How to get rid of the effects of scabies. Scabies: a complete description of the disease, including the main symptoms and treatment. Differential diagnosis of the disease

The female tick lays about two dozen eggs under the skin of a person, then dies. After 2-3 days, the eggs hatch into larvae. They make passages under the skin and release toxic substances that provoke severe itching in the affected areas.

After 14 days, the larvae turn into adults, and live in the skin until the moment when the person takes up anti-scabies therapy.

Symptoms

At the site of penetration of the tick under the skin, a small bubble appears. A characteristic symptom of scabies is the strongest itching of the affected areas of the skin, aggravated at night. In addition to skin itching, there are other manifestations of the disease:

• red rashes on the skin;
• scabies, noticeable on close examination;
• increase in body temperature;
• nervousness and anxiety.

Itching affects such parts of the body of an adult:

• lateral parts and lower abdomen;
• between the fingers and toes;
• inner thighs;
• genitals;
• the region of the mammary glands;
• elbow bends.

When a child is infected, the localization of ticks is slightly different from adults, the main ones are:

• the inner parts of the feet and the sole itself;
• head and neck;
• palms;
• buttocks.

Possible Complications

If scabies is started, a dangerous complication such as pyoderma can occur.

If the disease is detected in time and treated, relapses are practically excluded.

However, if the full treatment course is not completed or after self-administered therapy, scabies may recur. Symptoms can also appear after excessive scratching of the affected areas of the skin and infection.

Complications of scabies are manifested in the form of skin diseases that are more difficult to treat.

In case of improper treatment

There are cases that complications of scabies appear in the course of improper treatment or inadequately selected drugs. Most frequent complications in such cases are:

If you constantly comb the skin, an additional infection gets there, which can be accompanied by an unpleasant odor.

With strong scratching of the skin during intolerable itching, the upper layer is scraped off and open wounds. Fresh scratches and wounds open access to infection. The most common consequences of scabies when infected areas are:

• Pyoderma - suppurative lesion skin due to the penetration of harmful microorganisms into it. In the absence of timely treatment, the inflammation spreads further along the surface, scars appear.
• Microbial eczema. It develops on areas of the skin affected by microbes or fungi. The most common causative agent of microbial eczema is β-hemolytic streptococcus. The disease manifests itself on the skin in the form of ulcers, weeping wounds, scabs.
• Skin hyperemia - an increase in blood flow in the area of ​​​​inflammatory processes. Red spots on the skin with scabies occur against the background of wounds and abrasions.

Diagnosis and treatment of complications after scabies

If you find unpleasant symptoms, you should immediately consult a dermatologist and undergo the necessary studies. The diagnosis is based on the following tests:

Treatment of complications of scabies is aimed at getting rid of unpleasant symptoms, elimination of a hypodermic tick - adults and larvae.

For any skin disease that occurred during an exacerbation of scabies, the doctor prescribes an internal antibiotic and external ointments (Bactroban, Bonderm, lincomycin ointment).

As the pustules decrease, ointments are used directly from scabies: "Benzyl benzoate", "Spregal", Sulfuric ointment. In more advanced cases treatment of scabies with cold (cryotherapy) is prescribed.

Source: http://InfoParazit.ru/bolezni-ot-vneshnih/chesotka/oslozhneniya-posle-chesotki.html

The specificity of the manifestation and treatment of scabies in humans

The manifestation of the disease is always focal.

Typology

There are several types of scabies in humans:

• typical;
• atypical (in turn, the disease is divided into such subspecies: scabies without moves, Norwegian, scabies of the "incognito" type, complicated, postcabial lymphoplasia, pseudosarcoptic mange).

Typical scabies is characterized by multiple rashes localized on the interdigital folds of the hands, on the abdomen (around the navel), on the chest, in the genital area.

Diagnosis of scabies without moves is carried out by examining persons who have been in contact with other patients. The disease is characterized by the presence of follicular papules on the body and vesicles on the hands. There are no scabies.

Norwegian scabies can be diagnosed against the background of primary and secondary immunodeficiency states after prolonged use of cytotoxic and hormonal drugs.

Weakened body - ideal conditions in order to develop Norwegian scabies: the symptoms actively manifest themselves when systemic diseases. Characteristic features are itching, the presence of massive crusts on the patient's skin, multiple polymorphic rashes and erythroderma.

The patient's hair turns gray-ashy, alopecia occurs. At the same time, a rather unpleasant smell of fermented dough emanates from the patient, the body temperature is elevated.

Scabies "incognito" is often detected in people who often take a shower. During the procedure, most of the pathogen population is removed from the patient's body. The clinical picture of the disease is similar to typical scabies.

A complicated type of disease can only be detected by an analysis for scabies. Its most common types are dermatitis and pyoderma, less common are urticaria and microbial eczema.

Postcabiosis lymphoplasia of the skin is a special variant of the scabies course, which is localized in most cases on the patient's torso, and also occupies the genital area in men with widespread scabies.

Clinical picture of the disease

The disease begins in connection with the appearance of scabies mite. These pathogens most lives are spent on people's skin.

The female mite gradually gnaws through the so-called scabies, after which it lays eggs ( given period called reproductive). The larvae eventually come to the surface of the skin, settle on it, occupying the hair follicles and scales of the epidermis.

Gradually, the larvae transform into adults, which, mating, produce new females and males. The cycle ends.

Scabies is transmitted mainly through close contact between people, most often during their joint stay in bed.

The symptoms of scabies are quite typical, the main one being the unbearable itching of the affected area of ​​the skin. Signs of scabies are manifested in all patients in different ways. Itching often intensifies at night, which is caused by a specific biorhythm of the pathogen. Other symptoms of scabies are sleep disturbance and neuropsychiatric disorders.

External signs of scabies are as follows:

• the disease is manifested by the presence of scabies;
• scabies in humans can be identified by characteristic polymorphic rashes outside the scabies.

What does scabies look like? Furrows look like lines (straight or slightly curved), painted in dirty gray or White color. The length of these formations on the skin is 5-7 mm.

Sometimes scabies manifests itself on human skin with cavity elements (bubbles and vesicles) or lenticular papules.

Most often, the disease is localized in those areas of the epidermis, where the maximum thickness of its stratum corneum is noted.

Rashes and itching outside of scabies are caused by several factors:

• allergic reaction human body on the waste products of the pathogen (tick);
• addition of pyogenic flora.

Diagnostics

How to recognize scabies? If the disease is uncomplicated, then the patient's skin has papules, vesicles, bloody crusts, and scratches. Papules most often occupy the areas of hair follicles, their size does not exceed 2 mm; vesicles are located on the feet and wrists of the patient, their size reaches 3 mm.

The disease is diagnosed on the basis of patient complaints, physical examination, and a combination of epidemiological data, which are confirmed by laboratory tests that help to detect the pathogen.

Additional studies in most cases are not required.

The diagnostic criteria for scabies are as follows:

• skin itching worse at night and evening time;
• there are scabies;
• rashes have a typical localization;
• the effect of the treatment of scabies with antihistamine, desensitizing drugs is absent;
• the presence of a characteristic epidemiological history.

Traditional healing measures

The treatment of scabies is primarily aimed at the destruction of the pathogen (mite) using acaricidal preparations.

There are a number of requirements for anti-scabies drugs:

• preparations for the treatment of scabies should give a reliable therapeutic effect;
• medicines should not cause itching and irritation on the patient's skin;
• drugs should be stored for a long time;
• drugs must be widely available and inexpensive.

Treatment and prevention of scabies are carried out according to the following rules:

• patients identified in one focus of infection begin to be treated simultaneously, as soon as they have the first symptoms of the disease;
• since the activity of the pathogen increases in the evening, the main therapeutic measures should be carried out at this time of day;
• the consequences of scabies are eliminated in parallel with how the disease itself is treated;
• all family members and colleagues of the patient during his treatment are also in without fail must be inspected and carried out preventive measures to avoid the effect of "ping-pong" infection;
• sanitization is carried out for the first time days of the course of treatment and upon its completion; the patient, if necessary, can wash off the medicinal product every morning, provided that the duration of his stay on the skin was at least 12 hours;
• the patient should change bed linen before starting treatment and after the therapeutic course has been completed;
• post-cabin itching after medical therapy viewed by experts as allergic reaction organism on a dead tick and is eliminated with special antihistamines and ointments with corticosteroids (for example, benzyl benzoate or spregal).

