Scabies

Scabies - infection of the skin with tick Sarcoptes scabiei. Scabies causes severe itching, erythematous papules and subcutaneous passages between the fingers, wrists, waist and genitals. The diagnosis of "scabies" is made during examination and is based on the results of scrapes. In the treatment of local drugs are used or rarely prescribed oral administration of ivermectin.

[1], [2], [3], [4],

Epidemiology

Over the past two decades, the world has seen a significant increase in the incidence of scabies. According to statistics, scabies in the general structure of the incidence of scabies is 3.6-12.3%.

Infection with scabies occurs from a sick person to a healthy person, and in 50% - with sexual contact. It is also possible to transfer the itch mite indirectly (with the help of sick person's items, common use of bedding, washcloths, children's toys, writing materials).

Indirect route of transmission of scabies tick is observed very rarely due to mite's weak viability in the environment. The lifespan of an itch mite at room temperature of 22 ° C and a humidity of 35% is no more than 4 days. At a temperature of 60 ° C, parasites die within 1 hour, and at boiling and temperatures below 0 ° C - die right away. Favorable environments for the inhabiting of an itch mite outside the host are house dust, natural fabrics and wooden surfaces. Eggs of parasites are more resistant to acaricidal agents

Infection with scabies mite can occur in showers, saunas, baths, hotel rooms, train wagons under the condition of violation of the sanitary regime.

[5], [6], [7], [8], [9]

Causes of the scabies

Scabies (scabies) are caused by the itch mite Sarcoptes scabiei. The life cycle of the tick consists of two periods: reproductive and metamorphic. The reproductive cycle of the tick is as follows: the egg, which has an oval shape, is deposited by the female in the itch movement, in which after some time the larvae hatch. Scabies can last about 1.5 months and serve as a source of further infection. The metamorphic period begins with the appearance of the larva, penetrating through the course into the skin and transforming after molting into protonimus, and then into a teleimorph that turns into an adult. Scabby mite has a tortoiseshell shape measuring 0.35x0.25 mm.

Male scabies mite size is much smaller than the female. The female moves along the skin with the help of two front legs, on which are the suckers. In the stratum corneum of the mite penetrates with the help of its massive jaws and terminal spines of the fore pairs of paws. The female feeds on a granular layer of the epidermis, but at the same time moves in the stratum corneum. Laying eggs occurs in the formed passages in a row.

[10], [11], [12]

Pathogenesis

The excrement left by the parasite in the intradermal passages causes an allergic reaction. In case of violations in the immune system, generalization of the process takes place with the development of Norwegian scabies.

Proponents of the immunological hypothesis associate perennial fluctuations in morbidity with immunobiological processes. During the epidemic of scabies, there is a hypersensitivity to the population, which results in a certain degree of resistance to the pathogen, mainly in young people. There is an opinion on the influence of sexual promiscuity on the incidence of scabies, which arose on the basis of establishing a link between the incidence of scabies and sexually transmitted diseases

When scabies are clearly expressed seasonal dynamics of morbidity. The greatest number of patients is recorded in the fall and winter, the smallest in the summer.

The increase in the incidence of scabies is also facilitated by shortcomings in the work of the medical service: errors in diagnosis, a low indicator of active detection, incomplete involvement in the survey and treatment of sources of infection and persons who have been in contact with the patient.

[13], [14], [15], [16]

Symptoms of the scabies

The main symptoms of scabies are intense itching, usually worse at night, but time is not a determining factor.

Forms

[17]

Classical scabies

First, erythematous papules are formed in the interdigital folds, in the folds of the elbows and wrists, in the armpits, along the waist line or on the buttocks. Perhaps spread to any part of the body, except the face in adults. The disease is characterized by the presence of small, wavy courses, scaly lines from a few millimeters to 1 cm in length. A tiny, dark papule - a tick - can often be seen at one end.

