Treatment of scabies with HIV prognosis. Norwegian scabies is a dangerous companion of a weakened immune system. Basic Prevention Measures

In dermatology, there is a group of highly contagious (contagious) diseases transmitted from person to person. A small contact with a sick person is enough, as the risk of "catching" the infection becomes one hundred percent. Such skin diseases include scabies, one of the varieties of which is called Norwegian.

What is Norwegian scabies

Norwegian scabies is a highly contagious skin disease. It occurs quite rarely. In total, about 150 cases of the disease have been described. Adults and children are susceptible to infection. For this pathology, foci are expressed (lesion in a single area). Sick people easily transmit the infection to others. As a rule, such scabies develops against the background of immunodeficiency states, with prolonged use of certain drugs (cytostatics, hormonal agents, etc.), with violations of the sensitivity of the body.

The disease was first discovered in Norway in the 19th century. Synonyms: keratotic, crustose, crusted scabies.

The causative agent of this disease is a female scabies itch (mite), which gets on the skin of a person and begins to make special moves. This is how infection occurs. Over time, the number of itch moves gradually increases, the body becomes covered with crusts. With scratching and damage to the crusts, another infection (most often streptococcal) may join and suppuration may occur.

Causes and development factors

The disease begins when the pathogen enters the human skin. Infection occurs as a result of many factors:

• non-compliance with the rules of personal hygiene (use of other people's towels, combs, washcloths, underwear, bedding);
• crowded living in an apartment, dorm room, small houses, hotels, etc.;
• the occurrence of infection in preschool institutions, places of mass stay (baths, saunas);
• during sexual intercourse.

The first place in the distribution is occupied by the contact route of transmission (skin to skin), for example, with handshakes, hugs, etc. This is followed by the contact-household method, for example, through infected toys, linen, towels, etc. In third place - sexual transmission.

Symptoms and course of the disease

Since there are a lot of crusts, the skin can resemble a kind of shell. Polymorphic rashes on the body (papules, pustules, etc.) are characteristic. Peeling of the skin, nail lesions (nails thicken, deform, become prone to brittleness) and hair (lose their shine, become dry and dull) are observed. As the disease progresses, regional lymph nodes (cervical, axillary, inguinal) increase. Norwegian scabies is characterized by a specific symptom - the patient's skin has the smell of fermented dough.

Diagnosis and differential diagnosis

The diagnosis of the disease is made on the basis of clinical manifestations. With the help of microscopy, scabies in the skin are visualized, and the pathogen itself is also found. Making an accurate diagnosis is complicated by the absence of itching, which is characteristic of other types of scabies. Therefore, differential diagnosis is carried out with eczema, pyoderma, hyperkeratic psoriasis.

Histological examination of a piece of affected skin, biochemical and general blood tests will also help to make an accurate diagnosis. As a rule, leukocytosis, eosinophilia, and elevated ESR are observed in the blood.

Treatment

Medicines to combat Norwegian scabies are divided into the following groups:

Spregal contains a neurotoxic poison that affects the nervous system of ticks

It is important to note that the entire body is treated. After using the product on the second or third day, the patient is allowed to wash himself in the shower. Mandatory change of underwear and bed linen.

In the treatment of crusted scabies, folk remedies will not give the expected result.

Disease prognosis

Very often, Norwegian scabies is complicated by pyoderma (secondary streptococcal infection). In the case of an incorrect diagnosis and incorrect treatment, a fatal outcome may occur due to myocardial pathology that has arisen against the background of acute rheumatic fever. The latter is initiated by streptococci that have entered the connective tissue. And with the penetration of these microorganisms into the filtration system of the kidneys, a complication in the form of infectious glomerulonephritis is possible.

Prevention

Disease prevention plays an important role. By following the rules of personal hygiene, a person can protect himself and loved ones from scabies infection as much as possible. At the moment, there are two areas of prevention:

• public;
• individual (personal).