Exists big number a variety of means designed to combat scabies, as well as ways to use them. Let's talk about the scheme of using one of them.

Spregal should be treated as follows:

• on the first day, it is necessary to wash thoroughly, while steaming the skin well, after that, 200 ml of the drug emulsion should be carefully rubbed into the skin of the hands, feet and torso (do not forget about the soles and fingers);
• on the 2nd and 3rd day of treatment, you can not wash, change bed and underwear, the drug is not used;
• on day 4-1, the patient is again thoroughly washed, steams the skin, rubs the above amount of the drug into it, changes bed and underwear;
• on the fifth day leftovers medicinal product washed away warm water, underwear and bed linen are changed again.

Other drugs that can be used to treat scabies: Permethrin, combination drug Esdepalethrin / piperonyl butoxide (aerosol).

Home treatment of the disease

Scabies can be treated folk remedies at home. Here are some examples of the most effective recipes:

• Mustard oil is well suited as an external agent, which should be boiled with garlic. So, for 100 g of garlic gruel, you need 0.5 liters of mustard oil. The product must be boiled over low heat for 15-20 minutes, stirring occasionally. Next, the mixture must be filtered, and the remainder must be squeezed out. The product is stored in a cool, dark and dry place.
• Another variant home remedy from scabies looks like this: garlic ash, butter, molasses should be mixed in equal proportions. Such an ointment can be rubbed several times a day into the affected areas of the skin.
• Pure tar is applied to the skin, after a few hours the product is washed off with warm water. This remedy reduces itching and destroys scabies pathogens.
• For one teaspoon of turpentine, you will need two large tablespoons of vegetable oil. The ingredients are thoroughly mixed and applied to the affected areas of the skin.
• A remedy prepared from bay leaf powder, mixed in equal proportions with butter, helps well. The ointment is rubbed into the skin of the patient two to three times a day.

The effectiveness of treatment and the consequences of scabies depend on the correctness of therapeutic measures. If the treatment of the disease was adequate, then its signs (itching, rashes) disappear already on the second or fourth day.

True, at the end of the therapeutic course, additional medical supervision is required over the next two weeks, and if the disease has caused certain complications, then until they disappear.

In children, against the background of scabies, dermatitis can develop, sometimes eczema. This occurs as a result of skin irritation when exposed to medicinal preparations.

If patients have post-itch itching, they sometimes continue to use therapeutic agents on their own without consulting a doctor. This leads to the fact that itching only intensifies, additional inflammation may even occur.

Medicines should not get on the mucous membranes of the patient: this causes them itching, irritation and inflammation.

Characteristic itching may persist after discontinuation drug therapy(for several weeks). This phenomenon is explained side effect medicines. Sometimes, after a complete cure of the disease, benign lymphoplasia can be observed at the sites of rashes.

The prognosis for the treatment of scabies is favorable: if it is possible to determine the disease and organize therapy in time, then 100% of patients are cured.

In addition to this, there are several universal rules which should be adhered to in order for the treatment to be effective: firstly, it must be carried out in outpatient settings, secondly, the patient is prescribed external means of local action to relieve itching and fight the rash, and thirdly, his entire environment must undergo a series of preventive measures in order to protect himself from infection.

You can treat scabies at home, for this there is a whole arsenal of proven and quite effective folk recipes.

Any therapeutic measures should be started only after consultation with a dermatologist, who will correctly establish the diagnosis and select the optimal treatment regimen.

Source: http://dermatyt.ru/chesotka/lecheniya-chesotki-u-cheloveka.html

What is scabies, symptoms and treatment of the disease in adults

Once on human skin, the scabies mite gnaws through passages under the layer of the epidermis and lays 1-3 eggs there a day. The larvae hatched from the eggs become mature individuals in a couple of weeks. The cause of infection is close contact with a sick person. This leads to:

• High population density.
• Unsanitary environment.
• Disordered sex life.

It happens, although quite rarely, infection through household items: bedding, towels, washcloths. You can notice scabies with its characteristic symptoms after being in in public places where you touched:

• to the doorknob;
• railings of stairs;
• handsets.

Children can become infected from toys if they have been played with by a sick child.

Remember. Infection occurs through sexual contact, and usually a man becomes infected from a sick woman.

Itching in the external environment dies relatively quickly, but if the situation is favorable, then outside the body it can live up to 4-5 days.

Manifestations of the disease

Scabies has enough severe symptoms, upon detection of which it is necessary to take immediate measures for treatment. The disease begins with intense itching, which intensifies at night. Scabies are found on the body - sinuous grayish stripes raised above the skin and ending in a bubble (vesicle) at the end.

Pimples (papules) or almost inconspicuous plaques are visible on the surface of the skin. The most prone to rash areas on the body are:

• abdomen, umbilical region;
• inner thighs;
• buttocks;
• milk glands;
• lateral surfaces of fingers and toes;
• interdigital skin folds;
• scrotum and penis area in men.

One of the signs of the disease is a rash on typical parts of the body.

Possible consequences

Consequently, scabies is one of the serious diseases, the long-term impact of which on the human body can lead to various troubles. An insect under the skin lives for a long time in cases where the treatment is carried out incorrectly, or therapeutic measures are not taken at all.

In such situations, the patient's sleep pattern is disturbed, which further leads to insomnia. In addition, there is a risk of:

• pyoderma in the form of ecthyma;
• furuncle;
• dermatitis, etc.

In some cases, the doctor may put misdiagnosis. As a result, that person is being treated for something else. This, of course, does not give results, and meanwhile the disease does not stop its destructive action.

Ailment can be mistaken for hives and treated. This will be fraught with loss of time, and ultimately health.

However, any dermatologist knows what scabies looks like, so there should be no problems with diagnosis and treatment.

Advice. At the first suspicion of an infection, you should contact a dermatologist who will begin timely and correct treatment.

The development of complications often leads to diagnostic errors, since clinical picture the disease itself is usually blurred, it can be mistaken for another disease

How to correctly diagnose?

Clinical manifestations and complaints of patients are the basis for a diagnosis by a dermatologist.

An experienced doctor, of course, knows the signs inherent in scabies, but still in certain cases it is better to conduct a microscopic examination.

For this purpose, the affected area is lubricated with vaseline oil, and then a scraping is performed. Microscopy allows you to directly identify the insect or eggs.

The study confirms the presence or absence of infection. It should also be taken into account that patients who have previously washed themselves thoroughly come to see a doctor. As a result, you may not find anything. However, the doctor, knowing how a disease such as scabies should manifest itself, draws attention to symptoms such as:

• itching, worse at night;
• characteristic linear scratches present on the body;
• small papules visible on the skin.

And if it was not possible to detect the pathogen, then the doctor resorts to a diagnostic and treatment procedure, which is called ex juvantibus.

A good doctor is a guarantee that the disease will be successfully diagnosed and treated.

The manifestation of the disease in children

The symptoms found in children converge with the symptoms of scabies in adults, with the only difference being that in infants, in addition to scabies, there is also an urticarial rash (blisters). Symptoms in children at 6 months of age are similar to urticaria, which differs large quantity blisters. They are localized on the skin of the face, buttocks, back.

In some cases, the symptoms are similar to eczema, which is characterized by intense itching. The child is restless, almost does not sleep, the skin is often traced allergic dermatitis or pyoderma of the impetigo type. Therapy is best done in the evening, as the itch at this time shows maximum activity.

How should scabies be treated in children? We will consider this issue a little further down. But it should immediately be remembered that various means - ointments, talkers, creams - must be applied with protective gloves in order to exclude exposure chemical elements on your hands.

Remember! Bed linen needs to be changed every day. In the room where the child is, daily wet cleaning is carried out.

The first symptoms of the disease in children may appear already in the first hours after contact with a sick person.

Disease classification

• typical;
• nodular;
• Norwegian (crusty, characterized by the presence of crusts);
• scabies cleanliness;
• pseudoscabies (pseudosarcoptic mange).

typical scabies

This variety has:

• Severe itching, usually at night.
• The presence of tick moves.
• Paired rashes on the body.

The disease makes itself felt in the evening and at night. Itching becomes even more intolerable after a hot bath, because the scabies mite in the skin of a person, feeling warm, activates its functions.

The infection selects areas with delicate skin: wrists, chest, inner sides fingers. The tick usually does not move on the face.

