Not a feature of scabies –
Correct Answer: fever is a common finding
Description: Ans is 'd' i.e., Fever is a common findingScabieso Scabies in is caused by mites of the family Sarcoptidae, which includes Sarcoptes scabiei, the scabies mite. Usually affects children but can occur at any age. More common in low socioeconomic strata as overcrowding and poor hygiene facilitate the spread. The most imp mean of spread is direct contact with the infected individual. Scabies is water shed disease which occurs die to inadequate use of water and improper hygiene.Pathogenesiso After copulation male mite dies and female mite burrows down into superficial skin layer (s.corneum) at rate of 2mm/day. Female mite lays eggs which hatch into the larva, which moulds and mature into adult mites. The mites then burrow through stratum corneum. These burrows are visible clinically as irregular grey brown line. Burrow is pathognomic sign of scabies.o Incubation period is 4-6 weeks before itching starts. During this period there is no symptom because itching is due to hypersensitivity to some of the products (saliva scabin) of mites and it takes 4-6 weesk to hyprsensitivity to develop.Clinical featuresSevere itching is the most prominent clinical feature abd has following charactersticsWorse at nightGenerelisedAffecting severalfamily membersBody areas most commonly involved are web spaces of fingers, wrists, elbow, axilla and groin area, areas known as circle of Hebra.Burrow is serpentine (S. shaped), thread like grey brown line which represents the intraepidermal tunnel created by moving female mite in stratum corneum. Burrow is pathognomic sign of scabies. Burrows are very difficult to demonstrate in infants.Paules and papulovesicular eruptions due to hypersensitivity to mitePustules can occur due to seceondary infectionExcoriation and scratch marksHistory of involvement of family membersArea of predilection in scabieso Adultsi) Web of fingers, flexor surface of wrists, ulner border of forearm, anterior axillary foldii) Umbilical and periumblical region (anterior abdomen)iii) Genitals (scortum and penis in males, and nipple and areola in females)iv) Upper thigh and lower part of buttocksScalp, face, palms and soles are characteristically spared except in young children and infants.In whom these sites are typically involved.Atypical types of scabiesTypeFeatureo Infantile scabiesScalp, face, palms and soles are involvedo Norw egian scabiesCrusted hyperkeratotic lesions on face , palms, soles, nails. Itching is not prominent. Mites are found in thousand, most severe form of scabieso Crusted scabiesExtensive crustso Nodular scabiesItchy nodules over scortum and peniso Genital scabiesGenital affectedo Animal scabiesHistory of contact with cat or dog. Atypical presentationPrinciples of managemento After taking a proper bath, scabicides should be applied effectively to the whole body (below the jaw line) including genitals, soles and skin under the nails,o Reapply the scabicied after 7-10 days; to kill the larv a nymphso Itching will take 3-4 weeks to subside and does not need further treatment with scabicide. Symptomatic treatment with antihistaminic is adequate.o Treat all family members whether symptomatic or noto Ordinary laundering is adequate for linens. All clothing need not to be treated, because mites anyway die in unworn clothes in 7 days.TVeatmentScabtcide TopicalMethod of usePermethrin (5%) DOCSingle application of 12 hoursGamma benzene heachloride BHC 1%Single application of 1 hourBenzyl benzoate (25%)3 applications at 12 hourly intervalCrotamiton (10%)Twice daily for 14 daysMalathion (0.5%)left on the skin for 24 h. with a second application after an interval of a week.Oral IvermectinSingle dose 200microgm/kgbodyweight, repeat after 2 weeksNote :- BHC is not safe in pregnant female anf children (less then 2yrs) as it can cause neurotoxicity.o In secondary infections iv antibiotics can be given. Antihistaminics is given for itching.
Category:
Skin
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