Community prevention means:

• identification of patients at all stages of the disease;
• hospitalization of the sick and their isolation in the outbreak;
• active monitoring of contacts of patients;
• current and final disinfection of premises, personal belongings of the patient, bedding;
• preventive medical examinations in preschool institutions, schools;
• carrying out other quarantine measures.

In addition, each person must know and follow the rules of personal protection. In no case should you use other people's clothing and underwear. If you notice the initial symptoms of the disease, you should immediately consult a doctor.

Video: how scabies proceeds

Crusty Norwegian scabies is a rare form of the disease of infectious origin. Over the past three centuries, only 160 cases have been recorded and described. Both adults and children are affected with the same frequency. Pathology has no race or gender. Recently, outbreaks of infection have been recorded, the number of infected people is increasing, so it is so important to know how crusty scabies begins, how symptoms develop and treatment is carried out.

This skin pathology is a complication of common scabies. It develops with a massive lesion, accompanied by the appearance of thick crust-like formations. It is characterized by a long course, constant relapses and the absence of itching.

Causes of the disease

Various factors contribute to the spread of the described form of infection. Among them, the most common: a disorderly intimate life, ignoring the rules of personal hygiene, living in a small room for a large number of people. The most active process of the development of the disease occurs against the background of somatic and mental abnormalities. Therefore, scabies of the Norwegian form is most often diagnosed:

• people living in nursing homes;
• among patients of neuropsychiatric clinics;
• children with Down syndrome;
• infantile persons;
• patients with tuberculosis, AIDS, leprosy;
• suffering from leukemia, leukemia, lupus erythematosus and Bloom's syndrome.

Stages of the disease

The infection process can take years. Some patients develop clinical manifestations within five to six months, others within fifty years. They go through three stages:

1. incubation period. Its duration also varies - from two months to 15 years. The more mites that initially get on the skin of a person, the shorter the time interval between infection and the manifestation of the first symptoms.
2. The beginning of the layering of crusts.
3. The occurrence of associated complications.

The pathology is recurrent. It can become aggravated and progress, it can fade, stopping in its development. At any time, patients are contagious to others. They are capable of causing sporadic outbreaks within hospitals, so during the treatment of a patient diagnosed with scabies, quarantine rules are introduced.

Characteristic symptoms and signs

In addition, inflammation of all lymph nodes is noted.

Reasons for not itching

Only half of the patients have an allergic skin reaction. Infectionists explain the lack of itching for several reasons:

1. High weakness of the immune system, it is simply unable to respond to the introduction of foreign agents.
2. When scabs form, the transmission of nerve impulses is disrupted.
3. Degradation of muscle tissue and myopathy leads to the fact that the patient simply does not have the opportunity to scratch the itchy place, this is fixed in the brain.
4. Low skin sensitivity.

The absence of itching makes the diagnosis difficult. To confirm it, three components are needed: the presence of the above clinical manifestations, epidemiological data (confirming possible contact with an infected person), and the results of some laboratory tests.

To accurately determine the Norwegian type of scabies, it is necessary to perform a detailed biochemical blood test. The course of infection is indicated by an increase in the number of leukocytes, eosinophils and ESR.

Next, the doctor necessarily produces a biopsy of the affected areas, followed by microscopy. They manage to detect a huge number of characteristic tunnels, the presence of tick eggs and their larvae. Layered scraping of horny tissues helps to differentiate Norwegian scabies from eczema, psoriasis, complicated pyoderma.

When the diagnosis is confirmed, the patient is hospitalized.

Therapeutic treatment of scabies

Treatment is considered effective only at the initial stages of the disease; advanced forms often lead to complications from the cardiovascular system and to death.

There are general recommendations for getting rid of the disease. Anyone who lives under the same roof with a sick person needs to be treated for Norwegian scabies, this must be done at the same time. It is better to rub solutions and ointments into the affected areas of the skin with bare hands. Most often, it is the hands that are affected first, so they need to be treated first.