Note. If signs of this disease are found, then it is by no means recommended to postpone treatment, since the disease can very soon develop into a more complex form.

External symptoms spread through the body quickly enough, one of the first signs are ribbon-like papules

Scabies cleanliness

Benzyl benzoate ointment - an effective remedy for scabies

Norwegian scabies

• Dry eruption on the body with whitish scales.
• Dermatitis all over the body.
• Strong itching.

The considered form is considered the most contagious, it is especially susceptible to people already suffering from diseases such as leukemia, tuberculosis, scleroderma. Often mentally retarded persons become infected with it.

This form is rarely diagnosed, the main group of patients has a weakened immune reactivity, which determines the high contagiousness.

Pseudo scabies

Pseudo-scab, or pseudosarcoptic mange, is a type of disease that occurs when insects that were previously on animals or birds get on a person. Carriers of infection are dogs, chickens, pigs, sheep and other animals. Ticks do not bite under the dermis, so their incubation lasts no more than one hour. However, they bite causing severe itching.

The disease is characterized by rashes in the form of papules, blisters on areas of the body that have come into contact with animals.

The scrapings do not contain eggs and larvae of ticks, as they are able to reproduce exclusively on animals. In certain situations, it is possible to get rid of the infection by stopping contact with animals.

You can protect yourself from pseudo-scabies by disinfecting clothes, bedding in a house where there are animals.

False scabies, caused by mites that have come to humans from animals, causes severe itching, but is not contagious

Nodular type of disease

It manifests itself in the process of interaction of the body with the products of the activity of the tick. The clinical manifestation is expressed in the formation of small red-brown nodules under the passages.

Rashes are distributed according to:

• Belly.
• Buttocks.
• The genitals of a man.

Ways and methods of treatment

Treatment with sulfuric ointment is the most affordable and classic way. When scabies and its first symptoms appear, it is necessary to organize preventive measures and start treatment in both children and adults. The concentration for children and adults is different - 10 and 20%, respectively. The course lasts about 10 days.

Useful use tar soap. It does not completely cure, but, having excellent bactericidal properties, it successfully fights rashes and redness.

Another effective remedy for the treatment of scabies in humans is the Benzyl Benzoate cream. The percentage of funds for the treatment of the disease in children is 10%, and in adults - 20%. The course lasts up to 6 days.

A good effect can also be obtained from the use of the Spregal spray. It should be sprayed onto the skin at a distance of 20 cm. Especially diligently apply the product to:

• Fingers and toes.
• Armpits.
• Crotch.
• Other curves of the body.

After application, the medicine should be left for 12 hours. Sometimes this drug may cause side effects that do not last long.

Note. You need to be prepared for the fact that all symptoms after treatment with this remedy can continue for another 10 days.

Depending on the history and analysis of symptoms, the doctor prescribes a full-fledged drug treatment.

Treatment with folk methods

It is possible to destroy the scabies mite in a sick person using home methods. To do this, you can apply the following methods.

The sore on the affected area should be soaked and scratched. Then you need to rub the ashes from the wound into the wound. ordinary cigarette. After that, lubricate this place with sulfuric ointment and close it with adhesive tape.

This procedure is done in order to close the air to the insect.

To prepare an ointment that cures scabies, you need to mix 1 tsp. turpentine with 2 tbsp. l. butter. Rub this mixture on the affected areas. A good effect is obtained if a mixture of 1 tablespoon of celandine with 4 tablespoons of petroleum jelly is applied to the body. It is recommended to treat the skin in the evening.

Folk remedies are often quite effective

Scabies is a highly contagious disease. To protect others and get rid of unpleasant symptoms, do not delay contacting a dermatologist.

On the early stage The development of allergies and scabies have similar symptoms, so they can easily be confused. However, this is completely various diseases, the treatment and diagnosis of which are fundamentally different. Scabies, like allergies, have characteristic symptoms that distinguish the first disease from the second.

Distinctive features

Of 100% of cases, the diagnosis of scabies is made to young people under 30 years old, one in five of whom is a child. Foci of infection are often recorded in schools, kindergartens and hospitals.

A common symptom of both diseases is a rash and pruritus. But thanks to some features of the symptoms, you can understand how to distinguish scabies from allergies. What to look for:

You can independently check which disease struck a person with allergies or scabies in simple ways:

In addition to visual identification of characteristic external differences between the two diseases, there are laboratory diagnostic methods. An experienced dermatologist knows how to distinguish scabies from dermatitis, so he will recommend a series of procedures.

It is most difficult to diagnose scabies in children. If the infection occurred in a child under 6 months old, then typical differences from allergies may not be detected.

The disease is more like hives or weeping eczema. Ticks very rarely affect the lateral phalanges of the fingers and the spaces between the fingers in children under 3 years old, but often destroy the nail plates.

Diagnosis of allergies has a completely different direction. First of all, the patient undergoes skin tests with the introduction of various allergens. Allergen tests are different:

1. Scarifying.
2. prick test.
3. Provocative nasal tests.
4. Inhalation provocation test.

In addition to specific tests, the determination of allergens is possible by a blood test (ELISA or RAST study).

Differential diagnosis of allergy requires more time. Usually due to instability immune system It is difficult to determine the cause of an allergy in a child.

When diagnosing an allergy, the doctor necessarily asks the patient whether a new product has been eaten, whether the powder or detergent has changed, whether there has been contact with pets, etc. etc. Sometimes it takes more than one month to find the pathogen.

Differential diagnosis of allergies and scabies should distinguish these diseases from others, where itching and rash are also the main symptoms:

• pyoderma;
• eczema;
• diabetes;
• stagnation of bile;
• Hodgkin's disease;
• flea or mosquito bites;
• pubic lice (if the skin in the groin area itches).

Diagnosis of scabies does not take much time, an experienced dermatologist can quickly determine the pathology. Distinguishing scabies from allergies is quite difficult on its own, therefore, without consulting a specialist, treatment may be prescribed incorrectly. There is no need to risk health - neither yours, nor even your child's: any itchy rashes on the skin must be shown to a dermatologist and only then treated.

Project editor DoloyPsoriaz.ru

Useful article?

The causative agent of the disease is scabies mite, which is localized in the deep layers of the skin. Scabies is transmitted sexually by rubbing the skin. household way tick spread exists but is unlikely.

After the treatment, pigmentation, seals, seropapules, boils, dermatitis and rashes can form on the skin.

The main causes of the development of the consequences of scabies

Unsuccessful treatment of the disease occurs for the following reasons:

• non-compliance with the rules for applying and dosage of an anti-scabies agent;
• uneven or insufficient application remedy on the skin layers;
• reinfection human scabies mite after sexual contact;
• secondary infection of the patient from his own hygiene items.

Red spots after scabies

The formation of red spots after treatment is considered a symptom contact dermatitis. This complication is accompanied by the following clinical picture:

• spontaneous bouts of itching;
• redness and swelling of the affected skin;
• local increase in body temperature and a feeling of "burning".

For such patients, doctors conduct a thorough diagnosis and laboratory analysis for the presence of scabies mites and needle larvae. If scabies pathogens are found in smears, then the patient undergoes a second course of anti-scabies therapy.

Elimination of redness and swelling of the skin is carried out with the help of corticosteroid ointments (advantan, elidel or locoid). They are applied to the inflamed area of ​​\u200b\u200bthe skin with a thin layer with massaging movements. The duration of this treatment is about two weeks. These drugs are used only after prior consultation with a dermatologist.

Corticosteroid drugs for topical application effectively eliminate itching, redness and swelling of the epidermis.

Brown spots on the skin after scabies

In such cases, pigmentation and thickening of the skin occurs for two main reasons:

Eliminate persistent pigmentation skin after scabies, which is not accompanied by structural changes in the tissues of the epidermis, it is possible with the help of microdermabrasion, professional peeling and surgical polishing.

Rash and itching after scabies

If, after eliminating the scabies mite, the patient has multiple rashes and intense itching sensations, then the doctor can make a diagnosis: "allergic dermatitis". In such cases, patients complain of a burning sensation, tingling and itching, which are disturbing in the evening and at night.

As a result, the majority of patients have accession bacterial microflora in the scratch zone.

