The prevalence of scabies
Scabies has been known since ancient times. In the Middle Ages, scabies patients were isolated outside the city. Scabies was considered as contagious as head lice. In the 19th century, there were already mentions of the pathogen.
Scabies fully reflects the cultural, social, economic, sanitary situation in a particular area. The disease is common throughout the world. And accordingly, it has a higher percentage of infected in countries with a low standard of living.
The reality is this: any person, regardless of material wealth, is susceptible to infection with scabies.
In Russia, at the beginning of 1900, a universal infection with the disease was recorded in some cities and villages. Over the years, the number of people suffering from scabies has declined. But during the years of the Patriotic War, hundreds of thousands of infected people increased. In the postwar period in the USSR and foreign countries, the situation improved, but from time to time outbreaks of morbidity were recorded.
Features of the prevalence statistics among the child population
Scabies among the child population has its own characteristics. Young children tend to become infected within the family. But this rarely happens. Children in closed children's groups (preschool institutions, orphanages, camps, schools) are more often infected.
Also, children with long-term scabies are often identified and treated for allergies. Such patients are of particular danger to those around them. About 80% of all scabies are young people under 30 years of age. Moreover, every 5 patient is a child.
In the fall, there is a higher detection rate of the infected.
Features of the manifestation of scabies in the modern world
In the modern world, the prevalence of the disease is falling, but there are always outbreaks in a particular territory. Thanks to this, scabies does not lose its relevance today.
Scabies affects approximately 18 people per 100,000 of the population.
Scabies mite - getting to know the culprit
In order to fully understand the mechanism of infection and clinical manifestations of the disease, it is necessary to know about the structure and capabilities of the pathogen. In nature, there are a large number, namely more than 20 types of scabies mites. They can parasitize both humans and animals.
But Sarcoptes scabie requires a more thorough study, since only this species parasitizes on humans. For animals, this pathogen is not relevant. The scabies mite in the environment dies after 2 days, it parasitizes in the stratum corneum of the skin.
Tick structure
Like most pathogens, the female tick is large compared to the males. The latter (males) do not have a parasitic effect on humans, they have only one function - fertilization.
The male implements it on the surface of the skin, then dies after 2 days. To implement fertilization, males have suckers in their structure, with which they can move along the skin to achieve their goal. The movement speed reaches 3 cm per minute.
Females move inside the skin, making itch passages behind them, which are visible with the naked eye on the host's skin. Such passages are needed for tick breathing. And to produce them, the pathogen has special devices: multiple bristles and outgrowths all over the body, thorns and suckers for movement and fixation in the thickness of the skin, and most importantly, the mites have a gnawing apparatus to make these very moves.
The female, as she moves into the depths of the skin, lays 50 eggs, which after 3 weeks turn into sexually mature individuals.
Scabies mite life cycle
The life cycle of an itch mite can be divided into 2 stages: cutaneous, which has a very short interval, which is necessary only for fertilization, and intradermal, which is long. The last stage is also divided into 2 parts: reproductive and metamorphic.
The reproductive component consists in gnawing through scabies and laying eggs. The female can lay up to 2 eggs per day. In the place of localization of the latter, the mite makes a path to the surface of the skin. After a while, larvae emerge from the eggs, which immediately settle on the skin, at the base of the hair. It is in this place that metamorphosis (molting) occurs. The larvae turn into adults, and the process starts over.
In the life cycle of the pathogen, the temperature and humidity of the environment play an important role. Under favorable conditions (high humidity and low temperature), females retain their mobility for a long time. At high temperatures, the mite dies.
Quite interesting is the fact that the pathogen is characterized by a certain daily rhythm of activity, which is important for a specialist during diagnosis. At night, the pathogen is engaged in reproducing its own kind, and also gnaws through the itch passages, thereby feeding. In the daytime, the female rests.
This circadian rhythm explains the clinical symptoms: excruciating itching appears in the evening and at night, and this fact also leads to a higher degree of infection at night. A specialist can track the female's night work along the length of the itch passages.
During the period of existence, the female is able to pave a path up to 6 cm long.
