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Scabies

Scabies occurs in epidemics, in 30-year cycles with 15-year gaps between the cycles. The current epidemic we are in began in the mid-1960’s but unfortunately it’s still going. About 2% of dermatologic visits are due to scabies, probably more than that because we probably miss it a lot. It is transmitted by close and casual skin to skin contact, but close contact. The more parasites the more chance of transmission. I think the key is, if several family members or members of a group, are itching, the likely diagnosis is scabies. Because there’s almost nothing else that will make a whole family itch. They aren’t all taking the same medicine, usually, they aren’t all allergic to the same clothes, they scabies, scabes, scabie

The itching is usually at night but a lot of things itch at night because you have your mind on other things during the day. Again, it’s caused by hypersensitivity to the fecal matter and the saliva of the scabies, and it takes about four to six weeks to start itching because you’ve got to get sensitized to this. If you are sensitized to this it’s about one to

The characteristic locations, everybody is aware. The finger webs particularly, the sides of the finger, the wrists, the elbows, the axilla. The penis particularly. There is a dermatologist who I trained with who said, "If it’s a man and it’s not on the penis, it’s not scabies." The female breast, the areolar area, the umbilicus and the lower buttocks. These are the characteristic locations we like to look at. You diagnose it by scraping it and demonstrating the mites or the

There’s a lot of special forms, and I won’t dwell on this too much. I’ll quickly go through these. There’s so-called "Scabies in clean persons" which isn’t a good term, but again you just aren’t going to see many lesions, if somebody has very good cleanliness habits. Scabies incognito is steroid use. Somebody has scabies and you prescribe a steroid, it masks the signs and symptoms and also looks pretty unusual. Nodular scabies is what it says. You have big nodules because of a severe hypersensitivity reaction. Infants and young children; it looks different. It can be on the head. It usually isn’t on the head of adults and vesicles are common in infants. It’s the only time you will see vesicles with scabies is with infants. Elderly people are difficult because they don’t really show much reaction to the mite, but they itch like crazy, so they don’t have all the papules and the burrows. They just itch like crazy, so it’s diagnosed as senile pruritus or dry skin, when actually it’s scabies. Of course Norwegian scabies is a severe form in mentally retarded patients and HIV disease is really the

Okay, just a few clinicals, and again, the finger webs are where we like to look for it and here are the characteristic lesions on the finger webs. Finger web again, characteristic papules. Sides of a finger, papules. This is so-called scabies in clean people. There’s two bumps but it’s still scabies, but it’s a hard diagnosis because you’ve got to get

This is an infant and these are blisters. The only time you see blisters with scabies is infants. This is interesting. This looks like a fungus infection. It looks like a dermatophyte. It’s a raised, heaped up scaly bordered lesion so we

Treatment. Elimite, which is the pyrethrum 5% cream, single application. Works very well. Kwell isn’t used as much as it used to be. For pregnant women and infants I use the sulfur, %6 in petrolatum applied nightly for three nights. Works very nicely. The newest thing, of course, is the ivermectin. I have

Alternative treatment for scabies, which is ivermectin and they just had a dosage guideline. It’s called Stromecti, it’s the brand name for ivermectin. He says it simplifies the treatment of scabies with one oral dose. Very specific to