The main cause of the complication is considered to be scabies mite toxin, which persists in the human body for up to two weeks. Treatment of allergic rash and itching consists of the following activities:

• reception antihistamines(diazolin, suprastin, tavegil), which reduce swelling of soft tissues and reduce itching;
• treatment of affected areas of the skin with an anti-allergic cream (ruzam, tithes);
• disinfection of the rash area with ointments, sprays and powders.

Seropapules after scabies treatment

Sometimes, after anti-scabies therapy, solitary rashes remain in the genital area, which are accompanied by intense itching. They look like small white pimples. This clinical picture is typical for seropapules. These rashes can normally be observed for several months.

Complications of this kind, as a rule, do not require special treatment. Only with the appearance of new rashes and an increase in the intensity of itchy sensations, the patient should undergo a second course of therapy for scabies.

Inflammatory complications of the skin

If deep scratching remains after scabies, then bacterial dermatitis often develops in this area. This complication is the result of the penetration of pathological microorganisms into damaged areas of the epidermis. As a result, inflammation is caused by streptococci and staphylococci.

Progression bacterial infection may result in the accumulation of pus, the formation of boils and eczema. In some cases, the penetration of pus into the circulatory system can be fatal.

Accession of a bacterial infection requires timely treatment with antibiotics. Physicians usually prescribe antibacterial agents having a wide range actions. Such drugs are available in tablet and injection forms.

The choice of antibiotic is based on the prevalence and severity bacterial dermatitis. Before using antibacterial injections, the doctor should check that the patient does not have an allergic reaction to the antibiotic.

During this period, the patient undergoes the following types of drug therapy:

• antihistamines, which are designed to eliminate swelling and itching of the skin;
• treatment with antiseptics of the rash zone in the form of powders, aerosols or ointments;
• stimulation of skin regeneration with the help of herbal preparations.

Furunculosis of the skin

The consequence of deep combing of the epidermis after scabies may be a furuncle, which is purulent inflammation hair follicle. The disease is manifested by the formation of a limited area of ​​​​edema and redness of the skin. In the central part of such a seal, you can see a small white dot.

Treatment of furunculosis begins with drug therapy. A patient is placed on a pathological focus with a compress with ichthyol or Vishnevsky ointment.

With the ineffectiveness of such therapy, doctors recommend that the patient undergo a surgical opening of the abscess. The patient is under local anesthesia. The surgeon cuts the boil with a scalpel and installs a drain (a special rubber strip) to drain the purulent masses. After a radical intervention, the patient must undergo a course antibiotic therapy for the prevention of bacteriological complications.

Venereological lesions

According to modern medical classification scabies experts refer to sexual infections, because in this way scabies mites are most easily tolerated. In this regard, there is a high probability of the spread of concomitant sexually transmitted diseases.

In such cases, specialists refer the patient for consultation and complex diagnostics to a dermatovenereologist. Treatment of the patient, as a rule, takes place on an outpatient basis.

Psychogenic disorders

The main symptom of scabies are acute bouts of itching, which bothers a person in the second half of the day and at night. Reduced sleep time and a constant itching sensation are the cause of many nervous disorders and insomnia. The long course of the disease and the presence of dermatological complications can lead to more severe neurological consequences.

Particular attention should be paid to pediatric patients, who often have severe scratching, impaired healthy sleep and functional change in the function of the central nervous system.

Treatment of neurological complications consists in the following activities:

• Application of an anesthetic to damaged areas of the skin. This allows you to significantly reduce the intensity of itchy sensations.
• The patient is taking sedatives, which calms nervous system and normalizes sleep.

Prevention of complications of scabies

Prevent spread infectious process in the skin can be timely diagnosis disease, which allows for a comprehensive and complete treatment. The patient in the acute phase should be isolated from other family members. Direct contact with such a patient or his personal items leads to the spread of the scabies mite.

The disease is caused by the scabies mite. It is transmitted through household contact. main feature ailment - itching, worse at night. There are also scabies - red stripes on the skin. But there are other forms of the disease, for example, scabies without itching and a characteristic rash. The latter, for example, is often observed in people who are very fond of hygiene.

The therapy is carried out with acaricidal preparations (ex. benzyl benzoate, sulfuric ointment), and takes about a week.

Why did itching remain after treatment

Even with proper therapy and following the doctor's recommendations, the symptoms of the disease can persist for another month. Nodules on the skin are especially noticeable for a long time.

scabies mite

As a rule, doctors for relief residual symptoms appoint antihistamines and corticosteroids.

In some cases, if discomfort persists for more than 2 weeks, repeated use of acaricidal agents may be prescribed.

So, why does itching after scabies not go away:

1. Nodular form diagnosed. The reaction of the immune system is too strong, so the discomfort takes longer than usual.
2. Incorrect treatment - unsuitable drugs or their inadequate use (not the whole body was treated, too little medicine was used, the product was unevenly distributed over the skin). As a result, the mite remains to live in the skin.
3. Live unfertilized female ticks. They do not lay eggs and do not appear on the surface of the skin, so they are more difficult to get rid of. Such females can live up to 6 weeks. That is why the body can itch for another month and a half after treatment.
4. Allergic reaction on the anti-scabies agent used.
5. Re-infection. This happens if, for example, not all members of the family / team have been treated or things have not been disinfected.

nodular scabies

This form of the disease is different in that itching and scabies all over the body, even after successful treatment, can persist for several months.

Therapy is standard- prescribe anti-tick drugs for external treatment. It can be supplemented with antihistamines.

What to do if itching remains

Scabies on hands

antihistamines for itching

"Fenkarol"

Tablets are drunk immediately after a meal. The dosage is as follows:

1. A single dose for adults is 25-50 mg. The frequency of admission is 3-4 times a day. Maximum daily dose- 200 mg.
2. For children under 3 years of age, a single dose is 5 mg, the frequency of administration is 2-3 times a day.
3. For children 3-7 years old, a single dose is 10 mg, the frequency of administration is 2 times a day.
4. For children 7-12 years old, a single dose is 10-15 mg, the frequency of administration is 2-3 times a day.

The duration of the course is 10-20 days.

"Fenkarol" is contraindicated in case of hypersensitivity to the components and in the first trimester of pregnancy.

Side effects can occur with hypersensitivity to the drug or overdose. These include: dry mouth, dyspeptic symptoms (stool disorders, abdominal pain and disorders in digestive tract). With a significant and prolonged overdose, it may appear headache, vomit.

"Loratadine"

This anti-allergic drug acts within half an hour after ingestion. The dosage is as follows:

1. Children from 12 years old and adults - 1 tab. (10 mg) 1 time per day.
2. Children from 2 to 12 years old weighing up to 30 kg - ½ tab. once a day, and with a weight of more than 30 kg - 1 tab.

   Loratadine

Duration of admission - 10-15 days. The doctor can adjust the course - from 1 to 28 days.

"Loratadin" is contraindicated in case of hypersensitivity to the components and during lactation.

From side effects dry mouth and vomiting are possible. In case of an overdose, the heartbeat may become more frequent, drowsiness and headache may appear.

Glucocorticoid drugs

Hydrocortisone ointment

It treats the affected areas, applying a thin layer, up to 3 times a day. It is contraindicated in skin infections(tuberculosis, pyoderma - purulent inflammation of the skin, mycoses), wounds and sores.

How to get rid of itching after treating scabies with Sinaflan ointment

The ointment is used 1-3 times a day, applying a thin layer, without rubbing. Duration of therapy - 5-10 days, but may increase to 25. It is not recommended to treat areas with sensitive skin (face, skin folds) and over large areas with ointment.

At long-term use or processing sensitive skin possible side effects such as adrenal hypofunction and skin atrophy. Sinaflan ointment is contraindicated in case of hypersensitivity to components, skin tuberculosis, skin infections, sores and wounds, as well as during pregnancy.

Itching from the remaining mites

It happens that after the use of acaricidal agents, unfertilized female ticks remain alive. How long does itching last after scabies treatment? this case? About a month - one and a half, and for very sensitive people even longer.

Aerosol "Spregal"

Aerosol "Spregal"

The drug can be used even for babies. The first treatment is carried out in the evening (18-19 hours), so that the therapeutic effect occurs at night. After processing, you can not wash. First spray the patient, then the rest of the family.

"Spregal" is applied like other anti-scabies: they treat the whole body, except for the head and face. Spraying is carried out at a distance of about 25 cm from the surface of the body. Well-treated skin begins to shine.

After 12 hours, you need to wash your body well with soap.

