Scabies

Scabies is an infestation of the skin by the mite Sarcoptes scabiei. Scabies causes intense itching, erythematous papules, and subcutaneous tracts between the fingers, wrists, waist, and genitals. The diagnosis of scabies is made by examination and based on scrapings. Treatment involves topical medications or, rarely, oral ivermectin.

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Epidemiology

In the last two decades, there has been a significant increase in the incidence of scabies worldwide. According to statistics, scabies accounts for 3.6-12.3% of the overall incidence of scabies.

Scabies is transmitted from a sick person to a healthy person, and in 50% of cases - through sexual contact. It is also possible to transmit the scabies mite indirectly (using items of a sick person, sharing bedding, washcloths, children's toys, writing materials).

Indirect transmission of scabies mites is very rare due to the low viability of the mite in the environment. The lifespan of the scabies mite at a room temperature of 22°C and humidity of 35% is no more than 4 days. At a temperature of 60°C, the parasites die within 1 hour, and when boiling and at a temperature below 0°C, they die immediately. Favorable environments for the scabies mite to live outside the host are house dust, natural fabrics and wooden surfaces. The eggs of the parasites are more resistant to acaricides

Infection with scabies mites can occur in showers, saunas, baths, hotel rooms, train cars, if sanitary conditions are violated.

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Causes scabies

Scabies is caused by the itch mite Sarcoptes scabiei. The life cycle of the mite consists of two periods: reproductive and metamorphic. The reproductive cycle of the mite is as follows: the egg, which has an oval shape, is laid by the female in the scabies burrow, in which the larvae hatch after some time. The scabies burrow can remain for about 1.5 months and serve as a source of further infection. The metamorphic period begins with the appearance of the larva, penetrating the skin through the burrow and turning into a protonymph after molting, and then into a teleonymph, which turns into an adult. The scabies mite has a tortoise-shaped form measuring 0.35x0.25 mm.

The male scabies mite is much smaller in size than the female. The female moves along the skin with the help of two front legs, on which there are suckers. The mite penetrates the horny layer of the skin with the help of its massive jaws and the end spines of the front pairs of legs. The female feeds on the granular layer of the epidermis, but at the same time makes passages in the horny layer. Eggs are laid in the formed passages in a row.

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Pathogenesis

The excrements left by the parasite in the intradermal passages cause an allergic reaction. If the immune system is disrupted, the process becomes generalized with the development of Norwegian scabies.

Supporters of the immunological hypothesis associate long-term fluctuations in the incidence of scabies with immunobiological processes. During a scabies epidemic, the population becomes hypersensitized, which results in a certain degree of resistance to the pathogen, mainly in young people. There is an opinion about the influence of sexual promiscuity on the incidence of scabies, which arose on the basis of establishing a connection between the incidence of scabies and sexually transmitted diseases

Scabies has a distinct seasonal dynamics of morbidity. The largest number of patients is registered in autumn and winter, the smallest - in summer.

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

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Symptoms scabies

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

Forms

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Classic scabies

Initially, erythematous papules form in the interdigital folds, in the folds of the elbows and wrists, in the armpits, along the waistline or on the buttocks. It can spread to any part of the body, except for the face in adults. The disease is characterized by the presence of small, wavy passages, scaly lines from a few millimeters to 1 cm in length. A tiny, dark papule - a mite - can often be seen at one end.

The signs of classic scabies may be atypical. In black and dark-skinned people, scabies may present as granulomatous nodules. In infants, the palms, soles, face, and scalp, as well as the ears, may be affected. In patients with reduced immunity, peeling of the skin without accompanying itching is possible (especially on the palms and soles in adults and on the scalp in children).

The incubation period of scabies lasts from 8 to 12 days. The first and main symptom of scabies is itching of the skin, which intensifies at night. Paired, itchy papulovesicles are observed on the skin. The intensity of the itching of the skin increases with the duration of the disease, and depends on the number of mites and the individual characteristics of the body (the level of irritation of the nerve endings by the mite when it moves along the skin and sensitization to the parasite and its waste products (feces, secretion of the glands of the oviduct, secretion released when gnawing a passage)).

