Adviser: Dr. Sri Primawati Indraswari,Sp.

KK, MM

By : Mimi Suhaini bt Sudin (030.08.309)

Scabies is an itchy skin condition caused by a tiny burrowing mite called Sarcoptes scabiei. The presence of the mite leads to intense itching in the area of its burrows. The urge to scratch may be especially strong at night.

Sarcoptes scabiei var hominis

- Sarcoptes scabiei var.hominis : Phylum: Arthropoda Class: Arachnida Subclass: Acari Family: Sacroptidae Morfology Adult scabies mites are spherical, eyeless mites with four pairs of legs (two pairs in front and two pairs behind).[3] They are recognizable by their oval, ventrally flattened and dorsally convex tortoise-like bodies and multiple cuticular spines

Male

Differences

Female
330-450 mikron x 250350 mikron 2 pairs of feet in front of as a tool to attach and 2 pairs of feet with both ends of hair 30 days

200 240 mikron x 150- Size 200 mikron The third leg ended with a pair of hair and fourth ends with adhesive tools 10 days Leg

Duration of life

Adult Sarcoptes scabiei

Nymph have 4 pairs of legs

10-17 days

Female S.Scabiei lay their eggs in the burrow

Nymph
Male S.Scabies j
Female S . Scabies

Female of Sarcoptes scabiei lay eggs in the burrow

Nymph with 3 pairs of legs

2-3 days Larva 3-5 days Egg

Larva in the egg

Nokturna pruritus, itching at night means that mite activity is caused by higher temperatures are more humid and hot.

These diseases attack humans in groups

CARDINAL SIGN
The existence of the tunnel (kunikulus) Finding mites, are the most diagnostic. Can be found in one or more life stages of this mite.

TOTAL : 414 CASES

137 cases

Total cases

33% Men

67%
277 cases

Women

Age group
150 100 50 0 <1 1-4 5-14 15-24 25 - 44 Age group 45-64 25 - 44 46 >65 45-64 52 >65 5

Age group

<1 12

1-4 49

5-14 131

15-24 111

Environmental cleanliness

Predisposing factors

Poor personal hygiene

Low-income community

TRANSMISSION
- Direct contact ( prolonged, skin-to-skin contact with a person who has scabies )
-Indirect contact ( sharing articles such as clothing, towels, or bedding used by an infested person; however, such indirect spread can occur much more easily when the infested person has crusted scabies. )

wrists Elbows Umbilicus Axillae genitals Hands especially the webspaces.

can be made when two of these four cardinal signs is found

ANAMNESIS
A 22 years-old man, unmarried, moslem, live in ABABIL 9 RT/RW 07/06 Kelurahan Randugunting Kecamatan Tegal Selatan comes to Kardinah General Hospital, Tegal on Thursday, 21 November 2013.

Chief Complaint

Extensive rash with severe itchy at fingers of both hands, arms, legs, buttocks and genitals and become worsen especially during night for about one month ago

 1 month ago

Itching of the genitals that is getting worse at night and arose extensive rash , he scratch due to the itchy and cause bleeding and crust

1 day ago

Body feels hot, continuous, but not shievering

Come to Kardinah General Hospital

History of Past Illness

The patient had no history of food allergies, drugs, shortness of breath accompanied by wheezing, runny nose and sneezing, especially to changes in weather and dust

History of Family Illness

His father experienced similar symptoms like patient had one month ago and have been recovered

History of Habits

He live at home with father, mother, two brothers and sister. Patients sleep in a room with her sister in a mattress. 1 Bed linen is usually replaced once a month. Towels not be used interchangeably. Patients 2x daily bath using well water. Frequent use of soap is used together with the family.Patient change his clothes 2 times a day.

General Condition
General appearance Consciousness Vital Sign Blood pressure Pulse Temperature Respiration rate : Mild ill : Compos Mentis : : 110/80 mmHg : 80 x/minute : Afebris : 20 x/minute

General Condition

Head Eye

: Normocephali : Conjunctiva anemic (-/-), sclera icteric (-/-), Nose : Normal, no abnormalities Mouth : Good OH Leher : Lymph node enlargement (-) Thorax : Pulmo : Vesicular breath sound, Ronkhi (-/-), Wheezing(-/-) Cor : SI/SII Regular(+), murmur(-), Gallop(-) Extremities: Warm acrals (-/-)/(-/-), oedem (-/-)/(-/-)

Distribution Ad Regio

Regional

upper extremity, lower extremities, buttocks and genitalia

Multiple, discrete, partially confluent, rounded shapes, sizes miliar to lenticuler varies between 0.2-0.5 mm in diameter,, the edges do not seem more active, dry lesions

Lesion

Effloresency

Erythematous papules, crust

Lesion at upper extermity

Lesion at lower extremity

Lesion at patient`s body

Lesion at axilla

Lesion at the buttock Lesion at genital

- Skin scraping negative

Man , 22 years old, unmarried, Islam, came to Kardinah General Hospitals on November 21st , 2013 at 10:30 am with the extensive rash with severe itchy at fingers of both hands, arms, legs, buttocks and genitals and become worsen especially during night for about one month ago

In the history obtained the patient complaints of itching severe especially during at night and this itching make the patient to scratch. The patient was not bitten by the previous insects. Since 1 day ago body feels hot, continuous, and not to shiver. Patient had a similar pain 1 month ago but only in the genitals, has been seeing a general practitioner and he said that it is improved.

