Scabies: what does the disease look like and how is it treated? Scabies: a complete description of the disease, including the main symptoms and treatment Typical symptoms of scabies

Etiology and pathogenesis. Scabies mites have an oval tortoiseshell shape. The size of the female is about 0.3 mm in length and 0.25 mm in width, the size of the male is smaller.

The clinical picture of the disease is determined by females, since males, having fertilized them on the surface of the skin of a person (“host”), soon die. Fertilized females make scabies in the epidermis, on the border with the germ layer, where they lay their eggs. In the cover of the passages, the females gnaw through “ventilation shafts” for air access to the laid eggs and the subsequent exit of the larvae, which hatch from the eggs in 3–5 days. The postembryonic development of the tick has several stages and lasts an average of 3–7 days. The duration of the life of a tick outside the human body at room temperature is from 5 to 14 days. At an external temperature of 60°C, mites die within 1 hour, and when boiled or at temperatures below 0°C, they die almost immediately. Vapors of sulfur dioxide kill the scabies mite in 2-3 minutes. Tick eggs are more resistant to various acaricides. Infection with scabies occurs when a tick is transmitted from a sick person to a healthy person through contact or indirectly (through objects used by the patient, clothes, bedding). Infection with scabies favors close contact with the patient, in particular the common bed. Often, infection occurs through sexual contact, which served as the basis for including scabies in the group of sexually transmitted diseases. Much less often, infection is possible when caring for a patient, massage. In children's groups, the disease can be transmitted through soft toys, stationery, sports equipment. Infection can also occur in showers, baths, trains and other public places, provided that the sanitary regime is violated. The spread of scabies is facilitated by overcrowding, poor sanitary and hygienic conditions, insufficient hygiene skills of the population (rare washing, irregular change of linen, etc.). The factors contributing to the spread of scabies also include increased migration of the population, self-treatment.

Histologically, the changes in uncomplicated scabies are insignificant: the scabies course is located mainly in the stratum corneum, only its blind end reaches the germ layer of the epidermis or penetrates into it. There is a female tick here. In this area, intra- and intercellular edema develops, due to which a small bubble forms. In the dermis under the scabies course there is a chronic inflammatory lymphocytic infiltrate. With Norwegian scabies, hyperkeratosis, partial parakeratosis are noted; there is an abundance of itch passages located in 5–8 layers (“floors”) and containing shells of eggs, larvae and nymphs, and in deeper layers and mites, which are sometimes found in the spinous layer of the epidermis.

clinical picture. The duration of the incubation period for scabies can vary from 1 to 6 weeks, but most often it is 7-12 days. The duration of the incubation period is affected by the number of pathogens that have entered the human skin during infection, the reactivity of the body, and the patient's hygiene skills. The main clinical symptoms of scabies are itching, the presence of scabies, and the characteristic localization of clinical manifestations. The clinical picture is due to the activity of the tick, the patient's reaction to itching, secondary pyogenic flora, an allergic reaction of the body to the pathogen and its waste products. The most characteristic is the occurrence or intensification of itching in the evening and at night, which is due to the presence of a daily rhythm of tick activity with its intensification at night. Itching appears after the introduction of the scabies mite into the stratum corneum of the epidermis. Morphological changes on the skin at this time may either be absent or minimal (most often these are small vesicles, papules or blisters at the sites of pathogen penetration). The pathognomonic sign of the disease is the itch move. A typical scabies move has the appearance of a slightly raised straight or curved, whitish or dirty gray line from 1 mm to several centimeters long (usually about 1 cm). At the front (blind) end of the passage, a bubble is often found (here is a female tick, translucent through the stratum corneum in the form of a dark dot). Often, itch passages are represented by several vesicles at various stages of development, arranged linearly in the form of a chain. In the case of a secondary infection, the vesicles turn into pustules. When the exudate dries up, the passages take the form of serous or purulent crusts.