Symptoms of classic scabies may be atypical. In black and black people, scabies can manifest as granulomatous nodules. Infants may have palms, soles, face and head injuries, as well as ear auricles. In patients with low immunity, skin peeling without concomitant itching (especially on the palms and soles of adults and on the scalp in children) is possible.

The incubation period of scabies lasts from 8 to 12 days. The first and main symptom of scabies is the itching of the skin, which is worse at night. On the skin there are paired, itchy papulovesicles. The intensity of skin itching increases with the duration of the disease, and depends on the number of mites and the individual characteristics of the organism (the level of irritation of the nerve endings by the tick during its movement through the skin and sensitization to the parasite and its life products (feces, secretions of the glands of the oviduct, secret secreted by gnawing )).

The distribution of scabies along the skin is determined by the rate of recovery of the epidermis, the structure and thermal regime of the skin. The skin of the hands, wrists and feet has a lowered temperature, the maximum thickness of the stratum corneum of the epidermis and the minimum hair covering. The thick horny layer in these places allows the larvae of the itch mite to hatch from the eggs and not tear off with the horny skin scales. The height of the disease is characterized by a polymorphism of rashes: from follicular eruptions that occur at the site of the introduction of the parasite to the crusts and erosions.

Diagnostic criteria for scabies are the presence of itch moves, papules and vesicles. Typical localization of scabies is the area of the hands and elbows, the stomach, buttocks, mammary glands, hips. Often there are erased forms of scabies, which are often diagnosed as allergic dermatoses.

Other skin rash elements are also possible with scabies, such as erosion, hemorrhagic crusts, excoriation, erythematous-infiltrative spots. When attaching a bacterial infection, pustules and purulent crusts arise. In 20% of cases Ardy-Gorchakov's symptom is observed: point purulent crusts on the extensor surface of elbow joints.

It is possible to distinguish several separate forms of scabies: nodular (postskabioznaya skin lymphoplasia), scabies in children, Norwegian scabies, pseudocysts.

Features of scabies in children of the first months of life are the extent of the lesion of the parasite: combs and bloody crusty blisters are located on the skin of the back, buttocks and face. It is often complicated by pyoderma and sepsis until death. At schoolchildren the scabies often masks under signs of a children's pruritus, an eczema and a pyoderma.

Diagnosis of scabies is based on typical symptoms, epidemiological data, the results of laboratory tests.

[18], [19], [20]

Atypical clinical forms of scabies

Scabies without strokes are the beginning forms of the disease or occur in people who observe the rules of body hygiene. It is assumed that the absence of itch moves is possible at an early stage of the disease in persons who have been in contact with patients with scabies and is explained by infection with larvae. In this case, there are other symptoms characteristic of scabies: itching, which intensifies in the evening, papules and vesicles in places of typical localization.

In recent years, cases of atypical, grated forms of scabies have become frequent - the so-called scabies of "cleanliness" people, in which there are single eruptions in the form of papules and vesicles on the trunk and flexor surfaces of the limbs, there are no scabrous strokes.

Atypical forms also include Norwegian (cystic) scabies, first described 100 years ago by the Norwegian scientist Danielson, who observed it in patients with leprosy. Occurs with a decreased reactivity of the body. It is characterized by a slight infiltration of the skin with a layer of massive dirty gray color of crusts up to 3 cm thick. In some cases, they take the form of a cutaneous horn. In some patients, the cortical layers seize significant areas of the skin, resembling a solid horny carapace.

Often Norwegian scabies are accompanied by an increase in the patient's body temperature, which is maintained throughout the disease.

[21], [22], [23], [24],

Scabies unrecognized

Scabies unrecognized (incognito) develops against a background of topical application of corticosteroids. Steroids reduce inflammation and suppress the itching, while creating favorable conditions for the reproduction of mites, resulting in a large number of moves and increased contagiousness of the disease. Scabies loses its specific symptoms, takes papulo-squamous, papulo-vesicular, and sometimes even keratose character and becomes resistant, paradoxically, to corticosteroids.

