CLINICAL SCIENCE

SCABIES
1. MANSON TROPICAL DISEASE
2. FITZ PATRICK
 ETIOLOGY
• Species :
• Sarcoptes scabiei var. homini, family Sarcoptidae, class Arachnida.
• Morphology :
• The mite is pearl-like, translucent, white, eyeless
• oval in shape
• four pairs legs.
• The adult female mite : 0.4 × 0.3 mm
• Characteristic
• Able to live for 3 days in a sterile test tube, and for 7 days if placed
in mineral oil mounts.
Pathogenesis
• Direct Contact
TRANSMISSION
• Indirect through dead skin lay in clothes

• secreting enzymes that dissolve skin

PENETRATION
• Ingestion of skin by the mite

• fertilized female makes a permanent burrow in the epidermis

ENTRY • The male mite lives on the surface of the skin

• Eggs
• larvae
LIFE CYCLE • protonymphs
• Tritonymphs (2–3 day)
• Adult male or female mites (5–6 days).
 • lays two to three eggs a
LIFE CYCLE day during her life span
of 30 days.
• Eggs hatch in 10 days
and
• larvae leave the burrow
to mature on the skin
surface.
• The male mite lives on
the surface of the skin
and enters burrows to
procreate.
• Infective and diagnostic
stage : mites
COMPLICATION
1. DEATH
• Systemic sepsis from secondary bacterial infection
• Acute post-streptococcal glomerulonephritis
Infection due to nephritogenic Streptococcus pyogenes (Group A
streptococcus)
Isolation bacteria in mite fecal pellets and from skin burrows, with
mites possibly facilitating bacterial spread.
2. The metabolic burden of scabies
• contribute to malnutrition
• Occur in severe scabies in children and in crusted scabies.
CLINICAL FEATURE
• CC : intensely pruritic rash, worse at night
• 3–6 weeks first infection
• 24–48 previously infected
• Location
• Characteristic : no hair follicles and the stratum corneum is thin and sof
• Adult : fingers web; flexor surfaces of wrists; extensor surfaces of elbows; anterior axillary
folds; skin around the nipples (especially in women); periumbilical region; pelvic girdle
including waist and lower buttocks, upper thighs; penis (shaf and glans); extensor surfaces of
knees
• Infants and small children and in all ages : the palms, soles, face, neck, and scalp.
• Processes of rash delivered from:
1. Papular or vesicular lesions occur at the site of burrows made by mites
2. Generalized immune-mediated pruritic and erythematous papular eruption
CLINICAL FEATURE

1. Papular or vesicular lesions occur at the site of burrows

made by mites 2. Generalized immune-mediated pruritic and
erythematous papular eruption
CLINICAL FEATURE
• PHYSICAL EXAMINATION
1. Excoriations and eczematous dermatitis
2. Indurated, crusted nodules in children on intertriginous areas.
3. Crusted scabies : hyperkeratotic plaques on palmar and plantar
regions, with thickening and dystrophy of the toenails and
fingernails.
4. The pathognomonic lesion : a burrow
• a thin, thread-like, linear structure 1–10 mm in length.
• It is a tunnel caused by the movement of the mite in the
stratum corneum.
CLINICAL FEATURE
1. SECONDARY BACTERIAL INFECTION
• FEATURE : pyoderma  pustular/crusted skin sores, boils and cellulitis.

2. CRUSTED SCABIES
• ETIOLOGY :
• immunosuppressive therapy in transplantation,
• rheumatological conditions,
• chemotherapy for malignancy,
• infection with HIV and HTLV-1.
• malnutrition,
• Down’s syndrome
DIAGNOSIS
CARDINAL SIGN
1. Pruritus di malam hari
2. Menyerang sekelompok orang
3. Terdapat burrow/canaliculi sesuai predileksi (Circle of Hebra)
4. Ditemukan Sarcoptes scabiei dg skin scrapping (+)

DEFINITIVE DIAGNOSIS
1. Burrow ink test
Goals Pengisian tinta pada terowongan di stratum corneum
2. Pemeriksaan mikroskopis
Goals : Define mites, eggs, and scybala
Sample collection : skin scraping in burrow (tunnel)
DIFFERENTIAL DIAGNOSIS
TREATMENT
PREVENTION AND EPIDEMIOLOGY
EPIDEMIOLOGY
• most common in young children, in endemic situations, a lack of immunity.
• Not restricted to tropical climates, and in industrialized countries it can be
endemic in economically disadvantaged populations.

PREVENTION
• Community treatment with topical permethrin
• Mass drug administration programmes using oral ivermectin in those aged over 5
years, with topical permethrin for those under 5 years (or under 15 kg)
• Access to health hardware, health care and education.