SCABIES & OTHER

PARASITIC INFESTATIONS

DR FARID-UR-REHMAN
FCPS (Derm)
Professor & HOD
Dermatology Department, FUMC
 SCABIES
• Intensely itchy
• Contagious
• Parasitic infestation
• Sarcoptes Scabiei var hominis
 SARCOPTES SCABIEI

1.3mm

0.4mm
 Mode of spread
Skin to skin contact
• Prolonged (primary infestation)
• Casual (re-infestation)

Clothing, linens, furniture & towels

• Any race or age
• Both sexes
• Regardless of personal hygiene
• More prominent in overcrowded areas &
poor hygiene
 HISTORY
• Generalized itching
• More severe at night or whenever body
temperature rises
• history of pruritus + ve family members /
close contact
 EXAMINATION
PRIMARY LESIONS
• Characteristic lesions: Burrows

SECONDARY LESIONS
• Papules
• Excoriations
• Pustules
• Vesicles
• Eczema
• Post scabietic nodules
BURROWS
SECONDARY LESIONS
SECONDARY LESIONS
NORWEGIAN SCABIES
 CONFIRMATION
Skin scraping of burrow & direct
microscopy
• Presence of mites, eggs or fragments of
egg shells
PRINCIPLES OF TREATMENT

• Choice of drug: efficacy & potential toxicity

• Treat scabies first complications later
• Treat all inmates & close contacts whether
itching or not

Contd…
• Use specific scabicidal as per schedule
• Launder clothes.
• Treat whole body below collar line (whole
body in infants)
5% PERMETHRIN CREAM

Advantages : easy to use & effective

Side effects: irritation, burning,
exacerbation or recurrence of
pruritus
Disadvantages
Cannot be used in: pregnant, nursing mothers,
infants & young children
superadded eczematization
 1% GAMMA BENZENE HEXACHLORIDE
CREAM
Advantages : easy to use & effective

Side effects: seizures

Disadvantages
Cannot be used : pregnant, nursing mothers,
infants & young children
superadded eczematization
seizures or other neurological
disorder potential of toxicity from
misuse disturbed barrier
function
 PRECIPITATED SULPHUR OINTMENT
(10%, 5%, 2.5%)

Advantages
Safe & effective
Can be used in: pregnant, nursing mothers,
infants & young children,
disturbed barrier function,
superadded eczematization

Disadvantages : odor, messy

stains clothing & linen
difficult to use (3 consecutive nights bathe 4th
night)
OTHER TREATMENT OPTIONS

• 25% (12.5%) BENZYL BENZOATE

EMULSION
• 10% CROTAMITON CREAM
• 0.5% MALATHION LOTION
ORAL THERAPY
IVERMECTIN 200 µg/ kg in a single dose
 Other supportive therapies
• Antihistamines (for 2-3 weeks)
• Topical/ Systemic antibiotics
• Topical steroids (if eczematization)
 SCABIES

• MISDIAGNOSED
• IMPROPERLY TREATED
 FAILURE TO IMPROVE
• Itching takes a couple of weeks to settle

• Post scabietic nodules

• Lack of compliance
• Insufficient treatment
• Re-infestation
• Over treatment
POST SCABIETIC NODULES
 PEDICULOSIS
• Lice : blood sucking, wingless insects
• Pediculosis
Infestation by head, body & pubic lice
Bites painless
Clinical signs: hosts reaction to saliva & or
anticoagulant
 PEDICULOSIS CAPITIS
• Age & sex
• Main habitat
• Density of population
• Mode of Transmission
• Symptoms
• Signs
• Complications
 ANSWERS TO MYTHS ABOUT
HEAD LICE
• Lice do not jump or fly from one person to
another
• Straight hair more vulnerable
• All society
• Preference for clean heads
 Counseling the patient IMPORTANT

• Socially stigmatized
• Confused
• Extremely distressed
 TREATMENT
• 1% gamma benzene hexachloride cream
• 5% permethrin cream
• 0.5% malation lotion

• Use lice comb between & after treatment

• CONTROL
 RE-TREATMENT

• All pts should be re-treated in 1 week’s

time
• No t/m required if: lice not seen
no nits within ½ inch
of scalp
 TREATMENT FAILURE
• Poor technique
• Non-compliance
• Re-infection
• Same formulation used for extended
period of time
 PEDICULOSIS CORPORIS
• Age & Sex
• Mode of transmission
• Symptoms
• Signs
• Complications
 TREATMENT
• Delousing clothes & bedding
• Local antipruritics
• Topical antibiotics for secondary infection
 PEDICULOSIS PUBIS
• Mode of transmission
• Main habitat
• Maculae cerulae
 TREATMENT
• Same as for pediculosis capitis
 INSECT BITES
Cutaneous eruption to a biting or stinging
arthropod

Etiology: Fleas, bed bugs, mosquitoes,

 LICHEN URTICATUS
• Recurrent eruption
• Grouped, itchy papules
• Seasonal
• Hypersensitivity reaction
PREVENTION OF SCABIES