MEDICINE-DERMATOLOGY-DISEASES BY ARTHROPODS
SCABIES
HISTORY
1. Reported for >2500 years
2. Aristotle described “Lice in the
flesh”
3. Celsus recommended sulphur
mixed with liquid as remedy
4. Bonomo related mite to the
disease
5. First human disease known to
be caused by a specific
A. INTRO:
pathogen
a. Skin infestation caused by arthropod Sarcoptes
scabiei var hominis
b. Highly pruritic and contagious skin lesions
B. INCIDENCE:
a. 300 million cases annually
b. One of the 6 major epidermal parasitic skin
diseases (EPSD)
c. Any age group
d. M:F::1:1
C. ETIOPATHOGENESIS:
a. Risk Factors:
i. Young age
ii. Illiteracy
iii. Poor socioeconomic condition
iv. Poor housing condition
v. Overcrowding
vi. Poor hygiene, irregular bathing
vii. Sharing of clothes and towels
viii. Homosexual Men
b. Agent:
i. Sarcoptes scabiei var hominis
SARCOPTES SCABIEI VAR HOMINIS
1. Female infests the human
a. Can be seen with naked
eyes
2. Male is half the size of female
3. 4 pairs of legs
4. Unable to fly or jump
5. Crawl at the rate of 2.5 cm/min
6. Cannot penetrate deeper the
outer layer of epidermis
7. Complete life cycle in human
8. Survive in the beddings and
c. clothes for 2-3 days at room
temp
9. <20 deg C → remain immobile
SASHMI-5TH BATCH
LIFECYCLE OF SARCOPTES SCABIEI:
1. Eggs incubate and hatch (3-4
days)
2. 90% of the hatched eggs die and
1% survive
3. Larva (3 pairs of legs) migrate to
the skin surface → Burrow into
the intact Stratum Corneum →
Short Burrows (Molting
Pouches) (3-4 days)
4. Larger Nymph
5. Adults
6. Mating takes place once
a. Female fertile for life
b. Male die
7. Female secrete proteolytic
enzyme → Dissolve stratum
corneum further → Serpentine
burrows with Laying of eggs →
further burrowing (1-2 months)
OTHER VARIETIES OF SARCOPTES
8. Transmission of impregnated
SCABIEI (Mange)
female
1. Infest dogs, cats, pigs, ferrets
and horses
2. Unable to reproduce in humans
3. Cause irritation and transient
dermatitis
d. Mode of transmission:
i. Direct skin to skin contact (common)
ii. Sexual contact
iii. Indirect fomites (Larger the no of the
arthropod, more the chances)
D. CLINICAL:
a. History:
i. Age: any
ii. Sex: any
iii. Socioeco:any
iv. Itching
1. Short time or persistent (7 year itch)
2. More at night
a. Sensation more in quiet env
b. Steroid levels are low at night
3. Peak At 2- 3 weeks
4. Immunocompromised might not have
itching
v. Infestation in family members
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b. Examination:
i. Primary lesions: E. VARIANTS:
1. Sites (Circle of Hebra): a. Infantile:
a. Head and face (in children) i. Rare
b. Webbed spaces of fingers ii. Vesicopustules with eczematisation
c. Flexor area of wrist iii. May involve head and face
d. Axilla 1. Because sebum secre is less in infants in
e. Antecubital area head and face → So no lysis of the org
f. Breast and nipples (in female) iv. H/O scabies in parents
g. Abdomen
h. Umbilicus b. Nodular:
i. Genital areas (Glans penis, shaft and i. Firm, red itchy nodules
scortum involvement in males is ii. >=0.5 cm
typical) iii. Due to hypersensitivity reaction to the mite
j. Gluteal folds (Involvement of back in iv. In the covered areas (Axillary folds and
old age) scotum)
k. Feet
2. Lesions: c. Crusted/ Norwegian:
a. Burrows i. Thick hyperkeratotic crusted lesions with
b. Papules scales
c. Pustules ii. Usually immunocompromised, elderly and
d. Nodules retarded persons
e. Utricarial papules and plaques iii. Hundreds to millions mites
3. Burrows: iv. IgG and IgE are high
a. Pathognomic of Scabies infestation v. CD8 predominance
b. Short (2-3 mm) and thin (width of a
human hair) d. Scabies incognito:
c. Straight or tortuous (serpentine) i. Modified by steroids
raised tract
d. In the superficial epidermis e. Atypical/ Clean Scabies:
e. With a vesicle at the tip (where the i. Itching with few scattered papules
mite enters the burrow)
4. Mite may be visible as a small dot f. Scabies galeusus:
i. Development of primary lesions of syphilis
ii. Secondary lesions in scabetic lesions of genetalia
1. Utricaria
2. Impetigo F. D/D:
3. Eczematous plaques a. Insect bites
4. Pyoderma (Aerobic, anaerobic or mixed) b. Atopic dermatitis
c. Contact dermatitis
d. Psoriasis
e. Utricaria

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 MEDICINE-DERMATOLOGY-DISEASES BY ARTHROPODS

necessary (Some dev larva

survive the initial RX)
b. 1% Lindane
i. C/I in pediatrics
G. INVESTIGATIONS: ii. Transcutaneous absorption →
a. Diagnostic test: Neurotoxicity
i. Identification of the mites, eggs, 2. Oral:
eggshell fragments and mite pellets a. Ivermectin, 0.2 mg/kg once; can
(Scybala) repeat after 10-14 days
ii. Drop of mineral oil over the burrow → IVERMECTIN:
Longitudinal and lateral scrapping of 1. Not FDA recommended for the
skin with scalpel blade → Study under RX
microscope 2. MOA: Binds selectively to
iii. Avoid using KOH as it can dissolve the glutamate gated chloride
pellets channel of nerve and muscle
iv. Failure of the identification of eggs or cells → Paralysis and cell death
mites does not rule out the diagnosis 3. t1/2=16 hr, metabolized in the
liver
b. Localizing the burrow: Scabies
4. C/IPregnancy
in in infants and lactating
i. Application of topical tetracycline→ mother:
Washing off the excess → study under 1. 6% Sulphur Cream
the Wood Lamp → Fluorescence
2. Ivermectin, Petmithrin and
ii. Application of the washable ink
Lindane C/I
ii. Antihistaminics:
c. Others: 1. To relief itching – Hydroxyzine
i. Dermatoscopy hydrochloride
ii. PCR
iii. ↑ IgE and eosinophilia iii. Antibiotics:
iv. Skin biopsy 1. For sec bac infections

H. TREATMENT: I. COMPLICATIONS:
a. General: a. Impetigo
i. Consultation with the dermatologist b. Furunculosis
ii. Treatment of the family members and the c. Cellulitis
people in close contact d. Pyelonephritis
iii. Providing reassurance that the disease is e. Post strep glomerulonephritis
not a reflection of poor hygiene f. Abscess
g. Sepsis
b. Specific: h. Death
i. Scabicide:
1. Topical:
a. 5% Permethrin cream
i. DOC, esp for >2m and small
children
ii. Dose: Application all over the
body, except on the scalp;
Shower after 8-14 hours; repeat
the application after 7 days if

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