REFERAT

Scabies

Adviser :
dr. Suswardana, Sp.KK

Created by :
Lira Fitrianti 121. 0221.078

Departement ! Dermat "enere # $% RSAL &int 'ard( FK )*+ ,*emban$unan +asi na# )ni"ersit%*eri de 201.

Scabies
Abstract
Scabies is a 'uman s/in in!estati n caused b% t'r penetrati n ! t'e b#i$ate 'uman parasitic mite Sarcoptes scabiei "ar. hominis int t'e epidermis. T'e dia$n sis ! scabies rests #ar$e#% n t'e 'ist r% and e0aminati n ! t'e patient, as we## as n t'e 'ist r% ! t'e !ami#% and c# se c ntacts. 1#assic mani!estati ns ! scabies inc#ude $enera#i2ed and intense itc'in$, INTRODUCTION Scabies is a 'uman s/in in!estati n caused b% t'r penetrati n ! t'e b#i$ate 'uman parasitic mite Sarcoptes scabiei "ar. hominis int t'e epidermis. T'e scabies mite is an art'r p d ! t'e rder Acarina w'ic' was !irst identi!ied in t'e 1800s, but was n t rec $ni2ed as t'e cause ! t'e s/in erupti n unti# 1700s. T'ere are estimatess t'at "er .00 mi##i n pe p#e w r#dwide are in!ected wit' t'e scabies mite. Scabies a!!ects a## s ci ec n mic c#asses, wit' w men and c'i#dren bein$ dispr p rti nate#% in!ected. 5t tends t be m re pre"a#ent in urban areas, particu#ar#% in "ercr wded re$i ns.1 T'e scabies mite 'as ! ur pairs ! #e$s and measures 0.. mm in diameter. 5t is t'ere! re n t easi#% seen wit' t'e na/ed e%e. 5t #i"es its entire .09da%s #i!e c%c#e in and n t'e epidermis. T'e !ema#e mite burr ws int t'e stratum c rneum wit'in 20 inutes and #a%s appr 0iate#e e$$s a da%. T'e e$$s 'atc' !ter : da%s, and t'e #ar"ae mi$rate t t'e s/in sur!ace and mature int adu#t. T'e . e$$s a da%. T'e a T'e ma#e, w'ic' is s#i$'t#% sma##er t'an t'e !ema#e, !a## !! t'e s/in and peris'es.1 STRATEGIES AND EVIDENCE Diagnosis T'e dia$n sis ! scabies rests #ar$e#% n t'e 'ist r% and e0aminati n ! t'e patient, as we## as n t'e 'ist r% ! t'e !ami#% and c# se c ntacts. 1#assic mani!estati ns ! scabies inc#ude $enera#i2ed and intense itc'in$, usua##% sparin$ t'e !ace and 'ead. *ruritus is w rse at ni$'t. T'e #esi ns are # cated m st#% in t'e !in$er webs ,Fi$. 2A-, n t'e!#e0 r sur!aces ! t'e wrists, n t'e e#b ws, in t'e a0i##ae, n t'e butt c/s usua##% sparin$ t'e !ace and 'ead. *ruritus is w rse at ni$'t. F r t'e treatment ! c#assica# scabies, permet'rin 34 cream is ur pre!erred a$ent. 5"ermectin, administered ra##% at a d se ! 200 6$ per /i# $ram ! b d% wei$'t, is an e!!ecti"e a#ternati"e treatment. Keyword 7 scabies, pruritus at ni$'t, paracitic.

and $enita#ia ,Fi$. 2;-, and n t'e breasts ! w men ,Fi$. 21-. 5n!#ammat r% pruritic papu#es are present at m st sites. ;urr ws ,Fi$. 2D- and n du#es ,$enera##% in t'e $enita# re$i ns and a0i##ae- are speci!ic ! r scabies but ma% be absent. + nspeci!ic sec ndar% #esi ns, inc#udin$ e0c riati ns, ec2emati2ati n ,Fi$. 2E-, and 2 impeti$ini2ati n, ma% ccur an%w'ere.

Diagnostic Tests De!initi"e dia$n sis re#ies n t'e identi!icati n ! mites, e$$s, e$$s'e## !ra$ments, r mite pe##ets. &u#tip#e super!icia# s/in samp#es s' u#d be btained !r m c'aracteristic #esi ns < speci!ica##%, burr ws r papu#es and "esic#es in t'e site ! burr ws < b% scrapin$ #atera##% acr ss t'e s/in wit' a b#ade, ta/in$ care t a" id b#eedin$. T'e specimens can be e0amined wit' a #i$'t micr sc pe under # w p wer ,Fi$. 1-.2

Scabies ccasi na##% presents in at%pica# ! rms ,Tab#e 1- t'at are m re di!!icu#t t dia$n se t'an t'e c#assic ! rms and, t'ere! re, ma% be m re #i/e#% t #ead t utbrea/s. At%pica# presentati ns in in!ants !ten in" #"e t'e !ace, sca#p, pa#ms, and s #es.2