Nodular scabies

Nodular scabies (post-scabiosis lymphoplasia) occurs after a full treatment of the disease and is presented in the form of itchy nodules. It is suggested that the granulomatous skin reaction can occur as a result of the introduction of an itch mite, due to skin irritation during combing or absorption of the products of decay of excrement. There are reports of an immunoallergic genesis of nodular scabies, in favor of which histological evidence suggests.

Clinically, the disease is expressed by the appearance of round, dense nodules up to a string bean, cyanotic pink or brownish red with a smooth surface. The localization of elements predominantly on the closed parts of the body. The course is benign, but lasting (from several months to several years). It is possible spontaneous regress of nodular elements and their reappearance in the same places.

Conventional local and anti-stigma therapy is ineffective. We recommend the use of antihistamines inside, presocil, external steroid ointments for occlusive dressing. With long persistent nodules use liquid nitrogen, diathermocoagulation, laser therapy, leeches.

Pseudotum

Pseudochick is an itchy dermatosis that occurs when you infect an itch mites of animals. The most common source of human infection is the scabies of dogs, rarely other animals: pigs, horses, rabbits, sheep, goats, foxes.

The incubation period of pseudotum is very short and is several hours. Patients are troubled by severe itching. Ticks do not penetrate into the epidermis and do not form moves. Rashes are asymmetric, localized at sites of contact with a sick animal. The rash is presented in the form of urticaria and prurigopodobnyh papules, papulovesicles, blisters with a pronounced inflammatory component. From person to person, the disease is not transmitted, therefore, contact persons should not be treated. Laboratory diagnosis is difficult: only females are detected, and immature stages are absent.

Norwegian scabies

The Norwegian scabies is a disease first described in a survey of leprosy patients in Norway. The causative agent of Norwegian scabies is a common scabies mite. Norwegian scabies are characterized by the following features:

• rare disease registration;
• a special contingent of patients: Down's disease, senile dementia, infantilism, asthenia, immunodeficiency states;
• difficulty in diagnosing: often passes several months and even years from the time of the onset of lesions and until a diagnosis is made; this is due to the fact that the itching during the disease is often absent, and the lesions affect the face, scalp, nails in the form of crusts and hyperkeratosis, reminiscent of other diseases - psoriasis, Darya's disease, pitiriasis, histiocytosis;
• poorly studied pathogenesis; the main role is given to immunodeficiency; there is a hypothesis about the genetic predisposition of the organism to the development of hyperkeratosis lesions in connection with a decrease in the intake of vitamin A.

The main clinical symptoms of scabies of this form: massive crusts, scabies, polymorphic eruptions (papules, vesicles, pustules, scales, crusts) and erythroderma. Favorite localization of crusts - upper and lower extremities (elbows, knees, palms, soles), buttocks, face, ears, scalp. The surface of the crust is rough, covered with cracks or warty growths that resemble rupees. Nails of gray-yellow color with a tuberous surface, easily crumbled, the edge is eaten. The palmar-plantar hyperkeratosis is expressed. There is an increase in lymph nodes. Sometimes Norwegian scabies are accompanied by an increase in body temperature, which is maintained throughout the disease. The disease is characterized by high contagiosity due to a large number of mites: up to 200 per 1 cm ² of the patient's skin.

Complications and consequences

The most common complications of scabies are pyoderma and dermatitis, eczema and urticaria are less common. It is extremely rare lesion of nail plates in patients with scabies, mainly in infants.

[25], [26], [27], [28], [29]

Diagnostics of the scabies

The diagnosis is established during physical examination and is confirmed by the presence of ticks, eggs or excrement during microscopic examination. To take the scraping on the damaged skin, glycerin or mineral oil is applied (to prevent dispersion of mites and material), which are then scraped off with a scalpel. The material is placed on a slide and covered with a cover slip.