The distribution of scabies passages on the skin is determined by the rate of epidermis restoration, the structure and thermal conditions of the skin. The skin of the hands, wrists and feet has a lower temperature, the maximum thickness of the horny layer of the epidermis and minimal hair. The thick horny layer in these places allows the larvae of the scabies mite to hatch from eggs and not be rejected together with the horny scales of the skin. The height of the disease is characterized by polymorphism of rashes: from follicular rashes that occur at the site of parasite penetration to crusts and erosions.

Diagnostic criteria for scabies include the presence of scabies passages, papules and vesicles. Typical localization of scabies is the area of the hands and elbow joints, abdomen, buttocks, mammary glands, thighs. Often there are erased forms of scabies, which are often diagnosed as allergic dermatoses.

Other elements of the skin rash in scabies are also possible, such as erosions, hemorrhagic crusts, excoriations, erythematous-infiltrative spots. When a bacterial infection is added, pustules and purulent crusts appear. In 20% of cases, the Ardi-Gorchakov symptom is observed: punctate purulent crusts on the extensor surface of the elbow joints.

There are several distinct forms of scabies: nodular (post-scabies lymphoplasia of the skin), scabies in children, Norwegian scabies, pseudo-scabies.

The peculiarities of scabies in children in the first months of life are the extensiveness of the parasite's lesion: scratches and blisters covered with bloody crusts are located on the skin of the back, buttocks and face. It is often complicated by pyoderma and sepsis, even fatal cases. In schoolchildren, scabies is often disguised as symptoms of children's pruritus, eczema and pyoderma.

The diagnosis of scabies is made on the basis of typical symptoms, epidemiological data, and laboratory test results.

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Atypical clinical forms of scabies

Scabies without passages is an incipient form of the disease or occurs in people who observe the rules of personal hygiene. It is assumed that the absence of scabies passages is possible at an early stage of the disease in people who have been in contact with patients with scabies and is explained by infection with larvae. At the same time, 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, latent forms of scabies have become more frequent - the so-called scabies of "clean" people, in which isolated rashes in the form of papules and vesicles are observed on the trunk and flexor surfaces of the limbs, and there are no scabies passages.

Atypical forms also include Norwegian (custoid) scabies, first described 100 years ago by the Norwegian scientist Danielson, who observed it in patients with leprosy. It occurs with decreased reactivity of the body. It is characterized by minor infiltration of the skin with the layering of massive dirty-gray crusts up to 3 cm thick. In some cases, they take the form of a cutaneous horn. In some patients, crusty layers capture significant areas of the skin, resembling a solid horny shell.

Norwegian scabies is often accompanied by an increase in the patient's body temperature, which persists throughout the entire illness.

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Unrecognized scabies

Unrecognized scabies (incognito) develops against the background of local application of corticosteroids. Steroids reduce inflammation and suppress itching, creating favorable conditions for the reproduction of mites, resulting in the formation of a large number of passages and increasing the contagiousness of the disease. Scabies loses its specific symptoms, takes on a papulosquamous, papulovesicular, and sometimes even keratotic character and becomes resistant, paradoxically, to corticosteroids.

Nodular scabies

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

Clinically, the disease is expressed by the appearance of round, dense nodules up to the size of a bean, bluish-pink or brownish-red in color with a smooth surface. Localization of elements is predominantly on closed parts of the body. The course is benign, but long-term (from several months to several years). Spontaneous regression of nodular elements and their reappearance in the same places is possible.

Conventional local and anti-scabies therapy are ineffective. It is recommended to use antihistamines, presocil orally, and steroid ointments under an occlusive dressing externally. In case of long-term persistent nodules, liquid nitrogen, diathermocoagulation, laser therapy, and leeches are used.

