By:

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Microscopic image of scabies mites

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 Scabies is a contagious
disease caused by a mite
Latin term scabere meaning to scratch.

itchy skin condition caused by

very small,
wingless insects
or mites
called the Human Itch mite

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 Scabies itch mite OR

OR Acarus scabie

Sarcoptes scabiei OR

Scybula OR

/ hominis (Hering)
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a tiny insect just visible to the eye (about 0.4mm)
and is tiny,
eight-legged creature with a round body.

Pictures of Scabies
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History
Aristotle ( 1200 BC)

Roman physician Celsus (characteristic features)

& Giovan Cosimo Bonomo ( Italian Physician)

in 1687.

(It was the first human disease recognized to be

caused by a specific pathogen)

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 Epidemiology
The scabies mite has infested humans for at least
2,500 years.

More than 300 million cases of scabies occur

worldwide every year.

Anyone of any race or age,& social classes.

spreads rapidly under crowded conditions

where there is frequent skin-to-skin contact between
people,

such as
in hospitals,
institutions,
child-care facilities,
and nursing homes.

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 Types
1. Regular scabies
the number of mites is, on an infected person.
on average, 10 to 15

2. Norwegian scabies / Crusted scabies.

( Norwegian originated in Norway)
thousands to
millions of mites.

The type of mite in both presentations is usually the same.

3. Nodular In
pathognomonic orange red
nodules in the axillae and groin
AIDS
pt:

4. Bullous
bullae may occur in infants &
immunocompromised people

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Transmission

Scabies is very contagious and is

usually spread by:
close contact
with infected clothing, bedding or
towels
personal contact
shaking hands
sleeping together
sexual partners and household members.

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Most common breeding
environments are:

in overcrowded living conditions

in school children playing together
families
roommates
sexual partners
mothers of infants

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 elderly people in nursing homes
soldiers
Prisoners

The insect or the egg can spread the

infection and the mite can survive on
objects for a long time, so constant
washing of clothing, towels or bedding is
necessary.
Scabies does not occur because of poor
hygiene

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 Cycle
Attracted to warmth and odor,
the female mite is drawn to a new host,
making a burrow,
laying eggs ( 1-3 eggs daily )
and producing secretions that cause an allergic
reaction.
Larvae hatch from the eggs and travel to the skin
surface, lying in shallow pockets where they will
produce secretions.
The eggs hatch and the new mites begin the cycle
all over again.

The rash is extremely itchy, which often causes

sleeping problems especially in infants and young
children
Without a host, they survive only a few days
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Life Cycle
-There are 4 stages of the Sarcoptes scabiei life cycle:
egg, larva, nymph, adult
1. Following copulation, females lay eggs as they
burrow underneath the host's skin. up to 30 eggs
at rate of 2-3 per day.

2. Incubation time varies from 3-4 days.

3. When the eggs hatch, the larva (which only have 3

pairs of legs) migrate to the skin surface and take
residence in short burrows called molting
pouches. The larval stage lasts for 3-4 days.

4. Larva molt into nymphs, which are slightly larger

and have the full 4 pairs of legs.

5. Adult mites ( live for 1-2months )are round and sac-

like. (from egg to adult 10-15 days) The cycle
commences again when a nomadic male
penetrates the female's burrow and, fertilized, she
proceeds to lay her eggs in the host. (Scabies,
CDC)

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 SIGNS and SYMPTOMS
scabies rash / burrows / Pimple-like
irritations,
( 63%)
between fingers
wrists
Extensor aspects of elbow ( 11%)
auxiliary areas
female breasts (particularly the skin of the
nipples)
the umbilical area
penis and scrotum
buttocks
inside of legs
Intense itching, especially at night and over most of the body.
Sores on the body caused by scratching. These sores can
sometimes become infected with bacteria. 15
Symptoms
A very small, hard to see, zigzag blister
usually marks the trail of the insect as she
lays her eggs.
Other more obvious symptoms are:
Intense itching especially at night
A red rash can occur at the area that has been
scratched.
Skin may become crusty or scaly as the
infection progresses
Early scabies rash will show up:

pimples
tiny bites

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 Children usually have more overall
itching on the
palms of hands
soles of feet
scalp
The child may also have
irritability
sleeplessness
tiredness
due to itching

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2. C/ Features

Children younger than 15 years of age have the highest

prevalence.
severe itching with nocturnal exacerbation.
The pathognomonic lesion of scabies is the
burrow:
short, straight or curved, slightly elevated lesion which
often has a vesicle at its end .

Burrows are typically found on the

finger webs, front of the wrists, axillae and genitalia.
Intensely itchy papular and vesicular lesions soon develop
due to hypersensitivity
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Burrows

Mite

The scaly patch at the left is due to scratching of the

original papule.
The mite travelled from there to the upper right, where it
can be seen as a dark spot at the end of the burrow. 19
Scabies

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Affected webs pace
Scabies

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Scabies with extensive infestation of
Sarcoptes scabiei.
scabies

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Baby with Scabies Rash

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Scabies in Childhood
Scabies. Pustules at a common site in a child. Burrows
were present but cannot be seen at this distance.

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 In babies the neck and head may be
affected

The itching is due to an allergic reaction

to the tiny mites, which is associated
with a rash of red, raised spots.

Bacterial infection may occur through

infected lesions.
In many cases, children are treated
because of infected skin lesions rather
than for the scabies itself.

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Who is at risk for severe
infestation?

People with weakened immune systems

and the elderly are at risk for a more
severe form of scabies, called
Norwegian or crusted scabies.

How long will mites live?

Once away from the human body, mites
do not survive more than 48-72 hours.
When living on a person, an adult
female mite can live up to a month.

