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CLINICAL PHARMACY

PRESENTATION

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PRESENTED TO RESPECTED TEACHERS

• Sir Khalid Tipu • Sir Amir Riaz

M.Ayub

Zeeshan

Jahanzaib

Nousher

Wahidullah

Waqas 3

Scabies is an infestation of the skin with the Sarcoptes Scabiei mite.

It is characterized by intense itching, usually at night.

SCABIES

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Background

Scabies Is An Intensely Pruritic, Highly Contagious Infestation Of The Skin .

Originally, Scabies Was A Term Used By The Romans To Denote Any Pruritic Skin Disease.

In The 17th Century, Giovanni Cosimo Bonomo Identified The Mite As One Cause Of Scabies.

SCABIES

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SARCOPTES SCABIEI

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BACK GROUNDTHE NAME SARCOPTES SCABIEI IS DERIVED FROM THE GREEK WORDS

Sarx (the flesh)

Koptein (to smite or cut)

LATIN SCABERE (TO SCRATCH). TODAY, THE TERM SCABIES REFERS TO THE SKIN LESIONS PRODUCED BY THIS mite.

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PATHOPHYSIOLOGY

The larvae leave the burrow to mature on the skin. Fewer than 10% of the eggs laid result in mature mites.

An affected host harbors approximately 11 adult female mites during a typical infestation. The eggs hatch in 3-4 days.

The female mite burrows into the epidermis of the host using her jaws and front legs, where she lays up to 3 eggs per day for

the duration of her 30-60 day lifetime.

After mating, the male mite dies.

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Pathophysiology

Individuals who already are sensitized from a prior infestation can develop symptoms within hours.

This reaction is responsible for the intense pruritis, which is the hallmark of the disease.

A delayed type IV hypersensitivity reaction to the mites, their eggs, or scybala (packets of feces) occurs approximately 30 days

after infestation.

PATHOPHYSIOLOGY

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Scabies usually is transmitted by direct contact with an affected individual.

Although it has been disputed, it is believed possible to become infested by indirect contact with the personal items or clothing of an affected person because the mite can survive away from the skin for 2-5 days.

MODES OF TRANSMISSION

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Diagnosis

Definitive diagnosis of scabies is made by direct visualization of the mite, eggs, or feces. Under Microscope(Dermoscopy)

DIAGNOSIS

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Primary and secondary lesions

The classic rash of scabies includes primary and secondary lesions.

The primary lesions include burrows, papules, vesicles, and pustules.

The secondary lesions occur from scratching and include excoriated papules and crusted areas.

Short

zigzag or

'S'-shaped

lines or

burrows is

another

symptom

PHYSICAL EXAMINATION

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TYPES OF SCABIES

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CLASSIC SCABIES NORWEGIAN

SCABIES(CRUSTED)

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NORWEGIAN SCABIES

In 1848, the Norwegians Danielssen and Boeck described a highly contagious variant of scabies that occurs in immunocompromised patients.

This rare form of scabies occurs in elderly or Because of an impaired antibody response, i.e HIV & AIDS these individuals can be infested with thousands to a couple million mites.

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NORWEGIAN SCABIES

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NORWEGIAN SCABIES

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TREATMENT

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SR. #

DRUG BRAND DOSE SIDE EFFECTS DRUG INTERACTION

1 PERMETHRIN bioscabli-caremalin

nedax pluspermite

skab

Apply 5% preparation over whole body and wash off after 8–12 hours

Pruritus erythema stinging Rarely rashes

N/A

2 CROTAMITON crotanScat

SCABION

APPLY 10 % PREPARATION 2–3

TIMES DAILY; CHILD BELOW 3 YEARS,

APPLY ONCE DAILY

PRURITUS, IRRITATION, CONTACT DERMATITIS, WARMTH FEELING.

N/A

3 LINDANE Scabene APPLY 1 % PREPARATION APPLY

8 HOURLY

DIZZINESSHEADACHE SKIN IRRITATION CONTACT DERMATITIS.

N/A

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SR. #

DRUG BRAND DOSE SIDE EFFECTS DRUG INTERACTION

4 IVERMECTIN Stromectol 200 micrograms/kg HEADACHE

DIZZINESS

MUSCLE PAIN

N/A

5 BENZYL BENZOATE

Benzyl Benzoate APPLY 25% PREPARATION OVER WHOLE BODY AND

WASH OFF AFTER 8–12 HOURS

SKIN IRRITATION

MUCOUS MEMBRANE IRRITATION

N/A

6 SULPHUR Scabion APPLY PREPARATION OVER WHOLE BODY

AND WASH OFF AFTER 8–12 HOURS

SKIN IRRITATION

MUCOUS MEMBRANE IRRITATION

N/A

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SR. #

DRUG BRAND DOSE SIDE EFFECTS DRUG INTERACTION

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CHLORPHINRAMINE MALEATE

PIRITON

4 mg 6 hourly

Or

10 mg per day

DrowsinessDry mouthSedationConstipation

Phenytoin

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HYDROXYZINE MARAX

25 mg ORALY per day

Dizziness, Headache, Drowsiness, Fatigue, Nervousness

Anxiolytics and hypnotics

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SR. #

DRUG BRAND DOSE SIDE EFFECTS DRUG INTERACTION

9 POTENT STEROID

BetamethasoneBETNOVATE

0.1% twice or thrice a day Apply to the affected area only

Skin thinningSweatingHypersensitivity reactions

Phenytoin↓Carbamazepine↓

10MILD STEROID

HYDROCORTISONEHYDROCORTISONE

1% twice or thrice a day Apply to

the affected area only

Irritation, Allergic reactions, Itching, Burning

Carbamazepine,↓

Barbiturates ↓

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“HOW TO APPLY THE TOPICAL MEDICAMENT?”

AND WASHED OFF AFTER 10 TO 12 HOURS, USUALLY OVERNIGHT, AS DIRECTED BY THE PHYSICIAN.

DO NOT APPLY ON FACIAL AND SCALP REGION.

THEN APPLY THE MEDICAMENT TO THE WHOLE BODY FROM THE NECK DOWNWARDS.

TAKE A HOT BATH AND THOROUGHLY DRY YOUR BODY.

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ReferencesCurrent medical diagnosis and treatment 2010

Clinical medicine by Parveen j.kumar 6th Edition

Harrison principal of internal medicine 16th Edition

Basic and clinical pharmacology by Bertram G.Katzung 10th Edition

Robbin’s basic pathology 7th Edition

British national formulary 56th edition

Diagram from

Diagram from www.GOOGLE.com/images

Diagram from www.wikipedia.org

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Thank You

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