SCABIES

Infestation of the skin by the itchy mite Sarcoptes scabei , characterized by eruptive lesions produced from the burrowing of the female parasite into the skin

Sarcoptes scabei

•The causative factor is the itch mite, Sarcoptes scabiei. •Transmitted by direct contact with infected individuals or their bedding & clothing•May be found in people living in substandard hygienic conditions•May not be associated with sexual activity

•Mites frequently involve the fingers & hand contact may produce infection, overnight stays of children with friends or exchange of clothes; health care personnel who have prolonged hands-on physical contact with an infected person may be infected• INCUBATION: occurs within 24hours from

the original contact, length of time required for itch mite to burrow on infected skin & lay ova.

Signs and Symptoms:• Itching caused by delayed type of

immunological reaction to the mite or its fecal pellets; increased itching during overnight hours may be because of increased warmth of skin has a stimulating effect on the parasite. •When secondarily infected, the skin may feel

hot and burning but this is a mirror discomfort.•When large areas are’ involved and secondary

infection is severe, there will be fever, headache and malaise. Secondary dermatitis is common.

Fecal pellets

•Burrows may be multiple, straight or wavy, brown or black, threadlike lesions commonly observed between fingers & wrists•Red, pruritic eruptions usually appear in adjacent areas•Any patient with a rash, may have scabies

Diagnosis:•Appearance of the lesion, and the intense itching and finding of the causative mite.•Scraping from its burrow with a hypodermic needle or curette, and then examined under lower power of the microscope or by hard lens.

Treatment:•The whole family should be examined before undertaking treatment, as long as a member of the family remains infected, other members will get the disease.•Treatment is limited entirely to the skin.•Benzyl benzoate emulsion (Burroughs, Welcome) is cleaner to use and has more rapid effect.•Kwell ointment is also effective.

• Patient is instructed to take a warm, soapy bath or shower to remove the scaling debris from the crusts & then to dry thoroughly & allow skin to cool• Scabicide such as lindane, crotamiton(Eurax)

or 5%permethrin is applied to the entire skin from the neck down, sparing only the face & scalp. Medication is left on for 12-24 hours, after the patient is instructed to wash thoroughly. One application is curative, but is advisable to repeat the treatment in 1 week

NURSING MANAGEMENT• Instruct the patient to wear clean clothing &

sleep between freshly laundered bed linens•Wash all bedding & clothing in hot water &

dry on the hot dryer cycle; dry cleaning is advised•When treatment is completed, patient apply

topical corticosteroid to skin lesions because the scabicide may irritate the skin

•Tell the patient that pruritus may continue for several weeks as a sign of hypersensitivity but it does not mean that treatment has failed• Instruct the patient not to apply more scabicide because it increases irritation & itching; not to take frequent hot showers because it dries the skin & produce pruritus•Oral antihistamines can control pruritus

Prevention:•Good Personal Hygiene

- daily bath; washing the hands before and after eating, and after using the toilet; cutting of fingernails.•Regular of changing of clean clothing beddings and towels.

•Eating the right kind of food like rich in vitamin A and vitamin C such as green leafy vegetable and plenty of fruits and fluids.•Keeping the house clean.• Improving the sanitation of the surroundings.