The favorite localization of the pathogen is the skin of the hands, feet, wrists. In such places, there is a large thickness of the stratum corneum of the epidermis. Also, mites prefer skin with a lower temperature and no hair follicles.
How is scabies mite transmitted
It is important for everyone, without exception, to know how the scabies mite is transmitted in order to prevent infection. The source of the disease is only a sick person. Animals can be the cause of the disease, but it bears a different name - pseudosarcoptic mange, and in this case, the clinical picture and the corresponding therapeutic measures will be different.
There is usually no incubation period. If an infection with larvae has occurred, then clinical symptoms appear as the pathogen turns into sexually mature individuals (after about 2 weeks). Infection occurs through close contact, common household items. This is observed more often in public places, as well as in the family.
Sexual contact plays a significant role in scabies infection. Studies have shown that the disease is more common in individuals who have frequent promiscuous sex. Interestingly, scabies, along with sexually transmitted infections, has the same morbidity dynamics.
Manifestation of scabies in children
Scabies in children has a typical and atypical form of manifestation.
Typical form
The typical uncomplicated form is most often recorded among patients with scabies. The clinical signs of scabies in children are easy to identify. The leading manifestation of the disease is itching. As mentioned earlier, it manifests itself to a greater extent at night, since the pathogen begins its activity at this time.
Symptoms of the disease depend on the body's response to the infectious process. On the skin, you can see papules, nodules, scabies, combs, purulent elements, crusts.
The fact of the simultaneous appearance of clinical manifestations in contact persons greatly facilitates the diagnostic search for a doctor.
A specialist can observe various rashes on the skin of the fingers (more precisely, between them), feet, buttocks, anterior abdominal wall, mammary glands, genitals. However, scabies in the area of the interdigital spaces of the hands are more common.
Such elements look like white-gray stripes with a total length of 4 - 7 mm, and the size increases every day. At the end of the turn, the papulo-vesucule can be visualized. Often, through the stratum corneum of the skin, it is possible to see a tick, such a symptom is called "Itch eminence of Bazin"... Bloody crusts are observed between the fingers.
Typical symptoms for scabies are: Ardi, Gorchakova, Cesar, "triangle"... About each in order. Ardi's symptom is the appearance of hemorrhagic or purulent (when secondary microflora is attached) crusts on the extensor surface of the elbow joint. Gorchakov's symptom is small bloody crusts on the elbow joint itself.
All scabby passages on palpation have a slight elevation, as evidenced by a positive Cesari symptom. The symptom of the "triangle" is to observe the transition of hemorrhagic crusts from the intergluteal fold to the sacrum (Michaelis rhombus).
On the feet, the identification of typical elements is possible with their initial infection (in a bath, sauna, pool) or with a prolonged illness.
In older children, adolescents, scabies on the face, palms, head practically does not occur.
However, in infants, such localization is not uncommon. When a child is infected from a mother suffering from scabies of the mammary glands, elements of the disease will be observed in the face, namely, the cheeks, nasolabial triangle. Infants may also have scabies in the back of the head on the scalp.
A feature of the course of the disease in infants is that the elements are more often infected, thereby proceeding more severely, and scabies is often complicated by allergic dermatitis.
Atypical forms
The following forms, which will be proposed for study, are atypical.
"Scabies without moves"
A form of the disease that is much less common. This atypical form is observed in contact persons in the outbreak. With this type of disease, itch passages are not detected, because the process is triggered by the larvae, which are not able to produce what a mature individual can do.
Scabies "neat" or "incognito"
Also, the phenomenon is more rare than the typical form of the disease. This form does not differ in etiology and pathogenesis. It occurs in people who often take water procedures and change clothes in a timely manner.
Under such conditions, the parasite is mechanically removed from the host's skin, so clinical manifestations are minimal and may not bother a person. However, without treatment, it will not be possible to get rid of the disease. The positive aspects include the fact that this form is complicated extremely rarely.
Nodular form of scabies
It differs in the preserved elements after treatment at the site of the former rashes. Clinical symptoms persist and can cause significant discomfort to the patient for up to 6 months after recovery.
