B.

18 Scabies (B86)

I. Definition
A skin disease caused by infestation of Sarcoptes scabiei var. hominis. 1

II. Diagnostic criteria

Clinical
Approximate diagnosis (presumptive)1-3 if found triad:
1. Skin lesions in the area of predilection.
x Skin lesions: a tunnel (kunikulus) straight-line or curved, white or gray with a
tip papules or vesicles. In case of secondary infection raised pustules or
nodules.
x Regional predilection for a place with a thin stratum corneum, ie: between
the fingers, hand, wrist volar part, the outer elbow, armpit fold, the areola, the
umbilicus, buttocks, external genitalia and lower abdomen. In infants can hit
the face, skalp, palms and soles of the feet.
2. Itching especially at night (nocturnal pruritus).
3. There is a history of similar pain in one home / contacts.

A definitive diagnosis when found: mites, larvae, eggs or feces through the
investigation (microscopic).1.2
Diagnoses1.2
1. atopic dermatitis
2. contact dermatitis
3. papular urticaria
4. Insect bite
5. Dishidrosis
6. pyoderma

Supporting investigation
Some ways to find the tunnel:
1. Burrow ink test5 (B, 2)
2. test tetracycline6 (D, 5)
3. Dermoskopi7 (B, 2)

III. Non Medical

Management
1. Keeping the individual and environmental hygiene. 8 (B, 3)
2. Decontamination of clothing and bedding by washing at 60 ° C or stored in a
sealed plastic bag for a few days. Carpets, mattresses, pillows, seat made of
foam or fluffy need to be dried in the sun after vacuuming the dust. 1,3,9 (D, 5)

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 medikamentosa
Principle: a comprehensive governance include the use scabicide effective for all
stages of Sarcoptes scabiei for patients and contact persons simultaneously,
maintaining hygiene, and proper handling fomites. There are several medications that
can be selected according to the following indications:
1. topical
x Permethrin 5% cream applied to the skin and left for 8 hours. Could
repeated after one week.1,2,4,10,11 (A, 1)
x Lindane 1% cream applied to the skin and left for 8 hours. Quite a single use,
can be repeated if not healed after one week. Should not be used on infants,
small children, and pregnant women.1,2,4,10,11 (A, 1)
x 5-10% sulfur ointment, applied for 8 hours, 3 nights in a row. 1,4,10,12 (B, 3)
x Krotamiton 10% topical cream for 8 hours on days 1,2,3, and
8.1,2,4,13 (B, 1)
x Benzyl benzoate 10% emulsion is applied for 24 hours.1,4,10,14 (B, 2)
2. systemic
x Sedating antihistamines (oral) to reduce itching.1.2 (D, 5)
x When the secondary infection can be augmented systemic antibiotics. 1,2,4
(D, 5)
x In scabies krustosa given ivermectin (oral) 0.2 mg / kg single doses, 2-3
doses every 8-10 days. Should not be in children weighing less than 15 kg,
pregnant and lactating women.1,2,4,10,11 (A, 1)

IV. Education
1. Maintain personal hygiene and the environment.1 to 3.8 (B, 3)
2. Use of medication correctly and to all the people who contact simultaneously. 1
to 3.8
(B, 3)

V. prognosis
Prognosis is excellent if done with proper governance. Pruritus can last several
weeks after treatment due to hypersensitivity to mite antigen. Nodular scabies can
survive several months after treatment. Krustosa relatively difficult to treat scabies. 3.4
(D, 5)
Quo ad vitam : bonam
Quo ad funtionam : Ad dubia bonam
Quo ad sanactionam : bonam

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VI. Literature
1. Burkhart CN, Burkhart CG. Scabies, other mites, and pediculosis. In: Wolff K, Goldsmith LA,
Freedberg IM, Kazt SI, Gilchrest BA, Paller AS, Leffell DJ, editor. Fitzpatrick's dermatology in
general medicine. 8th edition. New York: McGraw-Hill; 2012.h.2569-72.
2. Shimose L, Munoz-Price LS, diagnosis, prevention, and treatment of scabies. Curr Infect Dis
Rep. 2013; 15: 426-31.
3. Sungkar S. scabies etiology, pathogenesis, treatment, eradication, and prevention. Jakarta:
FMUI Publisher Agency; 2016.
4. Chouela E, Abeldano A, Pellerano G, Hernandez MI. Diagnosis and treatment of scabies: a
practical guide. Am J Clin Dermatol. 2002; 3 (1): 9-18.
5. Woodley D, Saurat JH. The Burrow ink test and the scabies mite. J Am Acad Dermatol 1981; 4
(6): 715.
6. LK Gupta, MK Singhi. Wood's lamp. Indian J Dermatol Venereol Leprol. 2004; 70 (2): 131.
7. Dupuy A, Dehen L, Bourrat E, Lacroix C, Benderdouche M, Dubertret L, et al. Accuracy of
standard dermoscopy for diagnosing scabies.J Am Acad Dermatol. 2007; 56: 53-62.
8. K Talukder, Talukder MQ, Farooque MG, Khairul M, Sharmin F, Jerin I, et al. Controlling
scabies in madrasahs (Islamic religious schools) in Bangladesh. Public health 2012; 127: 83-
91.
9. Heukelbach J, Feldmeier H. Scabies. Lancet. 2006; 367: 1767-74.
10. WF Tucker, JB Powell. Scabies. In: Lebwohl MG, Hetmann WR, Jones JB, Coulson I,
editor. Treatment of skin disease. 4th Edition. China: Elsevier Sauders, 2014.h.697-9.
11. Strong M, Johnstone P. Interventions for treating scabies. Cochrane Database Syst Rev. 2007.
doi: 10.1002 / 14651858.CD000320.pub2.
12. Alipour H, Goldust M. The efficacy of oral ivermectin vs. 10% sulfur ointment for the treatment
of scabies. Anna Parasitol. 2015; 61 (2): 79-84.
13. Taplin D, Meinking TL, Chen JA, Sanchez R. Comparison of crotamiton 10% cream (Eurax) and
permethrin 5% cream (Elimite) for the treatment of scabies in children. Pediatr Dermatol 1990; 7
(1): 67-73.
14. Bachewar NP, Thawani VR, Mali SN, Gharpure KJ, Shingade VP, GN Dakhale. Comparison of
safety, efficacy, and cost effectiveness of benzyl benzoate, permethrin, and ivermectin in Patients
of scabies. Indian J Pharmacol. 2009; 41: 9-1

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