On physical examination, the status of generalist obtained is in a normal state. On the status dermatology it is found to appear erythematous papules on the upper and lower extremity, genitals, and buttocks multiple, discrete, partially confluent, rounded shapes, sizes miliary to lenticuler diameter varies between 0.2 to 0, 5 mm, the edges are not more active, dry lesions

In the anamnesis, itching worse at night and make the patient to scratch until it bled. Patients already get medication from Puskesmas but he complaints that it got worse since 3 days ago and returned to the clinic. In health centers were given sticky white ointment. But complaints got worse and finally the patient was referred to hospital. The patient was not bitten by the previous insects. His father also have a similar symptom as him but have been recovered.

SCABIES

=?

PRURIGO

DERMATITIS

Scabies with seconder infection

General: Explain to the patient about the disease and how treatment. Explaining that scabies is a contagious disease. Explaining the importance of maintaining personal hygiene and living environment. Wash bed linen, blankets, towels, and clothes with a final rinse using hot water. When itching should not scratch too hard because it can lead to injuries and the risk of infection (secondary infection). Explained to the patient that the drug will be given after topical at night, should not bathe or contact with water, allowed to stand for 10 hours until the next morning. Drugs used 1x, and can be repeated a week later. Treatment of all family members who suffer from the same complaint in the same time to prevent transmission to the members who are already healthy or improved.

MANAGEMENT : TOPICAL

Cream Permetrin 5%

Cream Fusidic acid 2 % k

SYSTEMIC
Antihistamin : Clorpheniramin maleat 3 x 4 mg Antibiotic: Amoxicilin 3x 500 mg

Quo ad vitam : ad bonam Quo ad fungtionam : ad bonam Quo ad sanationam : ad bonam

Found 3 cardinal signs of scabies: (condition 2 of 4 cardinal signs are met) nocturnal pruritus,Complaints of itching, especially at night ,Attacking a group of people, patient's father, Canaliculi Found / white Burrow, in between the fingers and the palm of the hand

Predisposing factors: Direct contact with patients: Patients with a father who suffered from the same complaint, Indirect contact with the patient: The use of soap with, Poor hygiene:sheets are rarely replaced, along with soap, shower water wells

SCABIES

Because S.scabiei in the form of eggs, larvae, nymphs, or adults as well as products are not found

PRURIGO

Because it resembles. However prurigo: non-specific itching worse at night - Hereditary

- Because it resembles however

DERMATITIS

dermatitis: non-specific itching worse at night

Skin scrapings

(- ve)

Skin condition may sometimes spontaneously resolve, but threatment options include: For noncrusted scabies: 5% pyrethrin or permethrin cream (Elimite) OR gamma benzene hexachloride (lindane), but may be neurotoxic and not suggested for pregnant or lactating women OR 10% crotamiton, N-ethyl-o-crotonotoluidide (Eurax) for infants under 2 months Applied to all skin surfaces in infants, children, and the elderly. Scabicide should be applied for 8 to 12 hours and then washed off. Repeat application in 1 week if live mites or eggs are still present

topical: Permethrin 5% in creams, because: Effective on all stages, Less toxic than gameksan, easy to use, Children over 2 years is SAFE

Fusidic acid 2% cream, because:There is a secondary infection topical antibiotic

Systemic:
Antihistamine: 3x4 mg clorpheniramine maleate, because: itch Cheap and easy to come by

Antibiotics: amoxilline 3x500 mg, because:

There is a secondary infection systemic broadspectrum antibiotics

Quo ad vitam : ad bonam Quo ad fungtionam : ad bonam Quo ad sanationam : ad bonam

Fitzpatrick, Thomas B., Johnson, Richard A., Wolff, Klaus, Polano, Machiel K., Suurmond, Scabies, In Color Atlas and Synopsis of Clinical Dermatology; common and Serious Disease. 3rd Ed., Mc Graw Hill. USA.1997. 842-849. 2. Handoko, Ronny P., Skabies, dalam Ilmu Penyakit Kulit dan Kelamin, diedit oleh Djuanda, A., Edisi Kelima, cetakan kedua FK UI. Jakarta 2007. Hal : 122-125. 3. Graham-Brown, Robin, Tony Burns, Infeksi Ektoparasit dalam Lecture Notes; Dermatologi. Alih bahasa oleh M. Anis Zakaria, diedit oleh Amalia Safitri. Edisi Kedelapan, Erlangga. Jakarta. 2005. Hal : 42-45. 4. Mansjoer, Arif., et al. KapitaSelektaKedokteran. Edisiketiga. Media Aesculapius. Jakarta. 2000: 110-112.
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