It is important for the patient to cut their nails very shortly. In the process of treatment, at certain periods, it is necessary to change the bed and linen of a hospitalized person, boil all things for fifteen minutes in a powder solution, and then, after washing, linen and clothes must be ironed with a hot iron. All tissues that come into contact with the patient's skin are subject to treatment. If disinfection is carried out poorly, it becomes possible to re-infect.

The listed activities are carried out exclusively by medical personnel in a medical hospital.

Review of modern preparations for scabies

Treatment begins with the treatment of affected areas of the skin with ointments based on sulfur and salicylic acid. They help to soften the hard shell and remove all crusts. After that, acaricidal (anti-mite) emulsions or aerosols are used.

Products based on benzyl benzoate are sold as a 10% emulsion (for children) and a 20% solution for adults. They are similar in texture and appearance to milk. Such preparations are odorless, after application they are quickly absorbed into the affected areas. Skin treatment is carried out on the first day of the patient's hospitalization, and then on the fourth day of treatment. For a single procedure, it is necessary to use 100 milliliters of emulsion. The medicine is applied to the skin and left for twelve hours. After this, the patient is washed with soap and all his linen is changed. Body washing and change of underwear, bed linen is carried out before the use of anti-tick drugs.

All surfaces of the body (both healthy and affected areas) are treated with ointments. In some patients, after the use of agents based on benzyl benzoate, itching increases. This symptom does not mean the occurrence of side effects. Thus, the body reacts to an increase in toxins that are formed at the time of the mass death of itching. Therefore, treatment must be continued. To alleviate the patient's condition, second and third generation antihistamines, as well as steroid drugs, can be prescribed to quickly stop inflammatory processes.

If such treatment does not help to improve the dynamics of the disease, 60% sodium hyposulfite or 6% hydrochloric acid solution is used for rubbing into the skin. Treatment of the skin with these drugs can provoke the development of contact dermatitis.

Recently, dermatologists in the treatment of Norwegian scabies prefer to use the Spregal aerosol. This is a new generation drug, its use allows you to get stable positive dynamics. The instructions attached to it say that to achieve the desired effect, it is enough to perform a single treatment of the body, but in Russia a scheme is practiced that involves the use of an aerosol twice: on the first and on the fourth day of treatment.

Spray "Permethrin" has a similar effect. Starting from the second day after the first treatment of the body, positive results become visible. The therapeutic effect is very high, but this medicine should not be used to treat infants, pregnant and breastfeeding women. For this category of persons, Lindan ointment is considered an effective acaricidal agent. The course of application is three days.

In parallel with the main course, therapy is necessarily carried out, aimed at increasing the body's defenses. The patient is prescribed immunomodulators, vitamin complexes, mineral supplements. Folk remedies give a good result only in the process of implementing rehabilitation measures. From this point of view, doctors consider baths with decoctions of chamomile, sage and calendula to be completely safe and useful.

Ways of personal prevention

Prevention of Norwegian scabies can be prevented by personal and community prevention. Each of us must learn a number of simple rules to prevent the spread of infection within the same family. Important:

If infection could not be avoided, when the first symptoms appear, you should immediately seek advice from a dermatologist.

Public prevention

Outbreaks of Norwegian scabies are recorded in crowded places of people who are unable to fully serve themselves (hospitals, boarding schools for the disabled, nursing homes, kindergartens). There are known cases of infection of athletes involved in contact sports. To prevent the spread of infection, public prevention of the disease is carried out.

1. Infected people are identified, all their contacts are established, and sanitary supervision authorities are immediately notified of cases of infection.
2. Preventive examinations of persons at risk are carried out.
3. It is considered mandatory to isolate the patient and immediately start treatment.
4. It is supposed to limit the contact of a sick person with the outside world until a complete cure.
5. All personal belongings are disinfected.
6. For those who communicated with patients with Norwegian scabies, constant monitoring is organized.

Compliance with such preventive measures helps to prevent the spread of infection.