A rare type of disease is Norwegian scabies (crustous, crusty) observed in persons with impaired skin sensitivity, mentally ill, persons with immune deficiency (often against the background of long-term use of corticosteroids and cytostatics). Norwegian scabies is characterized by the appearance in typical places of massive dirty-yellow or brown-black crusts with a thickness of several millimeters to 2-3 cm. The rash can spread to the skin of the face, neck, scalp, take on a generalized character, creating a picture of a continuous horny shell, making movement difficult and painful.

There are also cases with limited lesions (skin folds, elbows). Between the layers of crusts and under them, a large number of scabies mites are found, and on the lower surface of the layers there are sinuous depressions corresponding to scabies. When the crusts are rejected, extensive weeping erosive surfaces are exposed. The skin of patients with Norwegian scabies is dry, the nails are sharply thickened, hyperkeratosis is expressed on the palms and soles. The process is often complicated by pyoderma, lymphadenitis. In the blood - eosinophilia, leukocytosis, elevated ESR. With a pronounced clinical picture, itching is weak or absent. Norwegian scabies is highly contagious, with contacts developing the usual form of the disease. Severe itching, characteristic of scabies, leads to scratching, as a result of which the disease is often complicated by secondary pyoderma (folliculitis, impetigo, ecthyma, boils).

Sometimes in patients with scabies, post-cabinous nodules may occur - post-scabious lymphoplasia. Nodules develop in isolated areas of the skin with a particular predisposition to respond to stimuli with reactive hyperplasia of lymphoid tissue. Nodules ranging in size from peas to beans have round or oval outlines, bluish-pink or brownish-red color, smooth surface and dense texture. Most often they are located in closed areas (scrotum, inner thighs, abdomen, armpits, area around the nipples of the mammary glands). The course of the process is benign, but can be very long (from several months to several years). Lymphocytosis is often found in the blood. The nodules are resistant to anti-scabies therapy.

The diagnosis of scabies is made on the basis of the clinical picture, epidemiological data and is confirmed by laboratory methods, the purpose of which is to detect the pathogen. The method of extracting the tick with a needle: under a magnifying glass, the blind end of the scabies passage is opened in a place where a dark dot (female) is visible. Then the point of the needle is slightly advanced in the direction of the itch, while the female is usually attached with suction cups to the needle and is easily removed. The tick is placed on a glass slide in a drop of 10% alkali solution, covered with a coverslip and examined under a microscope. Thin section method: with a sharp razor or eye scissors, a section of the stratum corneum with an itch or vesicle is cut off. The material is poured with a 20% alkali solution, incubated for 5 minutes, then microscoped. The method, unlike the previous one, allows you to see not only the tick, but also its eggs, shells, excrement. The success of laboratory diagnostics largely depends on the ability to detect scabies. To facilitate the search, suspicious elements are smeared with an alcoholic solution of iodine, aniline dyes, ink, ink: the loosened layer of the epidermis at the site of the scabies absorbs the dye more intensively and becomes noticeable. Sokolova's method for detecting itch flare: a drop of 40% lactic acid solution is applied to any itch element (stroke, vesicle, papule, crust). After 5 minutes, the loosened epidermis is scraped off with a sharp spoon until capillary bleeding appears. The resulting material is transferred to a glass slide in a drop of lactic acid solution, covered with a coverslip and immediately microscoped.

One of the most effective treatments for scabies is the use of a water-soap emulsion of benzyl benzoate (20% for adults and 10% for children). The drug remains effective for 7 days after preparation. The emulsion is shaken and carefully rubbed into the skin with a cotton-gauze swab 2 times a day for 10 minutes with a 10-minute break on the first and fourth days of treatment, after which the patient should wash and change clothes. Effective treatment according to the Demyanovich method, which is carried out with two solutions: No. 1 (60% sodium thiosulfate solution) and No. 2 (6% hydrochloric acid solution). Solution No. 1 is rubbed into the skin for 10 minutes (2 minutes in each limb and trunk), after 10 minutes the rubbing is repeated. As soon as the skin dries, rub solution No. 2 in the same order for 20 minutes. After the end of treatment, change of underwear and bed linen is carried out and the next day the treatment is repeated. You can wash after 3 days. For the treatment of scabies, ointments containing sulfur or tar are also used (Wilkinson's ointment, 20–33% sulfuric ointment). Rubbing ointments produce 5 days in a row. A day after the last rubbing, the ointments are washed with soap, underwear and bedding, outerwear are changed. When complicated by pyoderma, these phenomena should first be stopped with the help of antibiotics or sulfonamides, aniline dyes, disinfectant ointments.