5n at%pica# cases r w'en direct e0aminati n is n t p ssib#e, a s/in bi ps% ma% p tentia##% c n!irm t'e dia$n sis ,Fi$. :-. = we"er, mites r t'er dia$n stic !indin$s are !re>uent#% absent, and t'e 'ist # $ic e0aminati n usua##% s' ws a n nspeci!ic, de#a%ed 2 '%persensiti"it% reacti n. Treatment ?ur rec mmendati ns ! r t'e treatment ! "ari us scabies s%ndr mes are summari2ed in ,Tab#e 2-. F r t'e treatment ! c#assica# scabies, permet'rin 34 cream is ur pre!erred a$ent. T ensure a re#iab#e cure, t'e cream s' u#d be app#ied t t'e entire sur!ace ! t'e s/in e0cept ar und t'e e%es. A#t' u$' s me $uide#ines su$$est t'at t pica# t'erap% need n t be app#ied ab "e t'e nec/, we be#ie"e t'at inc#udin$ t'is area is particu#ar#% imp rtant in sma## c'i#dren and t'e e#der#%, in w' m t'e in!ecti n >uite !ten in" #"es t'e sca#p. *articu#ar attenti n s' u#d be paid t t'e areas t'at are m st !ten in" #"ed, inc#udin$ t'e areas between t'e !in$ers and t es, under t'e arms, and under t'e !in$ernai#s and t enai#s@ t'e wrists@ t'e e0terna# $enita#ia@ and t'e butt c/s.2. T ma0imi2e e0p sure ! t'e mites t t'e dru$, it is $enera##% rec mmended t'at t'e cream be app#ied in t'e e"enin$ and #e!t n "erni$'t. T eradicate an% mites t'at were n t e0p sed at t'e time ! t'e !irst treatment, it is $enera##% rec mmended t'at a sec nd app#icati n be administered 1 t 2 wee/s a!ter t'e !irst. = we"er, t'e e!!icac% ! ne app#icati n as c mpared wit' tw app#icati ns 'as n t been ! rma##% tested, and t'e ptima# inter"a# between d ses 'as n t been precise#% de!ined.. 5"ermectin, administered ra##% at a d se ! 200 6$ per /i# $ram ! b d% wei$'t, is an e!!ecti"e a#ternati"e treatment. Since in$esti n ! ! d increases t'e bi a"ai#abi#it% ! i"ermectin b% a !act r ! tw ,2: ta/in$ t'e dru$ wit' ! d wi##

en'ance t'e penetrati n ! t'e dru$ int t'e epidermis. Since i"ermectin is n t "icida#, it is rec mmended t'at tw d ses, separated b% 1 t 2 wee/s, be administered ! r t'e treatment ! c#assica# scabies. T'e serum 'a#!9#i!e ! i"ermectin is 18 ' urs,2: wit' dru$ e#iminati n ccurrin$ t'r u$' metab #ism in t'e #i"er and e0creti n ! inacti"e metab #ites t'r u$' t'e /idne%s. Ad(ustment ! t'e d se is n t necessar% in patients wit' rena# impairment. = we"er, t'e sa!et% ! administerin$ mu#tip#e d ses ! i"ermectin in patients wit' se"ere #i"er disease 'as n t been studied.. Tabe# 2. T'erapies ! r scabies

SUMMAR AND RECOMMENDATIONS

*atients wit' scabies s' u#d be in! rmed t'at scabies is beni$n but transmissib#e and t'at se"era# treatments are a"ai#ab#e. Treatment s' u#d be rec mmended n t'e basis ! a c n!irmed dia$n sis. T pica# permet'rin is reas nab#e !irst9#ine t'erap% in t'e )nited States. A'ere permet'rin is n t a"ai#ab#e ,e.$., in France-, t pica# ben2%# ben2 ate r ra# i"ermectin are $ d c' ices. ?ra# i"ermectin is pre!erred ! r patients w' cann t t #erate t pica# t'erap% and t' se w' are un#i/e#% t ad'ere t a re$imen ! suc' t'erap%.. RE!ERENCES 1. A #!!K, B #dsmit' L. A, Kat2 S. 5, Bi#c'rest ;. A, *a##er A. S, Le!!ei# D. C. Scabies. Fit2patric/Ds dermat # $% in $enera# medicine. 7 ed. +ew E r/ 7 T''e &cBraw =i## &edica#@ 2008. p. 202F9.:. 2. 1' sid w ?. Scabies. + En$# C &ed 2008@.3:71718927. .. 1urrie ;. C, &c1art'% C. S. *ermet'rin and 5n"ermectin ! r Scabies. + En$# C &ed 2010@.827717923.