3. Explain that scabies can be prevented from
returning by bathing regularly and washing
bedding and clothing regularly

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 REFERENCE
• https://www.health.gov.fj/wp-content/uploads/2019/08/Fiji-Guidelines-for-Sore-Throat-and-
Skin-Disease.pdf
• https://www.uptodate.com/contents/scabies-management?search=SCABIES&topicRef=4038
&source=see_link#H2475940090
• https://www.uv.es/derma/CLindex/CLinfest/cycles001.htm
• https://www.who.int/news-room/fact-sheets/detail/scabies

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