At Norwegian scabies it is necessary to first remove the massive cortical layers with the help of sulfur-salicylic ointment and subsequent soda or soapy bath, and then carry out intensive anti-scabies treatment.

Lindane, crotamiton, spregal can also be used to treat scabies. Lindane lotion (1%) is applied once to the entire surface of the skin and left for 6 hours, then washed off. The drug can also be used as a 1% cream, shampoo, powder, 1-2% ointment. Crotamiton (Eurax) is used as a 10% cream, lotion or ointment: rubbed after washing 2 times a day with a daily interval or four times every 12 hours for 2 days. Spregal is used in the form of an aerosol.

Prevention consists in the early detection and treatment of patients with scabies with the examination of contact persons, compliance with sanitary standards, and disinfection in the foci of scabies. The most important anti-epidemic measures are early diagnosis of scabies, identification and simultaneous treatment of all contact persons; timely thorough disinfection of clothing, underwear and bed linen, furniture and other furnishings. If scabies is detected in a child or staff in a children's institution, it is necessary to examine all children, as well as staff (as in families, preventive treatment of all contacts is also necessary here). The control of cure is carried out 3 days after the end of treatment, and then every 10 days for 1.5 months. The linen of patients is boiled, the dress and other clothes (if it is impossible to process it in a disinfection chamber) are carefully ironed with a hot iron or aired in the air for 5 days, and in the cold - for 1 day. Carry out wet cleaning of the premises with a 5% solution of chloramine. Upholstered furniture is treated with the same disinfectant.

3. Scabies. Etiology, pathogenesis, clinic

After contact with individuals or larvae on human skin, females pierce the epidermis for 0.5–1 h, forming scabies in which they lay eggs. After 3–4 days, larvae appear from the laid eggs, which accumulate in the zone of the stratum corneum. After 2-3 days, they have the first molt with the formation of a nymph from the larvae, which comes to the surface of the skin, then after 3-4 days ticks appear from the nymphs.

transmission paths. The source of infection is a person with scabies. Scabies is transmitted by contact.

Clinic. Immediately after infection, the incubation period of the pathogen begins, the duration of which varies. The average duration of the incubation period is from 3 to 14 days.

The main complaint presented by patients with scabies is skin itching, which bothers them mainly in the evening and at night.

Typical form of scabies. Rashes are localized in the most typical places: on the abdomen, especially around the navel, on the anterior inner surface of the thigh, on the buttocks, mammary glands, lateral surfaces

in the bones of the fingers and toes, in men on the skin of the penis and scrotum. In addition to paired papulovesicles and scabies, pinpoint and linear excoriations (indicating itching) are found on the patient's skin, as well as various pyococcal complications, which often begin in the extensor zone of the elbows. Ardi's symptom is the detection of purulent or purulent-bloody crusts on the elbows.

Atypical forms of scabies include: clean scabies, nodular scabies and crusty (Norwegian) scabies.

Cleanliness scabies is an erased, abortive form of the disease that develops in people who carefully follow the rules of personal hygiene and have normal immunoreactivity.

Nodular scabies (nodular scabious lymphoplasia) occurs as a result of a delayed-type hyperergic reaction that develops on the waste products of the mite.

Itchy, lenticular, reddish-brown nodules occur under the burrows and are always located in areas characteristic of typical scabies.

The most rare atypical form of scabies is crusted or Norwegian scabies. This type of scabies occurs in patients who have a sharply weakened immunoreactivity. Crusted scabies is manifested by the formation of crusts on the surface of the skin and is the most contagious form of scabies. The extensor surfaces of the extremities (rear of the hands, fingers, elbows, knees), buttocks, scalp, face, and auricles are mainly affected.

