Scabies

It is quite common in Chaaria.
It is caused by an ectoparasite: Sarcoptes Scabies.
Sarcoptes Scabies can be viable on clothes or hospital beddings for more than 2 days.

TRANSMISSION
Direct contact with skin or hair.
Scabies is transmitted by direct contact with infected skin (even through sexual promiscuity), overcrowding, poverty and lack of hygiene).
It can be sexually transmitted.
It causes very severe and untreatable itching.
Sometimes lesions due to scratching can secondarily get infected.
It is greatly under diagnosed, it is to be considered in any patient with severe generalized and persistent pruritis at any age.

EPIDEMIOLOGY
Infection through sex, or hospital beddings or overcrowding.
Any age group can be affected.
Sometimes there are outbreaks.

NATURAL HISTORY
Incubation period is 1 month.
Itching starts 1 month after the infection in case of 1st infection but in case of secondary infection the itching starts immediately.
Itching is very strong, generalized, not responding to anti-histamines.
Itching is more at night for reasons not very clear.
Itching can be generalized even though skin lesions are every few.

TYPES OF LESIONS
BURROWS (galleries), palpable with a finger 0.5-1 cm long.
At the entry of the gallery there is a terminal PAPULE or BLISTER.
Other BLISTERS are independent for galleries.
SECONDARY LESIONS:
Urticaria, eczema, lesions due to scratching, crusts due to impetigo.

MORE FREQUENT AREAS
In adults normally hair and face, upper part of back not involved.
In infants: hair, face, palms and toes can be involved.
Galleries (burrows): more frequent in the interdigital spaces and in the palms of the hands, vulva, penis, nipples, buttocks, axilla and toes.
Blisters are more frequent at the sides of fingers.
NODULES; more frequent on scrotum, penis, buttocks and upper part of the back.

DIAGNOSIS
It is a clinical one in Chaaria.
Scabies should be suspected in all the patients with generalized, very itchy skin rash.

TREATMENT
BBA all over the body once daily, at bed time for 3 days.
Shower must be taken before application of BBA.
Changing of clothes and beddings every day during treatment.
We give a single dose of ivermectin, according to the body weight.
Anti-histamines very good for itching.
In case of secondary infection antibiotics must be given.

ITCHING AFTER BBA:
Generalized itching can persist for more than a week after finishing BBA.
This is due to sensitization to the dead bodies of Sarcoptes Scabiei


Dr G. Gaido
Dr J. Ogembo
Clinical and Nursing Officers
Cottolengo Mission Hospital Chaaria