The method of specific laboratory diagnosis of scabies is the microscopic examination of a tick taken with a needle from the end of the itch. It is also possible to conduct an alkaline preparation: the skin is treated with a 10% solution of alkali, followed by examination of the scraping of macerated epidermis.

Diagnosis of scabies includes examining the material (from the blisters after scraping with a sharp spoon) for the presence of an itch mite. At a microscopy mites, their eggs and excrements are found out. Only in 30% of cases it is possible to find a mite or eggs, so the diagnosis is often made on the basis of patient complaints and clinical picture.

Laboratory diagnosis of scabies

Several methods of laboratory diagnosis of scabies are known. The oldest of these is the method of extracting the tick with a needle. However, the method of scraping a papule or vesicles with a sharp spoon is more often used now. In 1984-J9S5 years. A new method for the rapid diagnosis of scabies using 40% aqueous solution of lactic acid was developed and introduced into practice. The method is based on the ability of lactic acid to rapidly brighten the epidermis and ticks in the preparation.

This acid does not crystallize, does not irritate the skin and loosens the stratum corneum of the epidermis well before scraping, prevents the spillage of the material during scraping and the development of pyogenic complications. A drop of 40% lactic acid is applied to the itch element (stroke, papule, vesicle, koichku idr.). After 5 minutes, the loosened epidermis is scraped with a sharp eye spoon until the appearance of capillary blood. The material is transferred to a slide in a drop of lactic acid, covered with a cover slip and microscopized. There is also a method of thin sections of the affected area of the stratum corneum of the epidermis and a method of layer-by-layer scraping, where a mixture of equal volumes of 20% NaOH and glycerol is used instead of a solution of 40% lactic acid.

Complications can mask the clinical manifestations of scabies, leading to errors in diagnosis. More common are dermatitis (simple or allergic), pyoderma, less often - microbial eczema and nodular lymphoplasia.

[30], [31], [32], [33], [34], [35]

Criteria for diagnosis of scabies

Diagnosis of scabies is established on the basis of:

• clinical data (evening-night itch, characteristic rashes in typical places);
• epidemiological information (examination of contact persons and detection of clinical signs of scabies, information about the patient's stay in the epido-shag, etc.);
• laboratory diagnostics (detection of the tick and its eggs in the scrapings of the elements of the rash).

[36], [37], [38], [39], [40],

Differential diagnosis

Differential diagnosis should be carried out with diseases accompanied by itching, nodular pruritis, microbial eczema, in which the itching disturbs during the day, and not in the evening and night, as in scabies.

Establishment of a correct diagnosis is facilitated by the identification in places of the typical location of itch moves, papulo-vesicles, in which it is possible to detect the pathogen of the disease - itchy itch.

[41], [42], [43], [44]

Treatment of the scabies

Patients are hospitalized for epidemiological reasons. Special regime and diet is not required.

Treatment of scabies consists in the use of drugs that have a harmful effect on parasites in the stratum corneum scabies and their larvae, without causing undesirable effects (general toxic, local skin irritation - simple or allergic).

Numerous preparations known for this purpose have been used and are currently used (sulfur and sulfur-containing compounds, benzyl benzoate, synthetic pyrethroids, etc.). Regardless of the drug chosen and the method of its use, for the successful treatment of a patient with scabies, a number of general rules must be observed:

• treat the anti-scratch drug all skin (except for the scalp), not just the affected areas;
• to conduct treatment in the evening, which is due to the activity of the pathogen at night;
• strictly follow the recommended method of treatment;
• wash immediately before and after treatment;
• Change the bed linen before and after the treatment.

In recent years, due to high efficiency and low toxicity, benzyl benzoate (benzyl benzoic acid ester) has become widespread. This preparation is made in the form of an official emulsion ointment (20% ointment in a tube, 30 g), which is successively rubbed into the skin for 10 minutes with a 10-minute break. Children use 10% ointment.