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The symptoms of scabies are caused by the host's immune-allergic reaction to the waste products of the tick, so all the symptoms develop only after the patient is sensitized. This explains the long asymptomatic period (up to 4 weeks) preceding the appearance of the first signs of the disease during primary infection. In cases of re-infection, the reaction to the pathogen can develop within a day. The development of protective immunity also explains the difficulty of re-infection in the experiment, as well as the fact that a significantly smaller number of ticks is found on the patient's body during re-infection.

Itching in scabies is mainly due to a type IV allergic reaction (delayed-type hypersensitivity) to saliva, eggs, and feces of mites. Scratches caused by itching often lead to the addition of bacterial flora (staphylococci and streptococci) with the development of pustules (pyoderma). Thus, the rash with scabies acquires polymorphism.

Interestingly, the same allergens were also found in household dust inhabited by microscopic household mites, which also feed on human epithelium, which forms the basis of house dust.

With severe tick damage, the level of interleukin-4 increases. Patients also have a Th2-type immune response, which is associated with an increase in their serum IgE and IgG in combination with eosinophilia. However, this pronounced humoral immune response does not have a significant protective effect. In scabies, the cellular immune response is more significant, which is studied at the histological level: ticks are surrounded by an inflammatory infiltrate consisting of eosionophils, lymphocytes, histiocytes, and a small number of neutrophils.

With the Norwegian form of scabies, pronounced hyperkeratosis is observed, and a large number of mites (up to several million on the body of one patient) are found in areas of inflammatory infiltrate. Norwegian scabies occurs in patients who do not feel severe itching, or who are unable to scratch. Such conditions occur in immunodeficiencies, when the immune response to ticks is sluggish (AIDS, regular use of glucocorticosteroid and other immunosuppressive drugs), in violation of peripheral sensitivity (leprosy, syringomyelia, paralysis, dorsal tabes), constitutional anomalies of keratinization, as well as in frail patients (senile dementia, dementia, limited mobility, etc.).

With prolonged existence of the infiltrate, the so-called scabious lymphoplasia is formed in the form of nodules (nodular scabies), when the infiltrates become very dense and are distributed around the subcutaneous vessels and in fatty tissue, resembling elements in lymphoma or pseudolymphoma.

Scabies Symptoms:

Scabies almost always occurs through prolonged direct skin-to-skin contact. The sexual route of transmission predominates. Children often become infected when they sleep in the same bed with sick parents. In crowded groups, other direct skin contacts are also realized (contact sports, children's fuss, frequent and strong handshakes, etc.). Although a number of guidelines continue to reproduce outdated information about the transmission of scabies through household items (household items, bedding, etc.), experts agree that this route of infection is extremely unlikely. An exception are cases of Norwegian scabies, when up to several million mites live on the patient's body (in typical cases, these are 10-20 mites).

A key experiment that proved that direct contact with the patient's skin plays a dominant role in the transmission of scabies was performed in 1940 in Great Britain under the leadership of Mellanby. Of 272 attempts to infect volunteers by putting them to bed, from which patients with severe scabies had just risen, only 4 attempts led to the disease.

You should be aware that mites that cause scabies in animals (dogs, cats, horses, etc.) can also get to humans, but do not find suitable conditions for their existence here and die rather quickly, causing only short-term itching and rash, which without re-infection pass even without treatment.

The incubation period for scabies is 7-10 days.

Scabies is characterized by itching, especially worse at night, paired nodular-bubble rashes with localization in certain favorite places. Outwardly, scabies are thin strips, barely elevated above the level of the skin, like a thread, running straight or zigzag. Often the end of the move ends with a transparent bubble through which a white dot is visible - the body of the tick. Sometimes scabies can not be detected (scabies without moves).

Permanent damage to the skin is often complicated by various types of pustular infection and the development of an eczema process.

Favorite localization of scabies rash: hands, especially interdigital folds and lateral surfaces of the fingers, flexor folds of the forearms and shoulders, nipple area, especially in women, buttocks, skin of the penis in men, thighs, popliteal cavities, in young children - the soles, as well as the face and even the scalp.

