4. •Mr. Salem, 30 yearsMr. Salem, 30 years
old, complaining ofold, complaining of
itching at nightitching at night
affecting the skinaffecting the skin
around umbilicus ,around umbilicus ,
axillae and groin ofaxillae and groin of
2weeks duration. Also2weeks duration. Also
his wife affected byhis wife affected by
the same conditionthe same condition..
5. Skin examination revealedSkin examination revealed::
Multiple papules and scratch marks aroundMultiple papules and scratch marks around
thethe umbilicus and in the axillaeumbilicus and in the axillae
6. What is the probableWhat is the probable
diagnosisdiagnosis??
8. ScabiesScabies
Scabies is anScabies is an ectoparasite infestationectoparasite infestation..
It is caused by theIt is caused by the mitemite Sarcoptes scabieiSarcoptes scabiei varietyvariety
hominishominis an obligate human parasite thatan obligate human parasite that
burrows tunnels downwards into the epidermisburrows tunnels downwards into the epidermis
(not deeper than the stratum granulosum(not deeper than the stratum granulosum(.(.
Mites of all developmental stages tunnel into theMites of all developmental stages tunnel into the
stratum corneum and deposit faeces behindstratum corneum and deposit faeces behind
them; the female also lays eggs in the tunnelsthem; the female also lays eggs in the tunnels..
10. Photograph of the mite,Photograph of the mite, S. scabieiS. scabiei, seen, seen
on a skin scraping from scabetic patienton a skin scraping from scabetic patient
11. In classic scabies, there are onlyIn classic scabies, there are only
aboutabout 11-1211-12 female mites perfemale mites per
casecase..
HypersensitivityHypersensitivity of both immediateof both immediate
and delayed types to the mite orand delayed types to the mite or
its products has been implicatedits products has been implicated
in the development ofin the development of lesionslesions
other thanother than burrowsburrows..
12. Mode of transmissionMode of transmission
--CloseClose person-to-personperson-to-person
contactcontact..
--Sexual intercourseSexual intercourse..
--Fomites may transmit theFomites may transmit the
infectioninfection..
13. Clinical pictureClinical picture
Itching : Nocturnal , scratchingItching : Nocturnal , scratching
………………………………………………………………………………………………
……………………………………....
The affected sites : Delicate skin asThe affected sites : Delicate skin as
………………………………………………………………………………………………
………………………………....
Morphology of the lesion : poly morphicMorphology of the lesion : poly morphic
………………………………………………………………………………………………
………………………………..
14. A scabies burrow underA scabies burrow under
magnificationmagnification
15.
16. Clinical variations of scabiesClinical variations of scabies
11--Scabies incognitoScabies incognito..
22--Scabies in infants and young childrenScabies in infants and young children..
33--Nodular scabiesNodular scabies..
44--Crusted ( Norwegian ) scabiesCrusted ( Norwegian ) scabies..
55--Animal scabiesAnimal scabies..
17. CrustedCrusted (Norwegian)(Norwegian) scabiesscabies
This type represents an abnormal hostThis type represents an abnormal host
immune response to the sarcoptesimmune response to the sarcoptes
scabiei.The condition is primarily seen inscabiei.The condition is primarily seen in
the following groupsthe following groups::
11--The mentally retarded ( DownThe mentally retarded ( Down,,
s syndromes syndrome((
22--Patients with poor cutaneous sensation ( leprosyPatients with poor cutaneous sensation ( leprosy
,syringomelia ,and tabes dorsalis,syringomelia ,and tabes dorsalis. (. (
33--Patients with severe systemic diseasesPatients with severe systemic diseases
( leukemia( leukemia –– diabetesdiabetes((
44--Patients with severe immunesuppressionPatients with severe immunesuppression..
18. Crusted scabies in a patient with noCrusted scabies in a patient with no
overt immunosuppressive illnessovert immunosuppressive illness
19. Photograph of patient withPhotograph of patient with
hyperkeratotic rash typical ofhyperkeratotic rash typical of
crusted (Norwegian) scabiescrusted (Norwegian) scabies..
20. Crusted scabies in a patient with claw handCrusted scabies in a patient with claw hand
from past leprosyfrom past leprosy..
21. Bullous ScabiesBullous Scabies
--These scabies can be seen in adults overThese scabies can be seen in adults over
65 years of age65 years of age..
--There is no linkage to an underlyingThere is no linkage to an underlying
condition or diseasecondition or disease..
--It can mimic bullous pemphigoid clinically,It can mimic bullous pemphigoid clinically,
pathologically,and immunopathologicallypathologically,and immunopathologically..
22. Diagnosis of scabiesDiagnosis of scabies
HistoryHistory
ExaminationExamination
Investigations : ScrapingInvestigations : Scraping
23. Complications of scabiesComplications of scabies
--Bacterial infectionsBacterial infections
--EczematizationEczematization
--UrticariaUrticaria
--AcarophobiaAcarophobia
24. Treatment of scabiesTreatment of scabies
--InstructionsInstructions
--Drugs : Topical and systemicDrugs : Topical and systemic..