After each treatment the patient changes the bed linen and bed linen, the dirty laundry after washing is heat treated. Rubbing is repeated on the 2nd day (or on the 4th day). This is justified by the fact that the hatching pruritic larvae hatched for two days from eggs are more accessible to the effect of antiscabic therapy. 3 days after the end of treatment, the patient is recommended washing and repeated change of clothes. It is necessary to disinfect the outer clothing and upholstery upholstery.

Among the preparations containing sulfur, sulfuric ointment (20%, for children 6-10%) and MP Demyanovich method are more often used (includes sequential treatment of the entire skin with 60% sodium thiosulfate solution - 200 ml and 6% hydrochloric acid - 200 ml).

Highly effective and safe are modern scabies such as Spregal (esdepalletrin aerosol in combination with piperonyl butoxide in the bottle, SCAT, France) and lindane. In the evening without preliminary washing, the patient sprinkles all the skin (except the head and face) with Spragal spray from a distance of 20-30 cm from the surface, leaving no part of the body untreated. After 12 hours, wash thoroughly with soap. Usually a single application of the drug is sufficient. For a considerable duration of the disease, the skin is treated twice (once a day). Undesirable effects (tingling of the skin and irritation of the larynx) are rare. One balloon is enough to handle 2-3 patients. Perhaps Spregal's treatment of children.

Lindane is an organochlorine insecticide (gamma-hexachlorocyclohexane). Has high efficiency, devoid of color and odor. 1% cream (emulsion) rub in the evening three days in a row in the entire skin from the neck to the toes of the toes. Before treatment and every day 12-24 hours after treatment, you must take a warm shower or bath. Pregnant women and children with lindane are not recommended.

The treatment of scabies is aimed at destroying the pathogen with the help of acaricidal drugs. The ideal antiscalant should:

• have an equally effective effect on ticks and their larvae;
• have a minimal sensitizing and irritating side effect even in the case of regular application;
• quickly excreted from the body in case of penetration through the skin, i.e., the general toxicity of the anti-scab agent should be negligible;
• be simple in use and the way it is used should be clearly indicated;
• to be pleasant enough from the cosmetic point of view: not to have a smell, not to spoil clothes.

For the treatment of scabies, various drugs were offered: sulfuric ointment, Wilkinson's ointment, Helmerich's ointment; Fluids of Flemings, Moore, Ehlers; Milian paste; solutions of creolin, lysol; pure tar, ethylene glycol, benzoic ether, etc. For a long time, non-medicinal products have also been used, for example, kerosene, gasoline, mazut, autol, crude oil, fly ash. Since 1938, a new era in the treatment of scabies has opened up, thanks to the successive discoveries of such drugs as benzyl benzoate (1936), DD T. (1946), crotamiton (1949), lindane (1959), spregal (1984). However, a unified approach to therapeutic methods for treating scabies has not been developed at present. It should also be noted that in most of the drugs sold, the dosage of the drugs is much greater than the therapeutic needs. At the same time, it is necessary to observe some general rules in the treatment of scabies patients:

• The whole surface of the body should be treated, and not only the affected areas; the preparation should be applied with a thin, uniform layer; special attention should be paid to the processing of hands, feet, interdigital spaces, underarms, scrotum and perineum;
• Avoid contact with eyes and mucous membranes;
• dosage should not be too large; At the same time, other local remedies should not be used with anti-scratch preparations;
• In the case of advanced scabies with complications, the skin lesions should be treated first; for the treatment of secondary infection, antiseptics and general therapy methods are used, for the treatment of dermatitis and eczema-softening drugs of local action;
• in the case of Norwegian scabies, it is necessary, with the help of keratolytic agents, to pre-clean skin areas covered with a crust and immediately isolate the patient. Preparations containing sulfur have been used for a long time to treat scabies (Helmerich ointment, Milian paste, sulfuric ointment). Sulfur ointment is used most often (33% for adults and 10-15% for children). Before starting treatment, the patient is washed with warm water and soap. Ointment is rubbed into the entire skin daily for 5-7 days. After 6-8 days the patient is washed with soap and changes the underwear and bed linen. For children, 15% of sulfuric ointment is recommended on the 1st and 4th day of therapy. Disadvantages of sulfuric ointment application: duration of treatment, unpleasant odor, frequent development of dermatitis, contamination of laundry.

