SCABIES AND PEDICULOSIS

Dr. Akreti Sobti Dept of Dermatology, Venereology & Leprosy K. J. Somaiya Hospital

Scabies
Common ectoparasitic skin infection

Causative mite Sarcoptes scabiei

Characterized by itchy papular lesions and

burrows (tunnels housing mites) Primarily affects children and young adults Predisposing factors are poverty, overcrowding and poor hygiene.

Morphology of mite
Ovoid body dorsoventrally flattened

Female longer than male

Dorsal surface bristles and spines Four pairs of short legs, anterior two pairs have

small suckers. Larva has three pairs of legs.

Adult female mite

Biology of the mite

Ovigerous female

Larva
1st nymph Adult male 2nd nymph Moulting pocket

Clinical features
Nocturnal itching

Positive family history

Rash

burrows/tunnels Papules nodules excoriations

Sites of predilection
Finger web spaces Wrist Axillae Breast

Umbilicus
Genitals

Diagnosis
Demonstration of the mite under the microscope

Burrow ink test

Liquid tetracycline test

Complications: Secondary bacterial infection Eczematization

Clinical variants
Scabies in the clean

Crusted/Norwegian/hyperkeratotic scabies
Nodular scabies Infantile scabies Genital scabies Scabies incognito Ping pong scabies Animal scabies

Nodular scabies

Infantile scabies

Genital scabies

Ping pong scabies

Crusted/Norwegian scabies
The patient harbours millions of mites.

Host response to the mite is modified, allowing

them to multiply. Etiology: Reduced itch : Sensory neuropathy, spinal injury Reduced scratching : Immobility due to paralysis or arthropathy Altered immunity Mental retardation

Norwegian Scabies
Clinical features:

Large warty crusts on extensor surfaces. Diffuse erythema and scaling Generalised lymphadenopathy Nail involvement * Rx same as for classical scabies Keratolytics for crusts

Treatment
Topical agents:

Gammabenzene hexachloride 1% Benzyl benzoate 25% Permethrin 5% Sulphur-5% Crotamiton- 10% Oral : Ivermectin

Pediculosis
Ectoparasitic infestation caused by the lice:
Pediculus capitis Pediculosis capitis Pediculus corporis Pediculosis corporis Phthirus pubis Pediculosis pubis

Pediculosis capitis
Common in children & women

No correlation between the hair length & louse

infection rates Spread of lice is encouraged by poverty, poor hygiene & overcrowding Transmission by direct head to head contact

Clinical features
Scalp pruritus

Secondary bacterial infection:

Impetigo Matting of hair[plica polonica] Occipital lymphadenopathy Generalised rash Fever O/E : Adult lice and Nits in the scalp

Pediculosis corporis (Vagabonds disease)

Mostly seen in adult males

Poor hygiene, poverty and overcrowding

Infrequently washed clothes harbour body lice Lice rarely seen on body

Clinical features
Severe itching on trunk esp. back

Erythematous macules and papules

Excoriations Hyperpigmentation in chronic cases Examination of clothing seams reveals lice and

nits

Pediculosis pubis
Sexually transmitted condition
Affected young adults

nocturnal itching Sites : pubis, inner thighs, perineum O/E :

Lice and nits in the pubic hair Excoriations and bluish macules on

lower trunk

Complications
Secondary bacterial infection

Louse borne relapsing fever Body louse

Epidemic typhus Body louse Trench fever Body louse

Treatment
Type Capitis Main therapy Supportive therapy Antibacterials Antihistaminics Shampooing

GBH 1% Permethrin 2% Malathion 0.5% Corporis Wash clothes in boiling water Hot ironing

Good hygeine Antihistaminics