The presence of itching, primary rash and scabies is the main clinical symptom complex of a typical form of scabies.

In domestic dermatology, it is customary to distinguish characteristic eponymous symptoms that facilitate the diagnosis:
Ardi's symptom - pustules and purulent crusts on the elbows and in their circumference;
Gorchakov's symptom - bloody crusts in the same place;
symptom of Michaelis - bloody crusts and impetiginous rashes in the intergluteal fold with a transition to the sacrum;
Cesari's symptom is the detection of itch moves in the form of a slight elevation during their palpation.

Scratching often leads to a pronounced bacterial infection of the primary elements with the development of pyoderma, which in rare cases can lead to post-streptococcal glomerulonephritis and possibly rheumatic heart disease. Sometimes pyoderma with scabies is accompanied by the appearance of boils, ecthyma and abscesses, accompanied by lymphadenitis and lymphangitis. A number of patients develop microbial eczema or allergic dermatitis, which, along with pyoderma, are classified as complicated forms of scabies in domestic dermatology. Complications of scabies in the form of dermatitis and pyoderma occur in approximately 50% of patients.

In children, especially infants, along with papulovesicles and scabies, there is a vesiculourticar rash, weeping develops, paronychia and onychia occur. In children in the first 6 months. life, the clinical picture of scabies often resembles urticaria and is characterized by a large number of combed and bloody crusted blisters in the center, localized on the skin of the face, back, buttocks. Later, a small vesicular rash prevails, sometimes blisters (pemphigoid form). In some cases, scabies in children resembles acute eczema, accompanied by intense itching not only in the localization of ticks, but also in remote areas of the skin. In this regard, sleep disturbances are often noted, complications in the form of allergic dermatitis, impetigo-type pyoderma are more often observed. Lymphadenitis and lymphangitis may occur, leukocytosis and lymphocytosis, eosinophilia, accelerated ESR, and albuminuria are observed. Infants may develop sepsis. In recent years, there has been an increase in cases of atypical scabies with erased forms in children.

Atypical forms of scabies also include Norwegian scabies, "clean" scabies (scabies "incognito") and pseudosarcoptic mange.

Scabies "clean" or scabies "incognito" is detected in people who often wash themselves at home or by the nature of their production activities. In this case, most of the scabies mite population is mechanically removed from the patient's body. The clinic of the disease corresponds to typical scabies with minimal manifestations. Complications often mask the true clinical picture of scabies. The most common are pyoderma and dermatitis, less common are microbial eczema and urticaria.

Pseudosarcoptic mange is a disease that occurs in humans when infected with scabies mites (S. scabiei other than var. homonis) from other mammals (usually dogs). The disease is characterized by a short incubation period, the absence of scabies (mites do not breed on an unusual host), urticaria papules in open areas of the skin. The disease is not transmitted from person to person.

Diagnosis of Scabies:

The diagnosis of scabies is made on the basis of clinical manifestations, epidemiological data, and laboratory data. Laboratory confirmation of the diagnosis is especially important with an erased clinical picture. There are the following methods of laboratory confirmation of the disease:
1. Traditional removal of the tick with a needle from the blind end of the scabies course, followed by microscopy of the pathogen. This method is ineffective in the study of old dilapidated papules.
2. The method of thin sections of sections of the stratum corneum of the epidermis in the area of the scabies during microscopy allows you to identify not only the tick, but also its eggs.
3. The method of layer-by-layer scraping from the area of the blind end of the scabies passage until blood appears. followed by microscopy of the material.
4. The method of alkaline preparation of the skin, with the application of an alkaline solution to the skin, followed by aspiration of the macerated skin and microscopy.

In every case when a patient complains of pruritus, scabies should be ruled out first, especially if itching also occurs in other members of the family or an organized team.

Detection of itch moves reliably confirms the diagnosis. To fully confirm the diagnosis, it is recommended to open the itch with a scalpel coated with an oily substance, carefully scratching the stratum corneum along the itch with a blade. The resulting scrapings are placed on a glass slide and microscoped. The best results are obtained with scrapings of "fresh", not combed scabies on the interdigital spaces of the hands. Although this method has 100% specificity, its sensitivity is low.