25. Topical scabicidesTopical scabicides
11--Benzyl benzoate 10% and 25% lotionsBenzyl benzoate 10% and 25% lotions
22--Pyrethrins: permethrin 5% cream, lotionPyrethrins: permethrin 5% cream, lotion
33--Malathion 0Malathion 0··5% lotion5% lotion
44--Sulphur (precipitated) 2Sulphur (precipitated) 2––10% in petrolatum10% in petrolatum
55--Crotamiton 10% cream (EuraxCrotamiton 10% cream (Eurax((
66--Gamma benzene hexachloride 1% cream orGamma benzene hexachloride 1% cream or
emulsionemulsion..
Special care fore Infant------ PregnantSpecial care fore Infant------ Pregnant
26. Systemic drug for scabiesSystemic drug for scabies
•Ivermectin.Ivermectin. (200 μg/kg once and repeated(200 μg/kg once and repeated
after 1-2 weeksafter 1-2 weeks( .( .
27. IvermectinIvermectin
11--The full benefit becomes evident whenThe full benefit becomes evident when
eradication of scabies in epidemic or endemiceradication of scabies in epidemic or endemic
situationssituations
22--in nursing homes and prisonsin nursing homes and prisons is needed sinceis needed since
ivermectin leads to reliable disease controlivermectin leads to reliable disease control..
33--Along the same lines,Along the same lines, crusted scabiescrusted scabies has beenhas been
effectively treated with ivermectin in adults andeffectively treated with ivermectin in adults and
children, sometimes in combination with topicalchildren, sometimes in combination with topical
permethrinpermethrin..
28. Mechanism of actionMechanism of action
IvermectinIvermectin interrupts the GABA-interrupts the GABA-
induced neurotransmission ofinduced neurotransmission of
many parasites.leading tomany parasites.leading to
paralysis of the parasitesparalysis of the parasites..
29. Novel drugNovel drug
Recently, the essential oil of the tea treeRecently, the essential oil of the tea tree
((Melaleuca alternifoliaMelaleuca alternifolia), containing), containing
oxygenetic terpenoids, was found to haveoxygenetic terpenoids, was found to have
rapid scabicidal and antibacterial activityrapid scabicidal and antibacterial activity..
30. vaccine developmentvaccine development
The multifunctional enzymeThe multifunctional enzyme
glutathione S-transferaseglutathione S-transferase ofof SS
scabieiscabiei could represent a specificcould represent a specific
target for vaccination againsttarget for vaccination against
human scabieshuman scabies..
31. 1313years old female patientyears old female patient
complaining of itching in the scalp ofcomplaining of itching in the scalp of
10 days duration with post auricular10 days duration with post auricular
and occipital swellingand occipital swelling
32. What is the probableWhat is the probable
diagnosisdiagnosis??
33. PediculosisPediculosis
PediculosisPediculosis is an infestation of liceis an infestation of lice —— blood-blood-
feeding ectoparasitic insects of the orderfeeding ectoparasitic insects of the order
Phthiraptera. The condition can occur in almostPhthiraptera. The condition can occur in almost
any species of warm-blooded animal (i.e.,any species of warm-blooded animal (i.e.,
mammals and birds), including humans.Althoughmammals and birds), including humans.Although
"pediculosis" in humans may properly refer to"pediculosis" in humans may properly refer to
lice infestation of any part of the body, the termlice infestation of any part of the body, the term
is sometimes used loosely to refer tois sometimes used loosely to refer to pediculosispediculosis
capitiscapitis, the infestation of the human head with, the infestation of the human head with
the specific head lousethe specific head louse..
34. Pediculus humanus capitisPediculus humanus capitis (♀) Lice are small gray(♀) Lice are small gray
brown,blood sucking insects which crawl among thebrown,blood sucking insects which crawl among the
hairshairs
35. ClassificationClassification
Pediculosis may be divided into thePediculosis may be divided into the
following typesfollowing types
11--Pediculosis capitis (Head lice infestationPediculosis capitis (Head lice infestation((
22--Pediculosis corporis (PediculosisPediculosis corporis (Pediculosis
vestimenti, Vagabond's disease) typhusvestimenti, Vagabond's disease) typhus
$relapsing fever$relapsing fever
33--Pediculosis pubis (Crabs) STDPediculosis pubis (Crabs) STD
36. Pediculosis, or louse infestation, remains aPediculosis, or louse infestation, remains a
worldwide problem. The lice that infestworldwide problem. The lice that infest
human beings are almost always suckinghuman beings are almost always sucking
lice that live in close association with thelice that live in close association with the
host and lay their eggs on hair shafts or inhost and lay their eggs on hair shafts or in
the seams of clothingthe seams of clothing
37. AA andand B,B, Identifying characteristics of a headIdentifying characteristics of a head
louselouse..
38. Head louse nit attached to hairHead louse nit attached to hair
shaftshaft