Often a single application of an aerosol is enough, but the doctor may advise another preventive treatment. When spraying the aerosol, a slight tingling sensation is possible. The latter is self-limiting.

Calcium gluconate for allergies

Calcium reduces the permeability of blood vessels, respectively, it is more difficult for allergens to penetrate into the blood. Calcium gluconate helps with various allergic reactions, including those caused by drugs.

How to relieve itching from scabies with calcium

Calcium gluconate should be drunk before a meal, it is recommended to drink milk. The dosage is as follows:

1. For children 3-4 years old, a single dose of 1 g.
2. Children 5-6 years old - 1-1.5 g.
3. 7-9 years - 1.5-2 g.
4. 10-14 years old - 2-3 years
5. From 14 years and older - up to 3 years.
6. Elderly people - no more than 2 g per day.

The frequency of admission is 2-3 times a day. Course duration - from 10 days to a month.

Calcium gluconate is contraindicated in renal failure, hypercalcemia, hypercalciuria, atherosclerosis, thrombosis. Possible side effects: nausea, vomiting, diarrhea, stomach pain.

Conclusion

Seek medical attention if you have symptoms of scabies

In addition, do not exclude an allergy to ticks or to the medicine used. Identification of the allergen will help prevent adverse events in the future.

Scabies, although treated quickly and simply, requires a visit to a specialist. The disease is highly contagious and its symptoms are severe discomfort. Therefore, it is better to entrust the diagnosis and prescription of therapy to a specialist.

How a child can get scabies: ways and causes of infection

The causative agent of the disease is the scabies mite. This is a small arachnid insect.

The size of the female insect is from 0.2 to 0.4 mm, the males are even smaller. They are not visible to the naked eye.

With scabies on the patient's body, you can notice the so-called "itch moves" - a winding line from 1 mm to 2-3 cm long, but the most typical external manifestation of the disease is a rash in the form of tiny bubbles.

Degree of infectivity

Degree of infectivity

When someone from close circle or family members becomes infected with a scabies mite, after a while, all household members will be affected. Allergy is considered a non-contagious disease that is not transmitted through bedding, common items, so allergies should be treated individually, while scabies has to undergo a preventive course of treatment for all family members.

The presence of external signs

The scabies mite is able to make paired passages in the skin, which can be easily seen when you carefully examine the affected skin. In the presence of allergies, such signs are absent, paired passages cannot be detected.

The skin is covered with red rashes almost evenly, they focus on the buttocks, abdomen, cheeks.

The female of this tick has the peculiarity of laying its larvae under the skin of the patient. Within two weeks, young individuals will go through the cycle of their immediate maturation.

Males of this species die within minutes of mating with a female scabies mite.

Outside their usual habitat, these representatives of insects live no more than three days. The temperature, the mark of which exceeds 65 degrees Celsius, is fatal for them.

Scabies is transmitted by contact, as a result of a tight touch on the skin of a sick person or on his hygiene and household items.

The main symptoms of this disease can be called:

It is worth remembering that when similar symptoms you should consult a doctor as soon as possible, because the disease can gain epidemiological proportions.

Allergy is a pathological process that is formed as a result of re-entry into the human body of a factor, which is commonly called an allergen. It is a certain allergen that provokes the activation of the protective immune system of a person.

Associated symptoms

For both diseases, outside redness of the skin, which causes itching and itching

With both ailments, a red rash appears on the surface of the skin, which begins to itch and itch. The symptoms that appear have a number of distinctive qualities: itching during an allergic reaction is disturbing despite the time of day, and with scabies it intensifies with the onset of night.

At this time of day, the female tick has a period of increased activity.

There you can see barely noticeable paired passages that the tick makes. In the case of itching caused by an allergic reaction, such passages are not visible.

Localized scabies rash on the hands, in the elbows, under kneecap, on the thighs and buttocks, as well as in the nipples.

In children - on the surfaces of the feet, face, in some cases on the head, in its scalp. In newborn babies, scabies may look like an allergic reaction, urticaria - a huge number of blisters, itchy, covered with a bloody crust.

With scabies, there is no runny nose and tearing. This is a sign of an allergic reaction. When allergies are present disease state and general weakness, signs that do not occur when infected with a scabies mite.

In some cases, a person who notices red spots on himself immediately begins to take antiallergic drugs. In the case of allergies, these medicines can help.

If the signs are associated with infection from a tick, the situation may worsen if there is no timely treatment. Typical symptoms for an allergic reaction are:

• puffiness;
• incessant sneezing;
• cough;
• itching in the sinuses.

Allergy is a contagious disease. Its presence or absence is due only to the specifics of the body and the immune system, unlike scabies, which is contagious.

Ways of transmission of scabies:

• sexually;
• during handshakes;
• contact sports.

In a family where there is one sick person, the infection spreads quickly. Soon, absolutely all family members will be amazed. With an allergic reaction, one sick person is treated, but with scabies, the whole family receives a course of treatment.

Common signs of scabies infection for adults and children:

• Itching, which is especially disturbing in the evening and at night, the mites are very active during these periods;
• The appearance of tick passages that look like whitish lines rising above the skin. At the end of these lines you can see black dots, these are ticks.
• The appearance of a small rash in the form of small bubbles.
• Localization of tick passages in armpits, between the fingers, on the elbows, buttocks.

The external manifestation of scabies in children has its own characteristics. This is due to the specific structure of the skin in babies. Unfortunately, infants can also suffer from this disease.

The judgment itself is due not so much to the actions of the tick as to the products of its vital activity. A person does not feel how the tick makes moves in the skin, but at the same time severe allergies produce waste products.

Here it should be clarified that during the initial infection with a tick, itching appears only after a week, but with a subsequent infection, an allergy leads to severe itching for almost 24 hours. This suggests that the body does not have the opportunity to develop immunity to the scabies mite.

Diagnosis and treatment

Spray Permethrin is one of the operating funds for the treatment of scabies

It is not difficult to identify the cause of the symptoms that have manifested, you need to go to a specialist. It is not superfluous to make a complete diagnosis of the body.

A dermatologist examines the skin, makes a scraping of the upper layer of the epithelium and uses a microscope to identify the pathogen.

First of all, you need to destroy the pathogens - scabies mites and their larvae. There are a lot of drugs that can neutralize their effects and destroy ticks, they are mainly used in the form of ointments.

The most popular of them are permethrin, benzybelen-zoate, sulfuric ointment, spregal, crotamiton, lindane are used somewhat less frequently. Ointments should be rubbed not only into the area of ​​​​the affected skin, but also into other areas of the skin.

Rubbing ointments into the skin of children under the age of 3 years must be done both in the area of ​​​​the scalp and over the entire surface of the body. Older children do not need to disinfect the hair and face area. In them, unlike babies, the face and the area of ​​hair on the head are not affected by ticks.

First of all, sulfur ointment is used to get rid of scabies, which is rubbed all over the body. The course of treatment is designed for 5 days, and the ointment is rubbed 1 time per day.

At the same time, while the course is underway, bed and underwear can not be changed in order to prevent ticks from spreading. Sulfur-based ointment has a minus, it is an unpleasant smell and possible allergy especially when reapplied.

Spregal is also used, which is presented in the form of an aerosol. It is sprayed over the entire surface of the body, with the exception of the head. 12 hours after applying the aerosol, you must take a shower, and thoroughly wash off the drug with soap from the skin surface. Bed and underwear can be changed.

Scabies: complications - are there any? Let's consider this in more detail.

Scabies: the consequences of the disease

If the diagnosis and treatment of such a disease are timely, the likelihood of relapse will be minimized. But if the course of treatment is not followed as required by the doctor or the patient is self-medicating, scabies can again make itself felt. Symptoms can make themselves felt after an additional infection enters the human body, excessive scratching.

Complications of scabies are most often skin diseases. It is very difficult to treat such atypical skin problems.

Complications after scabies in an adult: what happens with the wrong treatment?

In some cases, the consequences can manifest themselves due to inadequately prescribed drugs for the treatment of scabies by the doctor. The most common consequences in this case are considered to be:

“Consequences of scabies with a photo”, “consequences of scabies in adults (photo)”, “complicated scabies: photo” - such queries help a person to find out what complications of scabies really look like. In many cases, this can prompt a person to contact a qualified specialist in time.