Pseudo scabies

Pseudo-scabies is an itchy dermatosis that occurs when animals are infected with scabies mites. The most common source of infection for humans are scabies mites of dogs, less often - other animals: pigs, horses, rabbits, sheep, goats, foxes.

The incubation period of pseudo-scabies is very short and lasts for several hours. Patients are bothered by severe itching. The mites do not penetrate the epidermis and do not form passages. The rash is asymmetrical, localized in areas of contact with the sick animal. The rash is presented in the form of urticarial and pruritic papules, papulovesicles, blisters with a pronounced inflammatory component. The disease is not transmitted from person to person, so contact persons should not be treated. Laboratory diagnostics are difficult: only females are detected, and immature stages are absent.

Norwegian scabies

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

• rare registration of the disease;
• special contingent of patients: Down's syndrome, senile dementia, infantilism, asthenia, immunodeficiency states;
• difficulty in making a diagnosis: often several months and even years pass from the moment the lesions appear until the diagnosis is made; this is explained by the fact that itching is often absent during the course of the disease, and the lesions affect the face, scalp, nails in the form of crusts and hyperkeratosis, resembling other diseases - psoriasis, Darier's disease, pityriasis, histiocytosis;
• The pathogenesis is poorly understood; the main role is given to the immunodeficiency state; there is a hypothesis about the genetic predisposition of the body to the development of hyperkeratotic lesions due to a decrease in the consumption of vitamin A.

The main clinical symptoms of this form of scabies are: massive crusts, scabies passages, polymorphic rashes (papules, vesicles, pustules, scales, crusts) and erythroderma. The favorite localization of crusts is the upper and lower extremities (elbows, knees, palms, soles), buttocks, face, ears, and scalp. The surface of the crusts is rough, covered with cracks or warty growths that resemble rupees. The nails are gray-yellow with a bumpy surface, easily crumble, the edge is eaten away. Palmar-plantar hyperkeratosis is expressed. An increase in lymph nodes is noted. Sometimes Norwegian scabies is accompanied by an increase in body temperature, which lasts throughout the disease. The disease is characterized by high contagiousness due to the large number of ticks: up to 200 per 1 cm2 ^of the patient’s skin.

Complications and consequences

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

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Diagnostics scabies

Diagnosis is made by physical examination and confirmed by the presence of mites, eggs, or feces on microscopic examination. To obtain a scraping, glycerin or mineral oil is applied to the damaged skin (to prevent dispersion of mites and material), which is then scraped off with a scalpel. The material is placed on a glass slide and covered with a cover slip.

A method of specific laboratory diagnostics of scabies is a microscopic examination of a mite removed with a needle from the end of a scabies burrow. It is also possible to perform alkaline preparation: the skin is treated with a 10% alkali solution followed by examination of scrapings of the macerated epidermis.

Diagnosis of scabies includes examination of the material (from the blisters after scraping with a sharp spoon) for the presence of scabies mites. Microscopy reveals mites, their eggs and excrement. Only in 30% of cases is it possible to find a mite or eggs, so the diagnosis is often made based on the patient's complaints and the clinical picture.

Laboratory diagnostics of scabies

There are several methods of laboratory diagnostics of scabies. The oldest of them is the method of extracting the mite with a needle. However, now the method of scraping the papule or vesicle with a sharp spoon is more often used. In 1984-1985, a new method of express diagnostics of scabies was developed and introduced into practice using a 40% aqueous solution of lactic acid. The method is based on the ability of lactic acid to quickly clear the epidermis and mites 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 scattering of material during scraping and the development of pyogenic complications. A drop of 40% lactic acid is applied to the scabies element (burrow, papule, vesicle, lesion, etc.). After 5 minutes, the loosened epidermis is scraped off with a sharp eye spoon until capillary blood appears. The material is transferred to a glass slide in a drop of lactic acid, covered with a cover glass and examined under a microscope. 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 instead of a solution of 40% lactic acid, a mixture of equal volumes of 20% NaOH with glycerin is used.