Norwegian uniform
Particular attention should be paid to the Norwegian (crustal) form of scabies. This type of disease occurs in individuals with an immunosuppressive state, Down's syndrome, and patients who have been using glucocorticosteroid drugs for a long time can also be classified here.
The Norwegian form of scabies is highly contagious!
Such scabies is characterized by the absence of itching, the presence of a large number of crusts, under which there is a huge number of itch mites, which can be localized in any part of the body. Such patients give off an unpleasant odor.
Scabies in this form can affect hair and nails. The disease is difficult, often there is an increase in temperature. The Norwegian form is so contagious that outbreaks of the disease are possible in certain circles of the patient.
All forms of scabies are at risk of secondary infection. When combing, the patient creates an entrance gate for the attachment of microbial flora. More often, scabies is complicated by staphyloderma.
Despite the fact that all atypical and typical forms are caused by Sarcoptes scabie, it is necessary to remember and differentiate the disease from pseudo scabies (pseudosarcoptic mange). This disease is caused by ticks that parasitize animals. The pathogen does not produce scabies, since it does not multiply in the thickness of the human skin. The mite can only invade the epidermis, causing severe itching. The disease cannot be transmitted to another person.
What is the essence of diagnosing scabies in children
Parents who notice unusual elements on the child's skin, as well as if there is itching, should immediately contact the pediatrician. The latter, after examination, will refer you to a dermatologist for consultation. He, in turn, must carefully collect anamnesis, complaints. Information about contact with patients is important, and it is also necessary to find out the situation in the family and in the institution that the child visits.
Initially, the doctor should pay attention to the external manifestations of the disease. The elements will be clinically suspicious: scabies, rashes, and scratching. Favorite localization will also suggest the disease: interdigital spaces, hands, wrists, lower abdomen, flexion of the elbow joint.
Additional research methods do not always give an accurate answer. Therefore, the diagnosis can be made without laboratory diagnosis. But you shouldn't neglect it. Scabies stains for better visualization iodine solution or brilliant green... After the dye is absorbed, clear, painted, sinuous lines remain on the skin.
The mechanical method of removing the tick is that the doctor inserts a sterile needle into the itch. In the same place, the tick is attached to the needle and it is removed from the affected area of the skin. The resulting pathogen is placed on a glass slide and examined under a microscope.
Also for microscopic examination use the scraping method. A special solution is dripped onto the suspicious skin area. After a few minutes, scraping is performed with a scalpel. The contents are placed on a glass slide and microscoped.
Through a microscope, you can see the female tick, eggs, larvae. If only waste products are found, then scraping must be carried out on other areas of the skin.
Differential diagnosis
Scabies is differentiated from insect bites, allergic reactions, dermatological diseases (psoriasis). Allergic diseases are of great difficulty, since a similar reaction is observed with scabies.
When a patient with scabies is found, it is important to pay attention to the favorite localization of the scabies mite (hands, wrists, the area near the navel, intergluteal fold).
Allergic reactions are rarely observed in the interdigital spaces. With an allergy, scabies cannot be detected. Also, allergic conditions do not have a daily rhythm of the onset of clinical manifestations. Itching is troubling during the day and with low intensity.
Anamnesis also helps to establish the correct diagnosis and prescribe appropriate treatment.
Scabies treatment: types and principles
Scabies therapy should be carried out strictly according to certain rules. The goal of treatment should be aimed at the complete destruction of the parasite, as well as its waste products and inactive forms. It is also important to prevent the development of complications and infection of healthy individuals.
Therapies
It is customary to distinguish several types of therapy:
- specific;
- trial;
- prophylactic treatment.
The nature of the treatment is determined by the doctor at the appointment, based on the situation. A specific type of therapy is prescribed for patients with scabies, whose diagnosis is beyond doubt.Preventive treatment is aimed at contact persons who are in the outbreak.
As a rule, these are people who have arrived for a long time in close contact with the sick person (family members, collective in the kindergarten group, in the school class). It is also necessary to pay attention to the presence of sexual intercourse during illness and prescribe preventive treatment for the partner.