Forum: Scabies (Treatment and Consequences) is a place where patients can find proper support and calm down a bit after reading the stories of people who have been treated. In fact, scabies is not a dangerous disease, it can be treated.

Consequences of scabies due to an additional infection

When a person intensively scratches the skin, he can wear off the top layer of the skin, which leads to the formation of open and bleeding wounds. Such wounds and scratches are entry gates for additional infection. What happens when an injured area becomes infected?

1. Microbial eczema. It appears on skin that is infected with fungi or germs. The most common causative agent of such eczema is beta-hemolytic streptococcus. This disease is visualized as a scab, an abscess, a weeping wound;
2. Pyoderma. This is a purulent injury to the skin. It appears when harmful microorganisms penetrate the skin. If this problem is not treated in time, inflammation will go down skin surface with the formation of scars;
3. Skin hyperemia. This represents increased blood flow to the area of ​​inflammation. Red spots appear on the skin due to abrasions and wounds.

Scabies complicated by pyoderma

Pyoderma is treated by a dermatologist. The patient should not have much contact with water, especially if the disease occurs in an acute vase

The skin around the injured area is treated disinfectants and solutions are also effective salicylic acid and a solution of potassium permanganate. Although contact with water is undesirable, you should always wash your hands and treat the nail plates with a two percent iodine solution. You also need to wipe the intact skin with a damp sponge. This will protect the patient from the spread of infections.

The patient's diet should be balanced, you need to consume more dairy products and vegetables. You need to limit your salt intake simple carbohydrates, extractives and alcohol.

If pyoderma becomes chronic, treatment with antibacterial agents should be used.

Complication of scabies in the groin

What can be said about the complications of this type of scabies? In women, it may be vulvovaginitis. As for men, due to constant itching, there may be problems with erection and sexual intercourse.

Scabies during pregnancy: consequences

If the disease was detected in time and cured, the fetus during pregnancy will not undergo negative consequences.

The only problem lies in the fact that the expectant mother will be constantly distracted discomfort. This will contribute to the development of weakness, which will make her more irritable before childbirth.

At advanced stage scabies on the mother's skin abscesses are formed. This may negatively affect intrauterine development future child.

That is, if a person has any complications, it is better to immediately contact a specialist. However, the disease is easier to prevent than to cure. It is also much easier to treat initial stage than in the chronic stage. Thus, one must carefully monitor own body and listen to his feelings. This will help avoid the development of consequences.

There are many misconceptions about scabies. If you think that scabies is easily contracted by shaking hands, bed linen or towels, or that it comes from poor hygiene, then you definitely need to read this post.

Editor L.J. Media

Secondly, travelers have to deal with populations where almost the entire population is affected by scabies, such as the peoples of Sub-Saharan Africa or the natives of New Zealand and Australia.

Finally, in addition to scabies, the traveler is bothered by other itching mites, about which our tourists are almost not informed; most of them only bother with an itchy rash, but there are also those that carry deadly infections.

So, in order.

Part 1. Scabies

There are many misconceptions about scabies. If you think that scabies is easily contracted by shaking hands, bed linen or towels, or that it comes from poor hygiene, then you definitely need to read this post to the end.

In 1687 an Italian doctor Giovan Cosimo Bonomo and apothecary Diacinto Cestoni described for the first time the relationship between itching and typical skin symptoms developing after infection. It was they who first established that the disease can be caused by a microorganism. The greatest discovery ever! I do not understand why these names are not found in the Russian-language network ...

Epidemiology and modes of transmission

An adult female forms a passage in the skin, laying eggs along its entire length. Males drill short lateral branches from it. Having found such a move on the skin, any doctor will make an unmistakable diagnosis. The only pity is that only very few doctors know what these moves look like. The whole “family” sleeps peacefully during the day, and is active only at night (they gnaw passages, causing itching, crawl out to the surface to mate and develop new territories).

Outside the human body, mites quickly die (dry out). The higher the temperature and lower the humidity, the faster this happens. So, at 21C and a humidity of 40-80%, the tick dies in 24-36 hours. In my apartment (now I have 23C and a humidity of 40% due to the evaporation of 10 liters of water per day with two humidifiers), the tick will not live even a day. If the temperature is below 20C, the tick loses the ability to move.

From the foregoing, you probably already began to understand under what circumstances people most often become infected. Doctors have known about this for a long time, and therefore scabies has long been safely considered a sexually transmitted disease.

In defense of unfaithful partners, it must be said that it is still possible to get infected through other bodily contacts and even through household items. So, children often become infected from parents, older brothers / sisters, friends when they sleep with them under the same blanket in an embrace. Therefore, I would expand the “sexual” transmission path for scabies to “bed”. After all, it is not coitus itself that plays a role here, but long-term contact with the skin at night.

There are other situations where we come into contact with the patient's skin long enough or often enough to infect (guys like to measure strength on their elbows, other contact sports when we hold a child in our arms, frequent strong handshakes, medical staff working with patients, etc. .). These situations also account for some of the infections.

And although this rule is already 70 years old, domestic guidelines continue to put the contact (skin-skin) route of transmission and infection through household items in one row. inertia domestic medicine very into the hands of unfaithful sexual partners. Whenever I discover scabies in an oil shift worker (and this happens quite often), I hear how the patient begins to curse "dirty" linen on trains, poor hygiene in workers' settlements in the fields, foreigners scold "unwashed Russia", etc. P. As soon as information about scabies spreads in the team, an unthinkable panic overwhelms everyone, I am required to sterilize all trailers with all their contents. If I can still explain to the patient that he picked up scabies from a random girlfriend (conductor of the same train or cook at the mine), then I can’t say anything to the rest for ethical reasons and sadly order disinfection in the village. Everyone knows that a man is a polygamous mammal (moreover, women have almost caught up with men here), but when it comes to a particular family or a couple in love, it is blasphemous to mention this.

Speaking of other mammals. Many of our smaller brothers also suffer from scabies. Sarcoptes scabiei affects dogs, cats, and ungulates. Sick and pigs with cows, and koalas with monkeys. For example, according to veterinarians, up to 95% of the world's pig population is affected by scabies. However, different mammals have their own variants of itching. Although we can get scabies from a cow or dog, their mites are not able to complete the full life cycle on our skin, and therefore the itching will be short-lived and recovery will come by itself.

As for the strickenness of humanity, everything here depends on the overcrowding and genetic characteristics of the population. In poor countries, where people sleep in a crowd, there are more sick people. Also, the epidemiological situation worsens during wars and natural disasters, when people also crowd together. In countries where seasonality exists, the incidence is higher in the cold season (in our country it is autumn-winter). This is due to the desire of people to warm each other with bodily warmth, and better survival of ticks outside the body at low temperatures, and reduced sweating (sweat contains antimicrobial peptides, which partially act on ticks).

The incidence in modern England does not exceed 400-500 cases per 100 thousand person-years. Judging by the sale of anti-scabies, about a million people fall ill in Russia every year. But in Delhi, more than 50% of the population lives with itching. In total, about 300 million people are sick in the world (about 5% of the population). Among the Aborigines of Australia, Nov. Zealand and Sub-Saharan Africa, the incidence is very high (up to 80%), and many develop the same Norwegian forms scabies. This is due to the peculiarity of their immunity and the structure of the stratum corneum of the skin.

Immune response and pathogenesis

Speaking of immunity. As you understand, 10-20 ticks (namely, there are so many of them on average on the patient's body) could not cause so many problems by themselves. All because of an allergic reaction to the products of their vital activity - saliva and mainly feces. In English such dry microscopic excrement is called scybala. And all the evil lies in them! It is on them that a delayed-type allergic reaction is produced (type IV hypersensitivity). Such a reaction is not realized immediately, but only after 3 weeks. It is then that the first time an infected person begins to feel itching and then a characteristic skin rash. After infection, antibodies persist, therefore it is much more difficult to re-infect, but if you become infected, all symptoms will occur the very next day after infection. Therefore, in general, in the world, scabies affects more children who do not yet have immunity to it. In developed countries, including Russia, the main risk group is youth age group. Making up only 10% of the population, these hypersexual and promiscuous creatures account for more than a quarter of all cases of scabies. In second place we have schoolchildren, then preschoolers, and finally adults. Adults get sick less often, not only because they are less inclined to sleep all night in an embrace (after 30, you somehow already want your own blanket, bodily contact during sleep is more annoying, and casual sex is less and less likely to lead to falling asleep in the same bed) , but also because they already have immunity, even if not 100% effective.