Complications may mask the clinical manifestations of scabies, leading to diagnostic errors. Dermatitis (simple or allergic), pyoderma are more common, and microbial eczema and nodular lymphoplasia are less common.

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Diagnostic criteria for scabies

The diagnosis of scabies is established on the basis of:

• clinical data (evening-night itching, characteristic rashes in typical places);
• epidemiological information (examination of contact persons and detection of clinical signs of scabies in them, information about the patient’s stay in the epidemic focus, etc.);
• laboratory diagnostics (detection of the mite and its eggs in scrapings of rash elements).

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Differential diagnosis

Differential diagnosis must be made with diseases accompanied by itching - nodular prurigo, microbial eczema, in which itching bothers during the day, and not in the evening and at night, as with scabies.

Establishing the correct diagnosis is facilitated by identifying papulovesicles in the places of typical location of scabies passages, in which the causative agent of the disease - scabies mite - can be found.

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Treatment scabies

Patients are hospitalized according to epidemiological indications. No special regimen or diet is required.

Treatment of scabies involves the use of agents that have a detrimental effect on the scabies mites and their larvae parasitizing in the stratum corneum, without causing any undesirable effects (general toxicity, local skin irritation - simple or allergic).

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

• treat the entire skin (except the scalp) with an anti-scabies drug, not just the affected areas;
• carry out treatment in the evening, which is associated with the activity of the pathogen at night;
• strictly follow the treatment method recommended by your doctor;
• wash immediately before and after treatment;
• change underwear and bed linen before and after treatment.

In recent years, benzyl benzoate (benzyl ester of benzoic acid) has become widespread due to its high efficiency and low toxicity. This drug is produced in the form of an officinal emulsion ointment (20% ointment in a tube, 30 g), which is rubbed into the skin sequentially for 10 minutes with a 10-minute break. For children, a 10% ointment is used.

After each treatment, the patient changes underwear and bed linen; dirty linen is heat treated after washing. Rubbing is repeated on the 2nd day (or on the 4th day). This is justified by the fact that the larvae of the scabies mite hatched from the eggs within two days are more accessible to the effects of anti-scabies therapy. Three days after the end of treatment, the patient is recommended to wash and change linen again. It is necessary to disinfect outerwear and upholstery of upholstered furniture.

Of the preparations containing sulfur, the most commonly used are sulfur ointment (20%, 6-10% for children) and the M.P. Demyanovich method (includes sequential treatment of the entire skin with a 60% solution of sodium thiosulfate - 200 ml and a 6% solution of hydrochloric acid - 200 ml).

Modern scabies treatments such as Spregal (esdepalletrin aerosol combined with piperonyl butoxide in a canister; SCAT, France) and lindane are highly effective and safe. In the evening, without preliminary washing, the patient sprays the entire skin (except the head and face) with Spregal aerosol from a distance of 20-30 cm from the surface, leaving no area of the body untreated. After 12 hours, it is necessary to wash thoroughly with soap. Usually, a single application of the drug is sufficient. If the disease has been going on for a long time, the skin is treated twice (once a day). Undesirable effects (skin tingling and irritation of the larynx) are rare. One canister is enough to treat 2-3 patients. Spregal can be used to treat children.

Lindane is an organochlorine insecticide (gamma-hexachlorocyclohexane). It is highly effective, colorless and odorless. Rub 1% cream (emulsion) in the evening for three days in a row into the entire skin from the neck to the tips of the toes. Before treatment and daily 12-24 hours after treatment, take a warm shower or bath. Pregnant women and children are not recommended to use Lindane.

Treatment of scabies is aimed at destroying the pathogen using acaricidal drugs. The ideal anti-scabies agent should:

• have an equally effective effect on ticks and their larvae;
• have minimal sensitizing and irritating side effects even in case of regular use;
• quickly eliminated from the body if it penetrates through the skin, i.e. the overall toxicity of the anti-scabies agent should be negligible;
• be easy to use and the method of its use should be clearly indicated;
• be sufficiently pleasant from a cosmetic point of view: have no smell, do not stain clothes.

