Transcript Scabiesx

By
Dawn Landeck RN, BSN
NURS 870
 Scabies is a dermatological skin condition
caused by the Sarcoptes scabiei var hominisi
or a human skin mite
 Sarcoptes Scabiei are parasites that come
from the arachnid species that live off the
human body and feed off the epidermal
skin cells
The infestation by the scabies mite causes
intense pruritus and a red papular rash in
areas on the skin that are warm and dark
The mites, the saliva and feces of the mite
cause hypersensitive reaction in the patient
and causes an inflammatory response by
the body (Currie & McCarthy, 2010)
(Gunning, Pippitt, Kiraly, & Saylor, 2012)
 Infestation begins with the female scabies mite.
 This process starts when person has skin to skin contact with another infected
individual.
 In as little as 15 to 20 minutes a person can contract scabies from the other person.
 The female mite who measures approximately 0.4mm starts her mission of infestation
by first mating with the a slightly smaller male mite, after becoming fertilized her male
counterpart dies.
 The female mite then burrows herself into the epidermis where she can lay one to three
eggs per day for four to six weeks.
 She will maintain her fertility for the rest of her life span which is approximately the 4 to
6 weeks.
(Goldstein & Goldstein, 2016)
 During that time she continues to live in the burrow and feed of the host’s
epidermal skin cells.
 The life cycle of the eggs is about 3 to 4 days before the larvae hatch and the
immature mites burrow out the epidermis to the surface to continue maturing
 After approximately 14 days, the female mites that matured will mate with another
male mite.
 An individual can have as little as 10 mites on the body when they start
experiencing symptoms.
 The process continues over and over as the previously mentioned.
(Currie & McCarthy, 2010)
Presentation
 A patient complains of intense pruritus which is worse at night and a red, papular
rash on his/her body.
HPI
 Patients complain of intense itching that becomes worse at night.
 Patients also complain of rash that they have between the webbing of their fingers,
on the flexor surfaces of the wrists, axillae, buttocks, or groin area.
 They might admit that a family member or sexual partner is experiencing the same
intense itching.
 Ask about any recent virus or allergies to rule out a rash of viral etiology or rash
caused by allergens
 Inquire about any changes in medications to rule out this as cause
Gunning et al., 2012)
General:
• Patients with scabies will deny any fever or chills.
Skin:
• Will Admit to red, papular rash between the webbing of fingers, wrists, buttocks, or
groin area. deny any changes in hair or nails.
HEENT:
• The patient will deny any drainage from eyes or ears that could be infectious causes of the
rash. Denial of any nasal discharge or congestion. Denial any lesions in the mouth or throat.
Neck
• Denies any swollen glands
PMH – inquire about past scabies infestations, allergies, and current and
past medical problems
Social History – Partner with similar complaints of intense itching and
a rash that is similar in presentation
 Vital signs – no temperature
 Head to toe examination of skin
Rash that is red, papular usually with some areas of excoriation from scratching and
the classic finding of burrows in the common areas that scabies present such as the
webbing of fingers, flexor areas of the wrists, axillae, buttocks, or groin. Burrows can
appear as thin, greyish lines with dark spot at end of each line measuring
approximately 2 to 15 mm in length. Any areas of the body that have folds and are
warm, dark areas are a common area for scabies to be present.
(Goldstein & Goldstein, 2016)
 Presents in immunocompromised patients with HIV or AIDS, leprosy, or lymphoma
 Intense pruritus still most common complaint but a decreased response by their
immune system causes an increased number of mites on these individuals
anywhere from hundreds to thousands versus the less than hundred on healthy
individuals
 It commonly presents on the scalp, hands and feet
 Appearance is more of patchy red scales
 Large number of mites present in these areas and the crusting and scaling causes
fissures that can become secondarily infected with bacterial infections
 These individuals are infected in the same manner that common scabies
infestations occur but with increased numbers
(Currie & McCarthy, 2010)
 Diagnosing scabies is made through the detailed history of the rash including
characteristic intense pruritus, description of a rash in the normally occurring
places of scabies on the body, and physical examination of the unique presentation
of burrows on the skin that are commonly in the webbing of the fingers, wrists,
axillae, buttocks, or groin.
