SCABIES – SKIN INFESTATION – types, Pathophysiology, Clinical Manifestations, Diagnostic Evaluation and Management

Scabies is a condition of very itchy skin caused by tiny mites that burrow into skin. The itching is caused by an allergic reaction to the mites. Scabies is a contagious skin disease caused by the mite sarcoptes scabiei. The mite burrows under the skin.

It is so small it can hardly be seen with the naked eye.

Scabies is a parasitic infestation. It is results from intimate/prolonged skin contact or prolonged contact with infected clothing, bedding or animals. Scabies is found between the fingers, inner surfaces of the wrist and elbow, the axillae, the female nipple, the penis, the belt line and the gluteal crease. Sharing clothes and bedding transmit the infection.

TYPES OF SCABIES

There are two types of scabies.


  • Classical Scabies: This is the most common type of scabies, which comes up in a pimple-like, intensely itchy rash on your skin.
  • Crusted (Norwegian) Scabies: This is a rare type of scabies that usually only affects people who have a weakened immune system, such as those who have HIV/AIDS, or who are taking medicines that suppress their immune system.


 

PATHOPHYSIOLOGY


Pregnant female mite burrows into skin ---------- lay 2-3 eggs daily for about a month ---------- egg hatching occurs in 3-5 days and larvae came to the surface of skin but burrow into skin for food ------------- larvae develop and become adult mite in 10 days and cycle repeats

 

CLINICAL MANIFESTATIONS


  • Scabies spread by skin-to-skin contact with another person who has scabies
  • General signs and symptoms of scabies include: intensely itchy skin, with the itching being worse at night-time
  • A rash with tiny blisters or sores
  • Burrows, which are thin, grey, irregular tracks on the skin
  • Rash, appearing as small red blisters or bump
  • Lumps or nodules in the armpits and groin
  • Pruritis is common especially at night
  • Excoriation of skin present
  • Signs of secondary bacterial infection present like vesicles, papules, excoriations and crust.


 

DIAGNOSTIC EVALUATIONS


A diagnosis of scabies can be made by your doctor taking your medical history  and a physical examination. Laboratory tests are not usually necessary. A doctor who is experiencing in dealing with scabies will usually be able to recognize the typical inflamed burrows in the skin of the hands, wrists and elsewhere.

Sometimes a mite can be found, picked up on the tip of an needle, and examined under a microscope. Skin scrapings are examined under microscope for presence of mites or their feces.

 

TREATMENT


Scabies treatment involves the application of topical medications (creams and lotions) containing chemicals that kills the scabies mite and eggs. Scabicide lotion i.e. Lindane (Kwell) or crotamiton (eurax cream) or 5% permetrin applied to entire skin including skin folds except from face and scalp. Lotion is left on for 12-24 hours and after that patient has to take bath. This treatment is repeated in a week. Prior to application of scabicide lotion, patient has to take warm soapy bath and shower, then to dry thoroughly and allow to cool.

Itching may persist for some time after apply medication to kill the mites. These steps may help you find relief from itching:


  1. Cool and soak skin. Soaking in cool water or applying a cool, wet washcloth to irritated areas of your skin may minimize itching
  2. Apply soothing lotion. Calamine lotion, available without a prescription, can effectively relieve the pain and itching of minor skin irritations
  3. Take antihistamines. At doctor’s suggestion, may find that over-the-counter antihistamines relieve the allergic symptoms caused by scabies.


 

NURSING MANAGEMENT


  1. Impaired Skin Integrity may be related to presence of invasive parasite and development of pruritus, possibly evidenced by disruption of skin surface and inflammation
  2. Deficient Knowledge regarding communicable nature, possible complications, therapy, and self care needs may be related to lack of information/misinterpretations, possibly evidenced by questions and statements of concern about spread to others.


 

INTERVENTIONS


Nurse should educate the people to prevent, parasite infestations. Teach about following points:

For pediculosis


  • Wash clothing and linen with soap and hot water or dry cleaning of clothes has to be done
  • Ironing the clothes done as it kills lice eggs
  • Comb, hair brush may be boiled and cleaned
  • Do not share the hair brush, comb and clothes like towel, pillow cover and bed linen and hats


 

For Scabies


  • Patient should wear clean clothes and use clean bedding
  • All bedding and clothes should be washed in hot water and it should be dried in sun because mite survives up to 36 hours in linen.
  • All family members should apply scabicide lotion at a same time and same day and next morning bedding, clothes of all members should be washed in hot water and it should be dried in sun.
  • Not to apply more scabicide lotion as it causes irritation and itching and frequent hot shower also causes itching. Itching does not mean that treatment is failed
  • If it is sexually transmitted, patient may require treatment for co-existing sexually transmitted disease


 

SCABIES – SKIN INFESTATION – types, Pathophysiology, Clinical Manifestations, Diagnostic Evaluation and Management 

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