The Demjanovich Method

The Demjanovich method is based on the acaricidal action of sulfur and sulfurous anhydride, which are released during the interaction of sodium hyposulfite and hydrochloric acid. Treatment consists in the sequential rubbing into the skin of 60% solution of sodium hyposulfite (solution No. 1) and 6% solution of hydrochloric acid (solution No. 2). For children, lower concentrations are used - 40% and 4%, respectively. The solution of hyposulfite before use is slightly heated and rubbed into the skin in a certain sequence: begin with the skin of both hands, then rub in the left and right upper limbs, then into the skin of the trunk (chest, abdomen, back, gluteal region, genitals) and finally , in the skin of the lower extremities to the toes of the feet and soles. Rubbing in each area lasts 2 minutes, the entire procedure should take at least 10 minutes. When dried for 10 minutes on the skin appears a lot of crystals of hyposulfite. After a 10-minute break, 6% hydrochloric acid is started to be rubbed, which is carried out in the same order for one minute for each area 3 times with breaks of 5 minutes for drying. At the end of rubbing and after drying the skin, the patient puts on clean clothes and does not wash for 3 days, but in the hands of the solution re-rubbed after each wash. After 3 days the patient washes hot water and changes clothes again. Disadvantages of the method: labor intensity, often relapses, repeated cycles of treatment are necessary.

Bogdanovich's method

Bogdanovich's method is based on the use of polysulphide liniment (10% concentration for adults and 5% for children). The effective beginning of the liniment is sodium polysulphide, which is prepared with 600 ml of water, 200 g of sodium hydroxide ("clean" qualification) and immediately 200 g of powdered sulfur ("sulfur color", qualification "pure") and stir with a glass rod. The ratio of ingredients is 3: 1: 1 (water: NaOH: sulfur), the content of polysulphide in the solution is 27%. The polysulphide solution is usable for up to 1 year when stored in a sealed container. The basis of liniment is a soap gel, for the preparation of which take 50 g of crushed soap (preferably "Baby"), heated in 1 liter of water until completely dissolved, then cooled in an open container at room temperature. The liniment of the necessary concentration is prepared as follows: 10 ml (for 10%) or 5 ml (for 5%) of sodium polysulphide solution and 2 ml of sunflower oil are added to 100 ml of a 5% soap gel. Method of treatment: Liniment is rubbed for 10-15 minutes into the entire surface of the skin. Repeated rubbing is carried out on the 2nd and 4th day. Brushes are additionally treated after each washing of hands. Bathing before the first and third rubbing (1 st and 4 th day) and 2 days after the last third rubbing, i.e. On the sixth day. Change of linen after the first rubbing and 2 days after the last rubbing (on the 6th day). With common and complicated forms of the disease, it is recommended to rub the drug daily (once a day) for 4-5 days. Disadvantages of the method: an unpleasant smell of hydrogen sulfide, sometimes develop dermatitis.

[45], [46]

Benzyl benzoate

Benzyl benzoate is used in the form of 20% water-soap suspension, children under 3 years - 10% suspension. The suspension treats the entire skin (except the head), and in children under 3 years old - and the skin of the face. Rubbing should be carried out in a certain sequence: begin with the simultaneous rubbing into the skin of both hands, then into the left and right upper limbs, then into the skin of the trunk and finally into the skin of the lower limbs. A modification of the method of treatment of patients with benzyl benzoate is proposed: 20% water-soap emulsion is rubbed once only on the 1st and 4th day of treatment. Change of bed linen and bed linen is carried out twice: after the first and second rubbing of the preparation. The patient does not wash for the next 3 days, but in the hands, the drug is rubbed repeatedly after each wash. After 3 days, the patient is washed with hot water and changes clothes again. In infants instead of rubbing spend wetting the skin surface with these solutions, repeating the course of treatment after 3-4 days. Disadvantages of the drug: the development of dermatitis, effects on the central nervous system, marked cases of acute intoxication.