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Diagnosis
1. pt: complains of itching (worse at night)
2. On Exam:
follicular lesions at affected site.
3. secondary infection lead to:
crusted papules & pustules.
4. Diagnosis is probable if other members
of household are affected.

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 Confirmation
Diagnosis

Microscope Test
Byscraping the burrows and examining
under a microscope.
scabies mites, eggs and/or feces.
Ink Test
An ink test is where a blue or black felt-
tipped pen is applied to the suspected
areas. After the skin is cleaned mite
burrows can be located if the ink sinks into
them.
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OR Diagnosis
Telltale signs of scabies include:

Intense itching that worsens at night.

The appearance of short, wavy, scaly grey lines on
the skin due to burrowed scabies mites.
Symmetrical distribution of scabies rash noted in
the web spaces between the fingers, and on the
wrists, sides of the hands and feet, elbows,
armpits, waist, buttocks, genitals, and
breasts/nipples in women.
Secondary infection and eczema from scratching
can mask the signs of scabies and complicate
diagnosis
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Less specific signs of scabies include
Papules or nodules (small, solid bumps on
the skin), vesicles (small, fluid-filled
blisters), and pustules (small, pus-filled
blisters) on the skin
Eczema (itching, scaling and thickening of
the skin) resulting from the bodys immune
reaction to scabies mites and their fecal
matter.

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TREATMENT
(SCABICIDAL AGENTS:)
Topical agents:

Permethrin 5% cream: ( in young children ).

Gamma benzene hydrochloride (GBHC, Lindane) 1% cream or
lotion. ( Not recommend for application in infants. )
Benzyl benzoate 25% emulsion:
sulphur ointment : 6 to 10%
Crotamiton lotion or cream
Malathion .5% solution :
Topical thiabendazole is also said to be effective.
Monosulfirum -impregnated soaps are sometimes advised as a
prophylactic in outbreaks.

Systemic:- Ivermectin
Scabicidal treatment of family members and close contacts is mandatory

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 Permethrin 5% cream: single application, kept for 12
hours. Repeat application after a week may be advised.
Permethrin may be used in young children.
Gamma benzene hydrochloride (GBHC, Lindane) 1%
cream or lotion. GBHC is used as a single application on
dry skin kept for 12 to 24 hours. A repeat application after
7 days is often recommended. Not recommend for
application in infants.
Benzyl benzoate 25% emulsion: applied for three
consecutive days.
6 to 10% sulphur ointment : applied for 3 to 5
consecutive day, application is messy.
Crotamiton lotion or cream: less effective, may have a
non-specific anti-pruritic effect.
Malathion .5% solution : somewhat less effective, should
be applied repeatedly.
Topical thiabendazole is also said to be effective.
Monosulfirum -impregnated soaps are sometimes advised
as a prophylactic in outbreaks.
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Help Factors

A sauna
Keep finger nails cut short and apply mitts or socks to infants'
hands at bedtime to cut down on scratching.
Bathing, washing or soaking in diluted:
borax
enzyme cleaners
lice shampoo
sulfur
Do not treat scabies with:
hard soaps
home remedies
kerosene
laundry detergent
Consult a dermatologist before using steroids or any other
creams.

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Complications

Secondary pyogenic infection.

Streptococcal pyoderma may in turn be
complicated by glomerulonephritis.
Infective eczema
Persistent nodules
Crusted or Norwegian scabies ( in AIDS )
Erythroderma from crusted scabies

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Control of mites
Use of DDT
Cracks & crevices in ground ( Filling up )
Protection of workers in Tick infested areas.

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Prevention
Avoid sharing personal articles such as clothing,
hair brushes, combs or towels
Check family members
Chemical sprays for the household are unnecessary
Clothes, towels, bedding, combs, brushes, and
anything else the person has had contact with
should be soaked in very hot water in enzymes or
borax for 15 minutes or more
Clothing and underwear should be changed
regularly
Have regular saunas
If your child has scabies, please notify the school
authorities
Keep all bedding well laundered (hot water, 120oF)
Practice proper prevention measures
Vacuum rugs and furniture, such as chairs and
couches, that the infected person might have been
in contact with

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 SUMMARY

Scabies is a contagious disease by a mite /Acarus scabie / Sarcoptes. S

Epidemiology: 2,500 years ago, > 300 million cases every year.
any race, age & social classes. spreads rapidly under crowded conditions

Spreads: close contact, sleeping together, Towels, sexual cotact

Types: 1, Regular ( 10-15 m) 2. Norwegian (thou-mill ) 3. Nodular

Life cycle:- Eggs- Larva- Nymph Adult ( 10 15 days) live 1-2 months

Signs & Symptoms:--Intense itching ( at night.) short, wavy, scaly grey lines on the skin due to burrowed scabies mites. scabies
rash noted in the web spaces between the fingers, &.. Secondary infection and eczema
Less specific signs:- Papules or nodules (small, solid bumps on the skin), vesicles (small, fluid-filled blisters), and pustules
(small, pus-filled blisters) on the skin
Eczema
Diagnosis:- 1. H/o itching (worse at night),2. follicular lesions, 3. secondary inf: lead to: crusted papules & pustules. 4. H/o
other members of household.
Microscopic:-mineral oil & scrapings ( mites, eggs and/or feces.)
Ink test:-mite burrows can be located if the ink sinks into them.

Treatment :- Permethrin , Malathan, Benzyl benzoate, benzene hexa chloride, sulphur

Prevention: - Avoidance of contact with infested persons.

2. Treatment of all close contacts. 3. Maintenance of good personal hygiene.

4. Improvement of socio-economic conditions is associated with lowered prevalence of scabies.

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Thank you
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