Interestingly, an allergic reaction to the feces of scabies itch has many crossover points with an allergy to house dust, which is the main cause of asthma in children in developed countries. Household dust consists of 70-80% of the desquamated epithelium of our skin, namely, household mites that live perfectly outside of our body feed on it. They are much smaller than scabies, they cannot be seen by the eye, but under a microscope, our carpet looks like this:

All these mites also defecate, and when their feces are inhaled with dust, allergic reactions develop, including asthma. Fortunately, with age, in the vast majority of cases, the body desensitizes, and in most children, allergic reactions to dust disappear at puberty.

Symptoms and signs of scabies

In those very poor countries where scabies is most common, it rarely occurs in its classical forms. But my posts are read by "white" people, and therefore I will describe forms typical for us.

The characteristic symptom is pruritus. Itching is when something itches a lot. Itching, as I have already described, is due to an allergic reaction and can bother you all day. However, its intensity often increases at night, when ticks become active and when distracting daytime stimuli leave.

Next in our most frequent typical forms there is a skin rash follicular papules and vesicle(bubbles). Pathognomonic (i.e. having 100% diagnostic value) are scabies.

The rash is localized most often (in descending order) in the interdigital spaces of the hands, on the flexor side of the wrists, in guys with hands it quickly passes to the penis.

Then the elbows, feet, armpits, areas under the breasts in women, the umbilical region, the belt line, and the buttocks are affected. As a result, the whole body can be involved, except for the face and scalp (although the face is also affected in babies).

As a result of intensive scratching, the rash often becomes infected with pyogenic bacteria, resulting in pustular rash(pustules) as in pyoderma. Most often, such secondary infection of the skin is caused by staphylococci and streptococci. The latter can cause post-streptococcal glomerulonephritis (may result in chronic kidney failure) and possibly rheumatism. However, such formidable complications are more characteristic of poor countries.

With a long course of scabies in a number of patients, very itchy spots form on the skin. nodules. They are bluish-purple or brownish round skin seals up to 1 cm in diameter, which persist for months when the mites are no longer there (all this is also due to allergies). Such nodules are formed more often on the elbows, in the anterior-axillary region, on the penis and scrotum.

Once a guy with a terrible itch turned to me, sorry, anal area. Anything flashed through my head: from pinworms and hemorrhoids to herpes. He had no other skin lesions. It was only upon very close examination that I noticed the nodules. When asked about the sexual exploitation of this area, the boy answered positively. So, colleagues, let's not forget that receptive gays are characterized by the predominant involvement of the perianal region in the form of scabious lymphoplasia, and itching persists for months even after the successful destruction of ticks.

Diagnostics

It was from one of these patients that I caught scabies in my internship. The doctor in the ATC, looking at the most characteristic rash on my wrist, for some reason decided that it was herpes. After a week, I nevertheless decided to do scientific self-diagnosis, pierced one of the vials with a needle and smeared the cerebrospinal fluid that came out on a glass slide. Under the microscope, I immediately saw the itch, just like in the textbook.

This method of diagnosis under a microscope is 100% specific, but has low sensitivity (I was just lucky that the tick came into view under the microscope). Therefore, from a practical point of view, it is enough for diagnostics:

1) the presence of papules, vesicles (vesicles), sometimes with pustules

2) itching (especially at night)

3) well, if someone in the family has the same problems, there is no doubt about the diagnosis.

Treatment

General rules of treatment:

Experience shows that there are no relapses in scabies, the causes of the recurrence of the disease are reinvasion from non-treated contact persons in the focus or outside it, undertreatment of the patient due to non-compliance with treatment regimens, partial treatment of the skin, reduction in the duration of therapy.

1) Treatment should be carried out exclusively under the guidance of a physician.

2) Treatment of all patients living together should be carried out simultaneously.

3) Clearly follow the treatment regimen described in the instructions for the drug or as prescribed by the doctor.

4) Cover the entire body with the preparation, except for the face and scalp, and in children under 3 years old, these areas should also be treated.

5) Cut your nails short and apply the preparation thickly directly under them (itch eggs accumulate under the nails when combing).

6) Rubbing of any drug is carried out by hand, due to the high number of scabies on the hands. If the perineum and groin are densely covered with hair, it is better to rub the drug with a brush.

7) Treatment should be carried out in the evening, which is associated with the nocturnal activity of the pathogen.

8) It is recommended to wash the patient before and after the course of treatment, if necessary, the patient can wash off the drug every morning, while its exposure on the skin should be at least 12 hours, including the entire night period.

9) Change of underwear and bed linen is carried out at the end of the course of therapy.

10) Children, schoolchildren, soldiers, etc. a 10 day quarantine is desirable.

11) After 2 weeks, go back to the doctor to resolve the issue of treatment.

By drugs:

Surprisingly, there are very few good clinical trials on the comparative effectiveness of scabicides. Therefore, preferences for drugs vary in different countries.

Briefly about all:

1) benzyl benzoate in medical practice first appeared in the composition of the Peru balsam. Today it is used in various dosage forms prepared in a pharmacy or industrially. In our country, this is a water-soap suspension and emulsion ointment, abroad - soap-alcohol solutions, oil suspensions, aqueous solutions with the addition of DDT and anesthesin. It has been experimentally proven that after a single treatment with benzyl benzoate, all active stages of the tick die. However, the eggs survive. Taking into account the maximum residence time of the larvae in the egg (58 hours), an etiologically justified treatment regimen with benzyl benzoate was proposed: a water-soap suspension or ointment is carefully rubbed by hand once a day at night on the first and fourth days of the course. Washing and changing underwear and bed linen is recommended on the 5th day. The second and third days of the course are successfully used to treat complications associated with scabies. For the death of the active stages of ticks and embryos, an 8-10-hour exposure of the drug is sufficient. In connection with this, the sick can wash themselves in the morning. Overall efficacy (cure) at standard scheme does not exceed 50%, so courses often have to be repeated. Common side effects include local skin irritation with a burning sensation.

2) pyrethrins and pyrethroids. Pyrethrum flowers have been used as insecticides for centuries. active ingredient here are the pyrethrins. It is they who are included in the plates, spirals and fumigators from mosquitoes, in sprays about all kinds of midges and tropical leeches. They are also effective as scabicides. In the US, the pyrethroid permethrin has been used to treat scabies since 1989. According to Cochrane data, permethrin is the most effective topical anti-scabies agent. He kills and active forms ticks and eggs, so a single application is often sufficient (more than 90% cure). In Russia, the drug permethrin is called Medifox (5% and 20%). Almost always available in pharmacies.

Synthetic pyrethroid is also part of the most popular anti-scabies drug in Russia today - Spregal. Spregal is a combined French drug. The active principle is esdepalethrin - a neurotoxic poison that disrupts the cation exchange of membranes. nerve cells arthropods. The second component - piperonyl butoxide - enhances the action of esdepaletrin. The drug is sprayed overnight on the entire surface of the body, except for the face and scalp, from a distance of 20-30 cm from the surface of the skin. Spregal is especially carefully rubbed into the places of favorite localization of scabies (hands, wrists, feet, elbows). When localizing rashes on the face, they are treated cotton swab wetted with the drug. Avoid getting the drug on the mucous membranes. When treating children with a napkin, the mouth and nose are closed. After 12 hours, wash thoroughly with soap and water.

3) Lindane in the Russian Federation it is registered as Yakutin (Merck, Germany), it is almost never found on sale. It is widely used in the world because it is very cheap. However, since the 70s, a lot of data has accumulated about its neurotoxic side effects. So in developed countries, he left the list of first-line drugs.

4) Crotamione registered in the Russian Federation as Yuraks (Bristol-Myers Squibb, USA). According to randomized clinical trials, it is much inferior to Permethrin in terms of effectiveness. Side effects include short-term erythema and conjunctivitis.

5) Sulfuric ointment. Currently no longer used in developed countries due to bad smell, staining of clothing, irritant effects on the skin and mucous membranes, percutaneous absorption with potential effects on the kidneys. However, in Africa, the poorest countries of Latin America and in Russia, sulfuric ointment is still used due to its cheapness. If you only have enough money for the Internet and bread, use sulfuric ointment according to this scheme: for adults 20% concentration, for children -10%. The ointment is rubbed over the entire skin daily at night for 5-7 days. On the sixth or eighth day, the patient washes and changes underwear and bed linen.