[47], [48],

Lindane

Lindan - the drug is used in the form of 1% cream, lotion, shampoo, powder, ointment. Lindane or gamma-benzene hexachlorane is an organochlorine insecticide that is an isomer of hexachlorocyclohexane. The drug is applied for 6-24 hours, then washed off. It is necessary to strictly observe the following rules: it is not recommended to use lindane for the treatment of babies, children and pregnant women; the drug should be applied in a single dose on cold, dry skin; the concentration of the drug should be below 1%. Disadvantages of the drug: contact eczema; when ingested, is toxic to the nervous system and blood; penetrates through the skin of the newborn; local and general reaction associated with the presence of an anesthetic.

Crotamiton

Crotamiton - a cream containing 10% of 11-ethyl-0-crotonyltoludine, is effective as an anti-scab and antipruritic drug that does not cause adverse reactions. It is successfully used in the treatment of newborns and children. Crotamiton is applied after washing twice with an interval of 24 hours or four times in 12 hours for 2 days.

[49], [50], [51], [52]

Thiabendazole

The drug on the basis of tiabendazole was initially successfully used for oral administration at a dose of 25 mg / kg of weight per day for 10 days. However, due to the adverse effect on the digestive tract, its use is currently limited. Subsequent studies were associated with external administration of thiabendazole in the form of 5% cream 2 times a day for 5 days, and as a 10% suspension 2 times a day for 5 days. No adverse clinical or biological effects were observed.

Esdepalletrin

Esdepalletrin - this synthetic pyrethrin is used as the active start of the Spregal aerosol. The preparation treats the entire skin, with the exception of the face and scalp, spraying it from the top down along the trunk, then covering the arms and legs. After 12 hours, thorough washing with soap is recommended. Usually, only one processing cycle is sufficient. Itching and other symptoms can be observed for 7-8 days. If after this period the symptoms persist, repeat treatment is performed.

Spregal

Aerosol means "Spregal" can be used to treat scabies in pregnant women, nursing women, newborns.

Permethrin

Permethrin is used as a 5% ointment (or cream). Method of treatment: the ointment is carefully rubbed into the entire body from the head to the feet. After 8-14 hours a shower is taken. As a rule, one-time use of the drug is effective.

Ivermectin

Ivermectin is applied orally once in a dose of 20 μg / kg of patient weight. Ivermectin (ivermectin) is effective and safe. The drug is also applied topically once a day, but in 50% of cases it is necessary to repeat treatment after 5 days.

Diethylcarbamazine

Diethylcarbamazine is used to treat scabies only orally. The drug is prescribed for 100 mg 3 times a day for 7 days. Lack of the drug: low clinical efficacy (50%).