Various preparations have been proposed for the treatment of scabies: sulfur ointment, Wilkinson's ointment, Helmerich's ointment; Fleming's, Moore's, Ehlers's fluids; Milian's paste; creolin and lysol solutions; pure tar, ethylene glycol, benzoic ether, etc. Non-drug agents have also been used for a long time, such as kerosene, gasoline, fuel oil, autol, crude oil, and ash lye. Beginning in 1938, a new era in the treatment of scabies opened thanks to the successive discoveries of such preparations as benzyl benzoate (1936), DDT (1946), crotamiton (1949), lindane (1959), and spregal (1984). However, at present, no unified approach to therapeutic methods for the treatment of scabies has been developed. It should also be noted that in most drugs sold, the dosage of the drugs significantly exceeds the therapeutic needs. At the same time, it is necessary to follow some general rules when treating patients with scabies:

• the entire surface of the body should be treated, not just the affected areas; the preparation should be applied in a thin, uniform layer; special attention should be paid to the treatment of the hands, feet, interdigital spaces, armpits, scrotum and perineum;
• avoid contact of the drug with eyes and mucous membranes;
• the dosage should not be too high; other local remedies should not be used simultaneously with anti-scabies drugs;
• in case of advanced scabies with complications, the skin lesions should be treated first; antiseptics and general therapy methods are used to treat secondary infections, and local emollients are used to treat dermatitis and eczema;
• In case of Norwegian scabies, it is necessary to first clean the crusted skin areas with keratolytic agents and immediately isolate the patient. Preparations containing sulfur have been used for a long time to treat scabies (Helmerich ointment, Milian paste, sulfur ointment). Sulfur ointment is used most often (33% for adults and 10-15% for children). Before starting treatment, the patient washes with warm water and soap. The ointment is rubbed into the entire skin daily for 5-7 days. After 6-8 days, the patient washes with soap and changes underwear and bed linen. For children, it is recommended to use 15% sulfur ointment on the 1st and 4th day of the course of therapy. Disadvantages of using sulfur ointment: duration of treatment, unpleasant odor, frequent development of dermatitis, soiling of linen.

Demjanovich's method

The Dem'yanovich method is based on the acaricidal action of sulfur and sulfur dioxide, released during the interaction of sodium hyposulfite and hydrochloric acid. The treatment consists of successively rubbing a 60% solution of sodium hyposulfite (solution No. 1) and a 6% solution of hydrochloric acid (solution No. 2) into the skin. Lower concentrations are used for treating children - 40% and 4%, respectively. The hyposulfite solution is slightly warmed up before use and rubbed into the skin in a certain sequence: starting with the skin of both hands, then rubbed into the left and right upper limbs, then into the skin of the torso (chest, abdomen, back, gluteal region, genitals) and, finally, into the skin of the lower limbs to the toes and soles. Rubbing into each area lasts 2 minutes, the entire procedure should take at least 10 minutes. When drying for 10 minutes, a mass of hyposulfite crystals appears on the skin. After a 10-minute break, rub in 6% hydrochloric acid, which is done in the same order for one minute on each area 3 times with 5-minute breaks for drying. After rubbing in and the skin has dried, the patient puts on clean underwear and does not wash for 3 days, but the solutions are rubbed into the hands again after each wash. After 3 days, the patient washes with hot water and changes underwear again. Disadvantages of the method: labor-intensive, relapses are common, repeated treatment cycles are necessary.

