Scabies (the itch, scabies, itchy Agogo) is a skin disease caused by infestation and sensitization to Sarcoptes scabiei var. hominis and its products.
Contributing factors of this disease include low socioeconomic, bad hygiene, frequently changing sexual partners, fault diagnosis, and demographic and ecologic development.
Modes of Transmission
• Direct contact (skin to skin), such as shaking hands, sleeping together, and sexual relations.
• Indirect contact (through body), such as clothing, towels, bed linen, pillows, etc..
Transmission is usually by Sarcoptes scabiei that have been fertilized females or larval form. Also known as Sarcoptes scabiei var. animalis that can sometimes infect humans, especially those with pets such as dogs.
Etiology
Sarcoptes scabiei var. hominis
Life Cycle of Sarcoptes scabiei
The entire life cycle from egg to adult form takes between 8-12 days. The males die after copulation, the females dig tunnels in the stratum corneum and lay eggs after 3-5 days hatch into larvae, and 2-3 days later into nymphs (males and females).
Pathogenesis
Skin disorders caused by scabies mites itching and scratching caused by sensitization to mite secretions approximately one month after infestation. At the time of skin disorders like dermatitis with the discovery of Paul, vesicles, Urticaria, etc.. By scratching may arise erosion, ekskoriasi, crusting, and secondary infections.
Clinical Symptoms
Diagnosis is made by finding two of the four cardinal signs of the following:
• Nokturna pruritus (itch at night) because the activity of mites was higher in more humid and hot temperatures.
• Commonly found in a group of humans, for example about the whole family.
• The existence of the tunnel (kunikulus) in predilection sites are white or grayish, forming straight or curved lines, the average length of 1 cm, at the end of the tunnel was found papules or vesicles.
If there is secondary infection of the skin rash becomes polimorfi (pustules, ekskoriasi, etc..). place of predilection is usually an area with a thin stratum corneum, ie the sidelines of the fingers, the volar wrist, elbow the outside, fold the front of the armpit, areola mammae and folding glutea, umbilicus, buttocks, external genital and lower abdomen. In infants can affect the palms and soles of the feet and even the entire surface of the skin. in adolescents and adults may occur on the scalp and face.
• Finding mites are the most diagnostic.
In patients who always maintain hygiene, lesions that arise usually slightly so that the diagnosis is sometimes difficult to enforce. If the illness lasts a long time, can arise likenifikasi, impetigo, and furunkulosis.
Examination Support
How to find mites:
• Take a little with a needle and put on a glass object, then cover with a cover glass and see the light microscope.
• By way of brushing with a brush and placed on a sheet of white paper and viewed with a magnifying glass.
• By making the incision biopsy. How: flops lesions with 2 fingers and then make thin slices with a knife and check with a light microscope.
• With eksisional biopsy and examined by HE staining.
Differential Diagnoses
Pityriasis rosea, tinea versicolor, pediculosis corporis, prurigo, dermatitis, lichen planus, and various other skin diseases with complaints of itching.
Therapy
Terms ideal drug is effective against all stages of mites, not to cause irritation and is not toxic, odorless or dirty, no damage or color of clothing, easily obtained, and it’s cheap.
Types of topical medications:
•Benzyl benzoate emulsion 20-25% effective against all stages, is given every night for 3 times. These drugs are difficult to obtain, often giving irritation, and sometimes more itchy after use.
• Krotamiton 10% in a cream or lotion has two effects as an anti-scabies and anti-itch. Should be kept away from eyes, mouth, and urethra. Cream (eurax) is only effective in 50-60% of patients. Used for 2 consecutive nights and washed off after 24 hours of last use.
• Creep Sulfur (sulfur presipitatum) 40-20% in the form of ointment or cream. In infants and adults presipitatum 5% sulfur in oil is very safe and effective. The drawback is the use must not be less than 3 days because it is not effective against the egg stage, smelly, dirty clothes, and can cause irritation.
• Gama benzene hexa chloride (gameksan) 1% in a cream or lotion, including the drug of choice because it is effective against all stages, easy to use, and rarely gives irritation. The drug is not recommended in children under 6 years and pregnant women because of toxic central nervous system. Gift just once for 8 hours. If there are symptoms, repeated a week later.
• Permethrin Cream 5% is the drug most effective and safe as it is very lethal to the parasite S. scabiei and has low toxicity in humans.