Possible complications of the disease

Prognosis for diseases directly depends on how early adequate treatment was undertaken. If intensive therapy is not started on time, unwanted complications may occur. Among them:

• bacterial infection;
• microbial eczema;
• glomerulonephritis caused by staphylococci;
• infectious dermatitis.

Acute rheumatic fever and the addition of a purulent infection can cause death. If the treatment is chosen incorrectly, the whole body will be covered with crusts, pyogenic bacteria almost always begin to multiply under them. Their penetration into the general circulation ends with the death of the patient.

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Norwegian scabies or Scabies norvegica is one of the very rare types of acarodermatitis (a disease caused by a subcutaneous mite), which is an extremely severe form of typical scabies. The disease affects adults and children of all ages. About folk remedies and reviews of Norwegian scabies, an effective remedy for it, disease prevention, read our today's article.

Features of the disease

The synonyms of Norwegian scabies - scabies cortical, keratotic, crustose - convey the main external manifestations that accompany this pathology. Specificity:

If with the number of itching varies within tens of individuals, then with the Norwegian variant, the number of the pathogen reaches tens of thousands and even millions.

This video will tell about Norwegian and some other special types of scabies:

Stages of Norwegian scabies

The infectious process in the Norwegian form of the disease can last a lifetime. The duration of the disease varies from 5-6 months to 40-50 years. The duration of the latent period of incubation ranges from 2 - 3 months to 15 years, after which layers of crusts begin to appear. The pathology is recurrent, that is, the manifestations of crusty scabies sometimes subside for a while, but then become aggravated again.

Causes

About Norwegian scabies in an adult, a child, incl. chest read below in the article.

Symptoms

Main

The main external signs of the disease are:

• massive multi-layered (up to 7 layers) dense yellow-gray, gray-brown and black crusts up to 40 mm thick, covering almost the entire body with a hard "shell". The lesions are located in the following areas:
  • on the back of the hands and feet;
  • extensor surfaces;
  • elbows, spaces between fingers;
  • buttocks, knees, abdomen and auricles;
  • face skin, nails, scalp.
• development on the palms and soles of hyperkeratosis (pathological growth of the stratum corneum of the skin), which limits movement;
• numerous and multi-tiered scabies in the lower layer of crusts;
• polymorphic (of various forms and types) rashes in the form of papules (red pimples), vesicles (vesicles), scales, crusts, pustules (purulent-bubbly rash);
• dry and hot skin;
• erythroderma;
• thickening, loosening of the nail plates, which change color, exfoliate and quickly crumble, as happens with onychomycosis (fungus);
• a specific acidic smell from the infected (similar to the smell of sour dough).
• swollen and inflamed lymph nodes throughout the body.

There is a dense soldering of the layers of crusts between themselves and the tissues under them. The removal process is very painful. After removing the crusts, extensive weeping lesions with a thin yellowish-bloody bottom open.

With Norwegian scabies, only half of the patients have itching. Infectionists believe that the reasons for the absence of itching can be:

1. High weakness of the immune response to all irritants, allergens, the introduction of foreign agents. Toxins of subcutaneous mites are not able to cause severe allergies in the form of itching.
2. Violations in the transmission of nerve impulses in polyneuropathy (damage to many peripheral nerves), leprosy, syringomyelia (formation of cavities in the spinal cord).
3. The apparent absence of itching in cases where the sick person is not able to scratch the itchy place with paralysis, myopathy (degradation of muscle tissue).
4. Hereditary genetic predisposition.

Let's find out how to recognize Norwegian scabies in a child and an adult.

Diagnostics

When infected with crusted scabies, diagnosis is difficult due to the frequent absence of itching, which always occurs with other forms of scabies.

Pathology is often confused with, ordinary and complicated. Very often, the disease is mistaken for psoriasis that occurs with hyperkeratosis (pathological growth of the stratum corneum tissue), due to similar external signs: hyperemia (redness) of the skin throughout the body, thick crusts affecting the stratum corneum, peeling, deformation of the nail plates, lack of itching .