Bogdanovich method

Bogdanovich's method is based on the use of polysulfide liniment (10% concentration for adults and 5% for children). The active ingredient of the liniment is sodium polysulfide, for the preparation of which take 600 ml of water, add 200 g of caustic soda (qualification "pure") 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 polysulfide in the solution is 27%. The polysulfide solution is suitable for use for up to 1 year when stored in a tightly sealed container. The basis of the liniment is soap gel, for the preparation of which take 50 g of crushed soap (preferably "Children's"), heat in 1 liter of water until completely dissolved, then cool in an open container at room temperature. Liniment of the required concentration is prepared as follows: 10 ml (for 10%) or 5 ml (for 5%) sodium polysulfide solution and 2 ml of sunflower oil are added to 100 ml of 5% soap gel. Treatment method: liniment is rubbed into the entire skin surface for 10-15 minutes. Repeated rubbing is carried out on the 2nd and 4th days. Hands are additionally treated after each hand wash. Bathing before the first and third rubbing (1st and 4th days) 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). For widespread and complicated forms of the disease, it is recommended to rub the preparation daily (once a day) for 4-5 days. Disadvantages of the method: unpleasant smell of hydrogen sulfide, sometimes dermatitis develops.

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Benzyl benzoate

Benzyl benzoate is used as a 20% water-soap suspension, for children under 3 years - 10% suspension. The suspension is applied to the entire skin (except the head), and for children under 3 years - also to the skin of the face. Rubbing should be done in a certain sequence: start with 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 treating patients with benzyl benzoate has been proposed: 20% water-soap emulsion is rubbed in once only on the 1st and 4th day of the treatment course. Underwear and bed linen are changed twice: after the first and second rubbing of the drug. The patient does not wash for the next 3 days, but the drug is rubbed into the hands again after each wash. After 3 days, the patient washes with hot water and changes the linen again. In infants, instead of rubbing, the skin surface is moistened with the indicated solutions, repeating the course of treatment after 3-4 days. Disadvantages of the drug: development of dermatitis, impact on the central nervous system, cases of acute intoxication have been noted.

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Lindane

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

Crotamiton

Crotamiton is a cream containing 10% 11-ethyl-0-crotonyltoludine, effective as an anti-scabies and antipruritic drug that does not cause side effects. 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 after 12 hours for 2 days.

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Thiabendazole

A thiabendazole-based preparation was initially used successfully orally at a dose of 25 mg/kg body weight per day for 10 days. However, due to adverse effects on the gastrointestinal tract, its use is currently limited. Subsequent studies involved topical application of thiabendazole as a 5% cream twice daily for 5 days and as a 10% suspension twice daily for 5 days. No adverse clinical or biological effects were noted.

Esdepalletrin

Esdepalletrin - this synthetic pyrethrin is used as the active ingredient of the aerosol product "Spregal". The preparation is applied to the entire skin, except for the face and scalp, spraying it from top to bottom along the body, then covering the arms and legs. After 12 hours, thorough washing with soap is recommended. Usually, one treatment cycle is enough. Itching and other symptoms may be observed for 7-8 days. If after this period the symptoms persist, repeat treatment is carried out.

"Spregal"

The aerosol agent "Spregal" can be used to treat scabies in pregnant and lactating women and newborns.

Permethrin

Permethrin is used as a 5% ointment (or cream). Treatment method: the ointment is thoroughly rubbed into the skin of the entire body from head to toe. After 8-14 hours, a shower is taken. As a rule, a single application of the drug is effective.

Ivermectin

Ivermectin is administered orally once at a dose of 20 mcg/kg of the patient's weight. Ivermectin is effective and safe. The drug is also applied topically once a day, but in 50% of cases, repeated treatment is required after 5 days.

Diethylcarbamazine

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

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Treatment options for scabies and lice