However, for the treatment of human scabies, it has so far only been approved in France, Brazil, and a few other countries. Although almost universally, including the US, it is recommended as the drug of choice for the treatment of Norwegian scabies (200mg/kg twice).

Another reason is that developed countries reasonably limit the use of ivermectin to treat the most severe forms. The tick quickly develops resistance to the drug with its massive and uncontrolled use. Therefore, while there are other effective means, it is reasonable to keep ivermectin in reserve.

Therefore, I would still prefer less systemic, but no less effective pyrethroids.

When treating scabies, it must be remembered that itching is caused by an allergic reaction of a person to the waste products of ticks. Therefore, itching and individual elements of the rash (especially nodules) persist for several weeks (and even months) after the complete extermination of ticks.

A separate note on the treatment of pregnant women:

In the United States and Europe, pregnant women are not recommended to be treated with Spregal-type drugs, benzyl benzoate is prescribed to a limited extent, and only permethrin is prescribed without restrictions. In Russia, the opposite is true - only benzyl benzoate and Spregal are prescribed to pregnant women, while permethrin (medifox) is contraindicated according to our instructions. Whom to believe, decide for yourself.

Prevention

It comes out of the way of infection.

The main route of transmission is bed. But I can't tell you anything here. If you need regular sex with different partners, scabies is the least of your evils.

The patient should limit physical contact with others for the entire duration of treatment.

Patients with Norwegian scabies should be isolated for the duration of treatment.

The most important thing is a timely diagnosis, following the treatment regimen prescribed by the doctor, examining all contact persons.

What doesn't help is washing. Ticks are not susceptible to water and soap. If you bathe with special fanaticism in the best traditions of Moidodyr, you may have scabies in a latent form.

Itching is one of the common symptoms with which patients turn to a dermatovenereologist. This is often caused by allergies. But do not forget about such a disease as scabies. It is important to immediately determine the cause of the itching. How to find out on primary stage? What questions should you ask the patient?

What is scabies?

There are direct and indirect ways of tick transmission. Direct is carried out at night in bed, when the tick is most active. The indirect route is through shared items and bedding. There is also a transient invasion, which can be carried out in saunas, trains, baths, where streams of people use items that were used by a patient with scabies.

The pathogenesis of the disease fully reflects the life cycle of the tick, which is divided into 2 periods - short-term cutaneous and long-term intradermal phases.

The location of the moves in scabies depends on the density of the location sweat glands, the type of hair growth, the temperature of the outer skin, the rate of regeneration of the stratum corneum and the structure of the skin. So, often the moves are localized on the hands, elbows, wrists and feet, where the stratum corneum is the thickest. There are also many passages in those areas of the skin where the density of the sweat glands is increased (male genitals, wrists, hands, feet). That is why, when a patient has scabies combined with atopic dermatitis or ichthyosis vulgaris, there are very few scabies. Also, due to dry skin, they are few in the elderly. But there will be many moves with hyperhidrosis, epidermophytosis and dyshidrotic eczema.

But, given the fact that modern people several times a day they wash their hands with soapy chemicals, a patient with scabies may not have these moves at all. Then the diagnosis becomes difficult, because there is no main symptom, but the disease is. The only symptom who can help put provisional diagnosis- the time of occurrence of itching. This is the question that should be asked to the patient in order to make a differential diagnosis with allergies. This is due to the daily activity of ticks.

Daily activity of scabies mites.

The female is during the day calm state. In the evening and at night, she gnaws through the egg knees, laying an egg in each. At the same time, the female deepens the very bottom of this passage, making the subsequent exit of the larvae possible. This is done by every female and every night. One female leaves up to 2 eggs per night. From this process, the itch move on the skin of a patient with scabies is convoluted and consists of parts of moves, which are called the daily move element.

Thus, the nocturnal activity of ticks explains the predominance of the direct route of infection through the bed at night and in the evening, as well as the effectiveness of anti-scabies preparations at night.

Clinical picture of scabies

If the infection was by larvae, incubation period lasts 2 weeks. And if the infection happened from a female, then the clinic is immediately visible. Itching - chief characteristic symptom scabies. It occurs as a result of sensitization of the body to the end products of the vital activity of ticks (excrement, secretion of the glands of the oviduct, oral secretion). Itching appears after 1-2 weeks with a primary infection, and up to 3 weeks with a second infection.

Second feature scabies - the presence of scabies. The skin reacts to the appearance of these same moves. Non-inflammatory vesicles, follicular pustules, also appear. An allergic reaction to the end products of the tick's metabolism is also manifested, which manifests itself on the skin with bloody crusts, scratching and miliary papules. But we found that the skin of each person reacts differently to tick activity. Some burrows do not exist at all (intact burrows), others have vesicles, blisters, pustules and lenticular papules, which is caused by jet burrows. Now it becomes clear the similarity of allergies and scabies.

Diagnostic symptoms for scabies:

1. Ardi's symptom - purulent crusts and pustules on and near the elbows.
2. Gorchakov's symptom - bloody crusts in the same place.
3. Michaelis's symptom - impetigo rashes and bloody crusts in the intergluteal crease with the transition to the sacrum.
4. Cesari's symptom - on palpation, an elevation is determined, which indicates the presence of an itch.

Scabies can be complicated by dermatitis and pyoderma. Sometimes - urticaria and microbial eczema.

When a person is infected with ticks from animals (dogs, pigs, horses, wolves, foxes, rabbits), pseudosarcoptic mange develops. With this disease, the incubation period lasts several hours, and typical scabies are absent, because ticks do not multiply in conditions unusual for it. They only penetrate the skin, causing severe itching. Pseudosarcoptic mange is not transmitted from person to person.

Scabies in children occurs with possible defeat skin of the face and scalp. In infants, even the nail plates can be affected.

Methods for detecting scabies

In our country, the diagnosis of scabies must be confirmed by laboratory. For this use:

• The oil vitropressure method - the skin is lubricated with mineral oil, after which granulomas are visualized by pressing on the pouring element.
• Suspicious element staining method 5% alcohol solution iodine, ink, ink or aniline dyes.
• Scraping method - detection of contents in the scabies, vesicles and papules;
• The method of extracting the tick with a needle is after opening the blind end of the stroke. At the same time, sharp needles move in the direction of travel and the female is attached by suction cups to the manipulation needle.
• Dermoscopy - must be carried out necessarily for a patient with scabies.

Treatment and prevention of scabies

Scabies is treated on an outpatient basis. The most effective and commonly used ointments for scabies are benzyl benzoate, medifox, spregal and sulfur ointment. But, regardless of the treatment chosen, there are general principles treatment of patients with scabies:

Treatment of all patients in one focus is carried out simultaneously;

Rubbing ointments should be carried out exclusively in the evening;

For children under 3 years old, all areas of the skin are subject to rubbing, for the rest - with the exception of the scalp.

Scarbicides are rubbed only with hands, after which hands must be washed thoroughly;

The drug must be on the skin for at least 12 hours;

Treatment of complications should be carried out in parallel with the treatment of scabies;

Change of underwear and bed linen is carried out after the completion of the treatment process.

Treatment of scabies in children

Children under 1 year old can only use Spregal ointment, from 1 to 3 years old - Spregal and Medifox. From 3 years old - no restrictions.

The doctor must remember that in the treatment of scabies, relapses cannot occur, since the tick does not have long, latent periods. And such “relapses” are the result of non-compliance with treatment regimens, an independent decrease in the concentration of the drug, if the term and frequency of application of the ointment are not observed, as well as the use of the drug in the inactive phases of the tick cycle (in the afternoon) and the use of expired drugs. Reinvasion is possible - re-infection from the primary source of scabies, if the latter has not received adequate treatment.

Prevention of scabies consists in the active identification of patients at medical examinations and in any treatment for medical help.

It is important to know the preventive measures that will reduce the chances of contracting scabies:

Use of personal hygiene products and bed linen;

Stick to hygiene standards in saunas, pools, baths;

Follow basic hygiene procedures.

It is not always possible to prevent a disease such as scabies, but, remembering elementary rules can significantly reduce the risk of infection. And most importantly, after reading this article, you will have no doubts at the initial stage of diagnosis, whether it is an allergy or scabies.

Health to you and your patients!