To accurately diagnose the Norwegian type of scabies, a histological analysis of a biopsy specimen (cells or a piece of tissue taken from suspicious areas) and a biochemical blood test are performed.

The diagnosis of Norwegian scabies after diagnosis is made with the following identified pathologies:

1. In the biopsy of the abnormally thickened stratum corneum, a huge number of scabies arranged in tiers, mites, their eggs and larvae are found.
2. Identify signs of acanthosis (excessive pigmentation of the skin in the skin folds of the groin, neck, armpits).
3. Changes are observed in the blood - an increase in the number of leukocytes, eosinophils, an increase in ESR (erythrocyte sedimentation rate).

And now let's find out how to get rid of Norwegian scabies.

Treatment

Therapy of Norwegian scabies should take place only under the supervision of a specialized specialist after confirming the diagnosis. Self-medication and an attempt to use folk remedies only aggravates the condition of an infected person, leading to serious complications and death.

Important! If only those remedies are used that eliminate itching and inflammation (antihistamines and hormonal), this does not lead to the destruction of itching, but only hides the further development of the disease, which can lead to complications, infection of others and death of patients from severe complications.

About what kind of ointment from scabies helps, we will tell below.

Medical

1. Benzyl benzoate emulsion (25% for adults, 10% for children). The advantage over sulfur ointments is the absence of a specific smell and active, traceless absorption into the skin. The volume of the emulsion for a single treatment is 100 ml. 2 treatments are required - on days 1 and 4 of therapy. On the first and sixth day, bed and underwear are changed. It should be remembered that 20% ointment gives a reduced effect;
2. If the result in the treatment of benzyl benzoate is mild, sodium hyposulfite (60%) and hydrochloric acid solution (6%) are prescribed according to the Demyanovich method, which consists in using these agents for rubbing into the skin.
3. The most pronounced effect was noted when using 33% sulfuric ointment (sulphur-tar, Wilkinson's ointment), however, contact dermatitis often develops after it, which limits the use of this remedy.
4. Modern anti-caricidal ointments - Lindane, Permethrin, Spregal.

Wherein:

As a result of the use of these funds in getting rid of Norwegian scabies, the possibility of complications inevitable in this pathology is reduced to a minimum probability. In case of infection with crustacean scabies, in complex treatment it is necessary to use:

• additional funds to increase the immune defense of the body (immunomodulators);
• vitamin complexes, mineral supplements;
• preparations for the restoration of the skin (fatty and moisturizing creams, baths with the addition of oils).

As for folk remedies, with Norwegian scabies they are ineffective in treatment, but give a good result in the rehabilitation period. Absolutely safe doctors consider baths with a decoction of chamomile, sage, calendula, starch and oatmeal.

Prevention

Personal

In order not to become infected with crusty scabies, a number of measures should be observed:

This video will tell you about the repetition of Norwegian scabies:

Public

The outbreak of the Norwegian scabies epidemic can easily become a group of a kindergarten or a baby house, a family, a yard, a boarding school, a dorm room, a hotel room, a school class, a sports section. If Norwegian scabies is found, everyone who has been in contact with a person infected with a subcutaneous mite undergoes a mandatory examination.

Public prevention provides:

• active detection of those infected with crustose scabies and reporting any manifestations of pathology to the sanitary supervision authorities;
• carrying out preventive examinations of babies and adolescents in organized groups (schools, nurseries and kindergartens, boarding schools, sections, camps);
• early isolation of sick children and adults with immediate initiation of therapy;
• observation of children, adults who communicated with an infected scabies mite;
• disinfection of all things, clothes of sick people;
• avoiding contact until the complete cure of scabies and the disappearance of all symptoms.

Complications

If intensive therapy of the Norwegian form of scabies is not started in time, the disease is complicated by the following pathologies:

• microbial eczema;
• post-streptococcal glomerulonephritis (severe pathology of the glomerular filtration system of the kidneys caused by streptococcus);
• (development of multiple ulcers on the skin);
• leading to serious cardiac pathologies and defects in the structure of the myocardium.
• with the addition of a purulent infection, which easily develops with massive damage to the skin, the rapid development of sepsis (blood poisoning with a fatal outcome) is possible.