 A microscopic evaluation of mites, eggs or feces confirms the diagnosis of scabies
 This is done by lightly scraping the skin with a flat razor blade on the area where
burrows are present and examining the scraping for mites, eggs, or fecal material
under the microscope is highly sensitive and specific test for diagnosing scabies
 The slides need prepared with mineral oil and a cover slide to visualize the mites,
eggs or feces and using the lowest power on the microscope to view
 Dermoscopy can be used by a dermatologist to see mites or eggs in the epidermis
by the use of dermatoscope which shows the head of the mite as a dark, triangular
shape but this not very sensitive test in darker individuals
 Adhesive tape test consists of placing piece of tape with strong adhesive over the
burrow to pull a sample which is then applied to a glass slide and examined under
the microscope for mites, eggs, and feces
 Burrow ink test is done by placing blot of ink or washable felt-tipped pen over the
burrow, wiping the excess, and looking at the area with magnifying glass to verify
that it is a burrow on the skin but this is the least sensitive of the tests.
(Goldstein & Goldstein, 2016)
Popular Urticaria
 Red Flags
Atopic Dermatitis
 Systemic Lupus
Seborrheic Dermatitis
Contact Dermatitis
Insect Bites
Folliculitis
Lichen Planus
Dermatitis Herpetifromis
 Landgerhans Histiocytosis
 Bullous Pemiphigoid
 First line treatment for scabies is permethrin 5% cream
Permethrin is applied at bedtime, left on over night and washed off in the morning
This treatment is repeated in one week and all household members need treatment.
The cream works by altering the neurotransmitters in the nerve cells of the mite.
 Another part of treatment includes laundering bedding and clothes in
temperatures of least 140F because they can live up to 36 hours off the skin.
Anything that can not be laundered needs put in plastic bag for 72 hours due to life
cycle of the mite.
 Second line treatment for scabies is Ivermectin due to cost and availablility. This is
an oral medication that is dosed 200 mcg per kg and repeated in 14 days.
It is macrocyclic lactone antibiotic agent which works by disrupting the chloride ion
channels in scabes mite that causes paralysis and death of the mite
 Crusted scabies is treated with the oral ivermectin 200 mcg per kg on days 1,2, 8,
9, & 15 and applying permethrin 5% cream everyday for 7 days then twice weekly
 Treatment with permethrin cream is very effective and successful in ridding the
patient of scabies when patients are properly educated on the treatment and the
correct usage of the treatment. Patients need to be given clear written directions.
Another key part of treatment is explaining to patients that even when they follow the
directions as prescribed that they can continue to experience pruritus for two weeks
after treatment.
 Other treatment options have not been as effective as permethrin cream
 Lindane lotion used in the past was more neurotoxic and benzyl benzoate is no
longer available in the United States.
Centers for Disease Control and Prevention. (2010, November 2). Parasites – Scabies. Retrieved
March 18, 2016 from http://www.cdc.gov/parasites/scabies/
Currie, B. J., & McCarthy, J. S. (2010). Permethrin and ivermectin for scabies. The New England Journal of Medicine, 362 (2),
717-725. doi: 10.1056/NEJMct0910329
Ely, J. W., & Stone, M. S. (2010). The generalized rash: Part I. differential diagnosis. American
Family Physician, 81(6), 726-734. Retrieved from http://www.aafp.org/2010/0315/p726.html
Goldstein, B. G., & Goldstein, A. O. (2016). Scabies. Retrieved from March 18, 2016 from
http://www.uptodate.com/contents/scabies?source=search_result&search=scabies&selectedTitle=1%7E62
Gunning, K., Pippitt, K., Kiraly, B., & Saylor, M. (2012). Pediculosis and scabies: A treatment
update. American Family Physician, 86(6), 535-541. Retrieved from
http://www.aafp.org/afp/2012/0915/p535.html
Johnstone, P., & Strong, M. (2015). Clinical evidence handbook scabies. American Family
Physician, 92(10), 919-920. Retrieved from http://www.aafp.org/afp/bmj
Schalock, P. C., & Sober, A. J. (2014). Management of scabies and pediculosis. In A. H. Goroll
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Vernon, P., Brady, M. A., Starr, N. B., & Petersen-Smith, A. M. (2013). Dermatologic Disorders.
In C. E. Burns, A. M. Dunn, M. A. Brady, N. B. Starr, & C. G. Blosser (Eds.), Pediatric
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