Potassium hydrochloride dissolves keratin for better detection of mites and eggs, but also dissolves mite feces, which are also of diagnostic value.

Scabies moves are easier to detect if the skin is stained with iodine tincture - the moves are visualized as brown stripes against the background of healthy skin painted in light brown. Abroad, ink is used for these purposes.

A video dermatoscope with a magnification of 600 times allows you to detect scabies in almost all cases.

Due to the fact that ticks can not always be detected, a number of authors suggest the following practical approach for diagnosis: the diagnosis of scabies is established in the presence of a papulovesicular rash, pustular elements and pruritus (especially worse at night), as well as with a positive family history.

Scabies Treatment:

Spontaneously, scabies never goes away and can last for many months and years, sometimes getting worse. To cure a patient with scabies, it is enough to destroy the tick and its eggs, which is easily achieved by using local remedies; no general treatment is required here.

The most commonly used benzyl benzoate emulsion is 20% for adults and 10% for young children. Treatment is carried out according to the following scheme: on the first day, the emulsion with a cotton swab is sequentially rubbed into all lesions twice for 10 minutes with a 10-minute break. After that, the patient puts on disinfected clothes and changes bedding. On the second day, rubbing is repeated. 3 days after that - washing in the shower and again changing clothes.

Demyanovich method. Two solutions are made: No. 1 - 60% sodium hyposulfate and No. 2 - 6% hydrochloric acid solution. Treatment is carried out in a warm room. Solution No. 1 is poured into the dishes in an amount of 100 ml. The patient is stripped naked, the solution is rubbed into the skin with the hand in the following sequence: on the left shoulder and left arm; in the right shoulder in the right hand; in the body; in the left leg; in the right leg. Rub for 2 minutes with vigorous movements and especially carefully in those places where there are scabies. The patient then rests for a few minutes. During this time, the solution dries out rather quickly, the skin, covered with the smallest crystals of sodium hyposulphate, becomes white, as if powdered. After that, the second rubbing is carried out with the same solution and in the same sequence, also for 2 minutes in each area. Salt crystals, destroying the covers of scabies, facilitate the flow of the drug directly into the passages.

After drying, they begin to treat the skin with hydrochloric acid. This solution must be taken directly from the bottle, pouring it into the palm of your hand as needed. Rubbing is done in the same sequence, but it lasts only one minute. After drying the skin, repeat 2 more times.

Then the patient puts on clean underwear and does not wash off the remaining medicines for 3 days, and then washes. As a result of the interaction of sodium hyposulfate solution and hydrochloric acid, sulfur dioxide and sulfur are released, which kill the scabies mite, their eggs and larvae. In children with scabies, treatment according to the method of prof. Demyanovich is usually carried out by parents. If the first course did not give a complete recovery, then after 2-5 days the treatment should be repeated. In extremely rare cases, a 2nd course is required.

Sulfuric ointment (33%) is rubbed into the whole body, except for the head, 1 time at night for 4-5 days. Then rubbing is not done for 1-2 days, the patient remains in the same underwear that is soaked with ointment all this time. Then he washes and puts on everything clean. In persons with hypersensitivity, dermatitis often develops, therefore, rubbing sulfuric ointment into areas with thin and delicate skin should be done with extreme caution, and in children, ointments of 10-20% concentration should be used. A one-time rubbing of sulfuric ointment is also proposed. The patient at the same time first moisturizes the body with soapy water and rubs sulfuric ointment dry into the affected areas for 2 hours, after which the skin is powdered with talc or starch. The ointment is not washed off for 3 days, then the patient washes and changes clothes.

Good therapeutic results can be obtained from the use of an old folk remedy - simple wood ash, which contains a sufficient amount of sulfur compounds to destroy the scabies mite. From the ashes, either an ointment is prepared (30 parts of ash and 70 parts of any fat), which is used similarly to sulfuric ointment, or they take a glass of ash and two glasses of water and boil for 20 minutes. After boiling, the liquid is filtered through a gauze or cloth bag. The sediment remaining in the bag is moistened in the resulting liquid lye and rubbed into the skin every night for a week for 1/2 hour.