Forecast

If the treatment was not carried out or was erroneous, then the pathological process with Norwegian scabies captures the entire body. Concomitant infection, provoked by pyogenic bacteria that have invaded the lesions, penetrates into the bloodstream and often causes the death of the patient. With timely started and competently carried out treatment, the disease quickly completely regresses.

Therefore, very often among patients there is an erroneous opinion that Norwegian scabies is provoked by the defeat of a special type of tick (Norwegian). This is a wrong opinion. The causative agent of Norwegian scabies is also scabies itch. The only difference between the disease and the usual type of scabies is the complexity of the course and the formation of skin crusts.

The disease got its name from the place of its first manifestation (at the end of the 19th century, a severe form of scabies was discovered in Norwegian shelters). Consequently, the term has taken root in modern medicine.

This type of scabies lesion is characterized by an increased level of contagiousness, but, despite this, it is extremely rare. The main carriers of this disease are people with an asocial lifestyle. Further, drug addicts, people with mental retardation, those with weakened immunity or with its minimum level (with HIV infection), patients with tuberculosis and rheumatoid diseases fall into the risk group.

Attention! Patients who take corticosteroid therapy suffer from a complicated course of Norwegian scabies.

The symptomatology of Norwegian scabies is characterized by the formation of specific crusts on the surface of the skin, which are characterized by a green-yellow or brownish color, with purulent filling. Their thickness can vary from a few millimeters to a couple of centimeters. In this case, such crusts are localized throughout the body, starting from the head.

Reference! With the defeat of the Norwegian scabies of a man, the formation of purulent crusts is not excluded even on the penis.

It is easy to confuse a scabies lesion with a characteristic crusting on the skin with psoriasis, eczema and other skin lesions that are characteristic of cancer.

General signs

In some parts of the body, the crusts can merge together and form a continuous shell, the thickness of which can reach three centimeters. At the same time, in the formed scales, scabies are visible at once in several floors. Additional symptoms indicative of Norwegian scabies are expressed in the following signs:

• when separating the crust from the skin, you can notice the friability of the tissue and bleeding;
• itching is absent or manifests itself slightly;
• hairline on the body becomes scarce;
• dystrophic changes occur in the nail plates;
• a specific smell in the form of a sour dough becomes characteristic of a person;
• on palpation, there is an increase in lymph nodes;
• infection can be localized anywhere on the body.

It is worth noting that this disease is one of those that can lead to death in the absence of competent and timely treatment. Therefore, therapy should be started when the first symptoms are detected.

Diagnostic principles

Before carrying out a cut of the affected skin, the cover is necessarily treated with a solution of lactic acid (at least 40%). Then the removed material is studied in detail under a microscope. Be sure to conduct a differential diagnosis with a number of other skin lesions (eczema, dermatitis, psoriasis).

Transmission routes

Norwegian scabies is often defined as a cortical disease, it is transmitted in the following ways:

Principles of treatment

Since the disease is quite complex, it is treated exclusively in a clinical setting. The use of traditional medicine can only aggravate the course of the disease, and lead to irreparable complications. In this case, treatment begins with the isolation of the patient in a separate hospital box.

It is important! If the patient was in contact with his relatives, then they are shown without fail preventive therapy.

Basic drugs

With Norwegian scabies, self-medication and the use of traditional medicine are contraindicated, since an advanced form of the pathology can lead to death. Treatment is carried out exclusively in stationary conditions under the supervision of a physician. Timely diagnosis is mandatory, since it is possible that the therapy against psoriasis or eczema may be incorrectly prescribed due to the similarity of visual signs. It is also very important to carry out preventive measures for each of the family members who have been in close contact with the patient or his personal belongings.

You can learn more about the different types of scabies here:

Video - Types of scabies: typical, clean, complicated, Norwegian, pseudo-scabies, without moves