[53], [54],

Options for the treatment of scabies and lice

Disease	A drug	Instructions	Comments
Scabies	Permethrin 5% (60 g), cream	Apply on the whole body, wash off after 8-14 hours	The drug of the 1st line, can cause a burning sensation and itching
	Lindane 1% (60 ml), lotion	It is applied to the entire body, the adults are washed off after 8-12 hours, the children after 6 hours	It is not prescribed for children under 2 years, pregnant women and women during lactation, with extensive dermatitis, with skin disorders due to possible neurotoxicity. Repeated application in a week
	Ivermectin	200 mg / kg orally, repeat after 7-10 days	Assigned as an additional remedy for permetrin. Used in epidemics. You should be careful when appointing elderly patients with liver, kidney and heart disease. Can cause tachycardia. It is not recommended to prescribe to women during pregnancy and lactation. The safety of use by children under 15 kg or under 5 years is not proven
	Crotamiton 10%, cream or lotion	Apply after bathing on the whole body, second time in 24 hours, rinse after 48 hours	Repeat in 7-10 days
	Sulfur Ointment 6%	It is applied to the whole body before going to bed for 3 days	Very effective and safe
Lice
Head lice	Malathion 5%	Apply to dry hair and scalp, wash off after 8-12 h	It is necessary to re-use when detecting live nits. Unpleasant odor
	Permethrin	Apply to washed damp hair behind the ears and in the neck area, rinse after 10 minutes	It is necessary to reapply after 7 days if live nits are detected
	Combing	Should be used for any treatment
	Lindane 1% shampoo or lotion	Rinse for 4-5 minutes, comb comb with frequent teeth or apply lotion and rinse after 12 hours	It is necessary to repeat in a week. Toxicity is usually not observed, but should not be used during pregnancy and lactation, children younger than 2 years. Do not use if you lose eyelashes
	Ivermectin	Dosage is the same as with scabies	Effective in steady flow
Baby lice		Local treatment is not used, since lice are found on clothing. Treatment is aimed at relieving the itching and eliminating a secondary infection
Pubic lice	Lindane 1% (60 ml), shampoo / lotion	Same as for the treatment of head lice
	Pyrethrin with piperonyl butoxide (60 ml), shampoo	Apply to dry hair and skin for 10 minutes, then wash off, repeat after 7-10 days	Do not apply more than 2 times within 24 hours
	Permethrin1% (60 ml), cream	Same as for the treatment of head lice	It is necessary to repeat in 10 days
Lesion of eyelashes	Ointment based on Vaseline Fluorescein droplets 10-20%	Apply 3-4 times a day for 8-10 days Apply to the eyelids	Provides immediate pediculicidal effect

Clinical examination

Do not spend the dispensary.

[55], [56], [57], [58]

Prevention

Prevention of scabies is based on the characteristics of the epidemiology of this disease and includes the following activities:

• compulsory inpatient or outpatient treatment of patients;
• establishment of the source of the disease;
• Examination of all persons with whom the patient had a household or sexual contact;
• the control of cure of scabies is carried out within 2 weeks: patients and contact persons are examined twice - at the initial treatment and in 2 weeks;
• conducting current and final disinfection of the focus of infection, clothing and bedding of the patient.

Decontamination of bedding, towels, underwear is made in 1-2% solution of soda or any detergent powder within 5-10 minutes from the moment of boiling. The outer clothing (dresses, suits, trousers, sweaters, sweaters) is ironed on both sides with a hot iron. Part of things (fur coats, coats, raincoats, things made of leather and suede) can be decontaminated by airing outdoors for 5 days. Clothing and bedding, which can not be washed at temperatures above 55 ° C, can be disinfected with an anti-scratch drug - Aerosol A-PAR. In the patient's room a wet cleaning of the room is carried out daily with 1-2% soap and soda solution, including washing the floor, wiping the furnishings. Mattresses and blankets are decontaminated in a dry oven at a temperature of + 100 ° C for 1 hour. In the winter season, at sub-zero temperatures, these things stand for 3-4 hours in the open air. The final disinfection is carried out by the employee of the SES dezootdeleniya after hospitalization of the patient, after the end of outpatient treatment, and in children's teams twice: after the patient is identified in the group and at the end of treatment in the prison.

Scabies is a common disease. Called very small, visible only through a magnifying glass mite, which parasitizes in the skin and causes unbearable itching. The tick can be transmitted by contact with the patient, during sexual intercourse, when using household items and clothing, when traveling in public transport, in crowded places (markets, entertainment events). When itchy skin, itchy rashes, it is necessary to consult an infectious disease doctor or dermatovenerologist who, in the presence of scabies, prescribes an effective treatment.

[59], [60], [61]