Disease	Preparation	Instructions	Comments
Scabies	Permethrin 5% (60 g), cream	Apply to the entire body, rinse off after 8-14 hours.	1st line drug, may cause burning and itching
	Lindane 1% (60 ml), lotion	Apply to the entire body, wash off after 8-12 hours for adults, after 6 hours for children	Not prescribed to children under 2 years of age, pregnant and lactating women, with extensive dermatitis, with skin damage due to possible neurotoxicity. Re-apply after a week
	Ivermectin	200 mg/kg orally, repeat after 7-10 days	Prescribed as an additional remedy to permethrin. Used during epidemics. Caution should be exercised when prescribing to elderly patients with liver, kidney and heart disease. May cause tachycardia. Not recommended for use by women during pregnancy and lactation. Safety of use in children under 15 kg or under 5 years of age has not been proven.
	Crotamiton 10%, cream or lotion	Apply after bathing to the entire body, a second time after 24 hours, wash off after 48 hours.	Repeat after 7-10 days
	Sulfur ointment 6%	Apply to the entire body before bed for 3 days.	Very effective and safe
Lice
Head lice	Malathion 5%	Apply to dry hair and scalp, rinse off after 8-12 hours.	Re-application is necessary if live nits are found. Unpleasant odor
	Permethrin	Apply to washed damp hair behind the ears and in the neck area, rinse after 10 minutes.	Re-application is required after 7 days if live nits are found.
	Combing	Should be used in any treatment
	Lindane 1% shampoo or lotion	Rinse for 4-5 minutes, comb with a fine-tooth comb or apply lotion and rinse after 12 hours.	It is necessary to repeat in a week. Toxicity is usually not observed, but it should not be used by pregnant and lactating women, children under 2 years old. Do not use if eyelashes are affected.
	Ivermectin	The dosage is the same as for scabies.	Effective in steady flow
Body lice		Local treatment is not used because lice are found on clothing. Treatment is aimed at relieving itching and eliminating secondary infection.
Pubic lice	Lindane 1% (60 ml), shampoo/lotion	The same as for treating head lice
	Pyrethrin with piperonyl butoxide (60 ml), shampoo	Apply to dry hair and skin for 10 minutes, then rinse, repeat after 7-10 days	Do not apply more than 2 times within 24 hours.
	Permethrin 1% (60 ml), cream	The same as for treating head lice	A repeat is required after 10 days.
Eyelash damage	Vaseline-based ointment Fluorescein drops 10-20%	Apply 3-4 times a day for 8-10 days. Apply to eyelids	Provides immediate pediculicidal effect

Clinical examination

No medical examinations are carried out.

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Prevention

Prevention of scabies is based on the epidemiological features of this disease and includes the following measures:

• compulsory inpatient or outpatient treatment of patients;
• establishing the source of the disease;
• examination of all persons with whom the patient had domestic or sexual contact;
• monitoring of scabies cure is carried out over a period of 2 weeks: patients and contacts are examined twice - at the initial visit and after 2 weeks;
• conducting current and final disinfection of the source of infection, clothing and bedding of the patient.

Disinfection of bedding, towels, and underwear is carried out in a 1-2% soda solution or any washing powder for 5-10 minutes from the moment of boiling. Outerwear (dresses, suits, trousers, jumpers, sweaters) is ironed on both sides with a hot iron. Some items (fur coats, overcoats, raincoats, leather and suede items) can be disinfected by airing in the open air for 5 days. Clothes and bedding that cannot be washed at a temperature above 55°C can be disinfected with an anti-scabies drug - A-PAR aerosol. In the patient's room, wet cleaning is carried out daily with a 1-2% soap and soda solution, including washing the floor, wiping down the furnishings. Mattresses and blankets are disinfected in a dry-heat chamber at a temperature of +100°C for 1 hour. In winter, at subzero temperatures, these items are kept outdoors for 3-4 hours. The final disinfection is carried out by an employee of the SES disinfection department after the patient is hospitalized, after the end of outpatient treatment, and in children's groups twice: after identifying a patient in a group and after the end of treatment in the isolation ward.

Scabies is a common disease. It is caused by a very small mite, visible only through a magnifying glass, which parasitizes the skin and causes unbearable itching. The mite can be transmitted through contact with a sick person, during sexual intercourse, when using household items and clothes of a sick person, when traveling on public transport, in crowded places (markets, entertainment events). If itchy skin or itchy rashes appear, you should consult an infectious disease specialist or dermatovenerologist, who will prescribe effective treatment if you have scabies.

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