Kerosene in half with any vegetable oil, for 2-3 days, once at night, lubricate the whole body and spray underwear, stockings, mittens; in the morning they wash the body and change clothes; usually 2-3 times to lubricate is enough to cure. The disadvantage of this method is the possibility of dermatitis, especially in children.

Immediately after the end of treatment, all the patient's linen, both wearable and bedding, must be thoroughly washed and boiled; outer clothing should be decontaminated from a tick in a disinfection chamber or by ironing it with a hot iron, especially from the inside, or ventilated in the air for 5 -7 days.They are also treated with a mattress, blanket, etc. of the patient.It is extremely important to treat all the sick at the same time - in the same family, school, hostel, etc.

Current treatments for scabies in children and adults include the use of drugs such as lindane, crotamiton, permethrin, and spregal, available in solution, cream, or aerosol.

Crotamiton. Before prescribing a drug to a patient, it is desirable to determine the sensitivity of the microflora to it that caused the disease in this patient. The drug is used externally. For scabies, a cream or lotion (after shaking) is applied as follows. After a bath or shower, the cream or lotion is carefully rubbed into the skin from the chin to the toes, paying special attention to the creases and folds. The procedure is repeated after 24 hours. The next day, clothes and bed linen are changed. 48 hours after the second rubbing, a hygienic bath is taken. When used as an antipruritic agent, crotamiton is gently rubbed into the skin until completely absorbed. If necessary, rubbing the drug is repeated.

Spregal. Before prescribing a drug to a patient, it is desirable to determine the sensitivity of the microflora to it that caused the disease in this patient. Treatment begins in the evening at 18-19 h, so that the drug acts during the night. After applying the drug, do not wash. First, the infected person is treated, then all other family members. Spray the entire surface of the body, except for the head and face, from a distance of 20-30 cm from the surface of the skin. The drug is first applied to the trunk, and then to the limbs, without leaving a single part of the body untreated (the treated areas begin to shine). Especially carefully the drug is applied between the fingers, toes, in the armpits, perineum, on all folds and affected areas and left on the skin for 12 hours. After 12 hours, wash thoroughly with soap and dry yourself. As a rule, a single application of the spregal is sufficient. However, it must be borne in mind that even if the treatment is effective, itching and other symptoms may be observed for another 8-10 days. If after this period the symptoms persist, you can apply the drug again. In the case of infected scabies, impetigo (superficial pustular skin lesions with the formation of purulent crusts) must first be treated.

If scabies is accompanied by eczema, 24 hours before applying the spregal, lubricate the affected surface with a glucocorticoid ointment (containing adrenal hormones or their synthetic analogues, for example, fluorocort). When treating children and newborns during the spraying of the drug, it is necessary to cover their nose and mouth with a napkin; in the case of changing diapers, it is necessary to re-treat the entire area of the buttocks. When scratching is localized on the face, they are treated with cotton wool moistened with a spregal. To avoid secondary infection, it is necessary to treat the bed and clothes. One can of Spregal is enough to treat three people. It is necessary to avoid getting the drug on the face. In case of accidental contact with eyes, rinse thoroughly with warm water.

Forecast.
In the case of a preserved immune status, the disease does not pose an immediate threat to life. Timely adequate treatment allows you to completely eliminate the symptoms and consequences of the disease. The ability to work is fully restored.

In rare cases, seen mainly in the poorest countries, complicated scabies can lead to post-streptococcal glomerulonephritis and possibly rheumatic heart disease.

Image from lori.ru

Etiology

Scabies is caused by a member of the arachnid class, the scabies mite. This is an extremely small animal (the body length of the female is only 0.5 millimeters). The lifespan of a scabies mite is approximately one month. In order to lay their eggs (2-3 pieces per day), females gnaw through passages in the stratum corneum of the epidermis. The eggs hatch into larvae, which go through a series of developmental stages and finally transform into an adult tick. All these processes occur inside the human skin. Adults come to the surface of the skin, and mating takes place here. After fertilization, the males die, and the females penetrate the skin of their or a new host, and the entire development cycle is repeated. Outside the skin of a person, a tick can live at room temperature for two to three days. At temperatures of 100 degrees or below zero, ticks die instantly.

