Scabies

IND Version

Case:

A girl, eight years old, went to hospital of his parents due to appear red spots measuring 5mm x 5mm in between her fingers and itchy. The itchy-red spots (sometimes watery) was felt since a week ago, and would not diminish. The spots are initially only in the hands, now appears also in the body and groin. Itching began to be felt in almost all of the body. Itchy becomes heavy at night.

From results of examination, the girl was diagnosed Scabies skin disease. Scabicite cream was given that are taken once at night. Not only the girl, the family also was given the same drugs to prevent transmission.

DEFINITION

Scabies is a skin disease that is caused by infestation and sensitization to Sarcoptes scabies mites. Infestation is the penetration. Its predilection is on the skin. Sensitization is the process of the body's reaction to scabies infestation on the skin.

EPIDEMIOLOGY

Scabies disease can occur in different socioeconomic groups. However, higher incidence was found in children and women than in men. In areas with high population density also found a higher incidence. In regions with four seasons, found an increase in cases in autumn and winter. Perhaps this is influenced by human activity who are more likely to stay at home and use warm clothes over and over again (long time no scaling). Outside the human body, Scabies mite can live for 3 days. These characteristic allow the spread of this disease not only through direct physical contact, but no direct physical contact such as changing clothes or sleeping in the same place with people with scabies.

CLINICAL OVERVIEW

Early signs are often complained of itching. Itching is heavier at night. When nighttime Scabies activity infestation is more active than during the day because the more humid temperatures. This are often accompanied by itchy skin and (rash), and occasionally appear as crusted papule at the site of predilection, such as between fingers, part of the volar wrist, the sides of the hands, elbows, axila, areola, scrotum, penis, and labia. Sometimes it can show erythematous eruption on the body by a hypersensitivity reaction. In children aged <2 6-8="6-8" after="after" and="and" appear="appear" be="be" can="can" crusting="crusting" face="face" feet.="feet." found="found" hands="hands" head.="head." in="in" infants="infants" infestation="infestation" itching="itching" lice="lice" of="of" on="on" palms="palms" predilection="predilection" rash="rash" scabies.="scabies." span="span" the="the" weeks="weeks" years="years">

The results of inspections at the site of predilection, especially in between your fingers, you will find a tunnel (kunikulus) white-gray along the 1-10 mm. At the end of the tunnel papules or vesicles can be found. This tunnel is often difficult to be seen by the naked eye, especially when the lesion had suffered scratching, the manipulation treatment, and secondary infections. With a black marker ink dripping on the tunnel, then rinsed, then match the black line indicates the elongated tunnel, which houses the ink black marker.

Sarcoptes scabei (scabies mite)

DIAGNOSE

Scabies diagnosis is based on epidemiological characteristics, clinical features and results of investigations. There are 4 cardinal signs that should be known, namely:

a. Nokturnal pruritus, meaning itch is felt more and become heavy at night.

b. Attack humans in groups. For example, families of patients who live at home (or roommate) with the patient also experienced the same symptoms.

c. The existence of the tunnel on the predilection.

d. Found the mites / lice in one or more stages of development.

Diagnosis can be established if found to have two of the four cardinal symptoms of the above.

Scabies is a disease known as the great imitator because appearance can mimic many skin disorders. Some differential diagnosis to consider such as:

a. The most resemble: Atopic dermatitis, insect sting reactions, contact dermatitis, dermatitis herpetiformis, eczema dyshidrotic.

b. For consideration: psoriasi (especially crusted varieties), pempigus bullosa, drug eruptions.

COMPLICATION

Because the symptoms of itching are common symptoms appear, it is very likely to occur due to scratching of mechanical manipulation. This manipulation can cause erosion or excoriation of lesions that facilitate the occurrence of secondary infection. In the Norwegian scabies, this disease can cause lymphangitis and septicemia.

HANDLING

Principles of disease management is addressing the causes / etiology and symptomatic. Drug that is ideal in addressing the causes should have :

a. Should be effective against all stages of mites.

b. Should not cause irritation and is not toxic.

c. Odorless and does not damage or dirty clothing or color.

d. Easily available and cheap.

The special thing to note is that this treatment should be given to the whole family or those close to the patient (who had intensive contact with patients).

Ø This type of topical medication is given (to overcome the cause):

a.  Sulfur Presipitatum with content of 4% - 20% in the form of an ointment or cream.

These preparations are not effective against the egg stage so that its use should be at least 3 days. These preparations can be used in infants aged <2 cause="cause" often="often" old.="old." span="span" sulfur="sulfur" years="years">s bad odors for people, and soiling of clothes. Sulfur can also cause irritation.

b. Benzyl-Benzoas emulsion of 20% - 25%.

It effective against all stages. It is used every night for 3 days. These drugs often cause irritation and itching sometimes increases.

c. Gamma benzene hexa chloride (gameksan) 1% in a cream or lotion.

It effective against all stages, easy to use, and rarely cause irritation. This drug is not recommended in children <6 1="1" administration="administration" again.="again." and="and" be="be" because="because" central="central" effects="effects" evaluated="evaluated" giving="giving" has="has" it="it" may="may" necessary="necessary" nervous="nervous" on="on" only="only" pregnant="pregnant" repeated="repeated" span="span" system.="system." the="the" time="time" toxic="toxic" week.="week." where="where" within="within" women="women" years="years">

d. Krotamiton 10% in a cream or lotion.

Has the effect anti-scabies and itching. This medication should be kept away from eyes, mouth, and urethra.

e. Permethrin 5% in the cream.

Less toxicity than gameksan, with equal effectiveness. Applied one time and removed after 10 hours. If the deasease is not cured it can be repeated one week later. Not recommended in infants under 2 months.

Ø A variety of drugs and cope with symptomatic complications.

In patients who experience an annoying itch may be given an antihistamine. When the patients were found secondary infection, then we can consider to provide the appropriate antibiotics.

PROGNOSIS

If addressed properly in accordance with the indications of drugs and handling of epidemiological factors, the prognosis will be good. In patients who do not get adequate treatment, which will cause protracted symptoms. Patients with a competent immune system will be able to reduce the number of lice Scabies on his body, but in patients with imunocompremise, drug delivery and regulation of environmental conditions will help achieve a good prognosis.

PREVENTION

After reading the above, then it needs to be done to reduce the likelihood of disease Scabies is:

1. Increase self hygiene.

2. Increase hygiene neighborhood with a wash cloth, clothes, and places the fabric into  place live lice Scabies.

3. Motivation to contribute to family self-maintaining hygiene.

4. Let the sunshine into the room, because Scabies is impaired in hot temperatures.

5. Increase your endurance by exercising and eating nutritious food.

6. Immediately see if they get an itch that does not go away for 3 days.