The tick can be transmitted from one host to another at any stage of its development, but the most dangerous in this sense are fertilized females.

During the day, the tick is not active. The female begins to make a move in the skin with the onset of darkness. That is why people suffering from typical forms of scabies feel intense itching in the evening. At night, sexually mature individuals come to the surface of the skin to mate. At the same time, ticks move throughout the body. The speed of their movement at normal body temperature is 2.5 cm per minute. It is at this time that it is easiest for another person to become infected from the carrier of the scabies mite.

Scabies mite lives and breeds only on the human body. If the disease is not treated, in three months 6 generations of pathogens are born in the skin - a total of 15 million individuals.

After fertilization, the adult female makes a passage in the upper layer of the skin, where she lays her eggs. Sexually mature individuals come to the surface of the skin and provoke itching and scratching with their bites.

The pathogenesis of scabies

Allergens like those given off by the scabies mite are found in household dust. The fact is that microscopic mites that feed on human epithelial tissue live in particles of household dust.

If the scabies mite infection is severe, the level of interleukin-4 increases in the blood. In addition, patients have a Th2-type immune reaction, which is associated with an increase in IgE and IgG antibodies in combination with eosinophilic manifestations. However, this immune reaction does not guarantee effective protection of the body. With scabies, a cellular immune response is more effective, which consists in the fact that an inflammatory infiltrate is formed around the pathogens, containing lymphocytes, eosinophils, histiocytes and neutrophils.

There is the so-called Norwegian scabies, which is characterized by pronounced hyperkeratosis (excessive coarsening of the stratum corneum of the skin). On the inflamed areas, giant accumulations of scabies mites are detected (up to several million in one person). Norwegian scabies affects people who do not feel itching and do not scratch. These may include patients with:

immunodeficiency states (, taking certain drugs), in which the immune response to ticks is too weak;
violations of skin sensitivity (leprosy, paralysis, syringomyelia, tabes of the spinal cord);
violations of the stratum corneum;
limited mental and physical abilities (senile insanity, immobility, etc.).

If the inflammatory infiltrate remains untreated for a long time, scabious lymphoplasia - nodules - forms on the skin. In this case, they talk about the nodular form of scabies, in which the infiltrates become extremely hard, located in the area of subcutaneous blood vessels and adipose tissue, resembling neoplasms in both types of lymphomas.

Characteristic signs of scabies are tick tunnels and itching. They can be found on the skin in the form of small winding lines. The most common location is the interdigital folds of skin on the hands, the back of the forearm. The moves may not be noticeable until a rash appears, which is accompanied by severe itching.

Common Causes

Scabies is a fairly common skin disease and is transmitted by contact, both through household and sexual contact with a patient with scabies or with objects (clothing, bedding) used by the patient. Infection can only occur from person to person.

Diagnosis of scabies in our clinic

To diagnose scabies, in most cases it is enough to correctly collect an anamnesis, examine the patient well and do dermatoscopy of rashes and scabies. In some cases, microscopy of skin scrapings is necessary to confirm the diagnosis. In the photographs you can see the microscopic picture of scabies. In the first photo, the scabies mite, and in the second, the eggs and excrement of the scabies mite.

photographic materials from the daily practice of the scientific director of the clinic

How do we treat scabies in the clinic

For effective scabies treatment topical preparations are used in the form of solutions, ointments and creams. These are preparations of acaricidal (i.e., killing ticks) action. One of the effective and safe drugs prescribed for scabies is Permethrin. In case of intolerance (in rare cases) or an allergic reaction to a medicinal substance, Spregal may be prescribed.

It is not recommended to self-medicate, as it may not give results, lead to a long course of the process. In addition, other family members living with a person with scabies will become infected, and eventually the whole family will have to see a doctor.