There are cases when clinical symptoms of scabies are present and at the same time laboratory identification of the pathogen is not possible. Then the doctor prescribes a trial treatment. This type of therapy takes place under the close supervision of a specialist, if there is a positive effect, the diagnosis is confirmed.
Treatment principles
The principles of treating scabies must be strict and must be followed regardless of the type of therapy:
- treatment must begin at the same time, both for patients and for contact;
- due to the fact that the maximum activity of the pathogen is recorded at night, therefore treatment starts after 7 pm;
- before starting treatment it is necessary take a shower with a hard washcloth, for more effective action of drugs;
- for infants and children under 3 years of age, the preparations are applied to the entire skin, while at an older age, avoid applying to the face and scalp;
- apply drugs with bare hands and rub especially carefully in the area of the hands and palms. If the child is not able to perform this procedure, due to his age, then parents are given recommendations based on their infection;
- hands should not be washed after processing the skin;
- bed and underwear are changed on the first day initiation of therapy and after the end of the course of treatment;
- medicinal product evenly applied to the skin, the entire night period must be on the body;
- treatment of complications of scabies is carried out simultaneously with therapy of the underlying disease;
- when registering a disease in pregnant women, it is necessary assess the risks and benefits to the fetus and mother... In case of infection of a nursing woman, it is recommended to stop lactation for the period of treatment;
- after undergoing treatment bed linen, underwear, clothes must be boiled, process shoes, carry out wet cleaning in the room. It is recommended to iron the patient's clothes and linen on both sides. It is important not to forget about toys. If things cannot be boiled, then they must be isolated from processed clean things for more than 3 days, during this period of time the parasite will die;
- in the presence of itching after a full course of therapy, prescribe antihistamines, since this clinical symptom is allergic in nature and does not require the continuation of specific treatment;
- control of the treatment is assessed no earlier than In 2 weeks;
- treatment in most cases is carried out in outpatient.
Indications for hospitalization
These include the following indications:
- in the absence of an individual providing direct care to the patient during the illness;
- children living in orphanages, boarding schools. In short, in places where isolation of the patient is impossible. In such cases, the child is hospitalized in order to prevent further spread of the disease;
- severe course of the disease with complications;
- children who have the disease with high fever, swollen lymph nodes.
Characteristics of the main drugs
In modern medicine, there are several schemes and drugs for the treatment of the disease.
Sulfur preparations
Sulfur-containing preparations: sulfuric ointment, sulfuric petrolatum, Sulfodecortem, Miliana paste and others. This range of drugs has more historical significance.
Sulfur-containing preparations have side effects, have an unpleasant odor, and spoil the linen that comes into contact with the body when medications are applied. Drugs are rarely used, in special cases.
Benzyl benzoate preparations
Benzyl benzoate preparations (Askabiol, Benzoseptol, Novoskabiol). An aqueous solution of benzyl benzoate is quite effective when freshly prepared. If the solution has been stored for some time, then its effectiveness drops sharply.
Rub the prepared solution in a certain sequence. First, the hands and palms are carefully treated, then the upper limbs, then the stomach, chest, back, face and scalp (children under 3 years old), genitals, buttocks, lower limbs, feet. 2 treatments are usually enough for a course.
Crotamiton (Juraks)
Has the form of ointment, cream, lotion. This medication can be used for babies, pregnant women and lactating women. But at the same time, Crotamiton does not have absolute effectiveness.
Permethrin preparations
Permethrin preparations - Medifox, Nittifor. The preparations are rubbed into the skin overnight for 3 days. These drugs are capable of "killing" adult sexually mature individuals, as well as eggs.
Pyrethrin preparations
Pyrethrin preparations - Spregal. A convenient form of aerosol allows you to quickly and evenly apply the drug to the entire skin. Children need to cover their mouth, nose and eyes with a tissue when processing.
A single use of the drug can be quite effective. But clinical symptoms can persist for up to 2 weeks. In such cases, re-treatment of the patient's skin is possible.
The drug is widely used in both children and adults. However, it has contraindications. Since the drug has an aerosol form, it is impossible to use it in children with bronchial asthma, obstructive bronchitis, due to the risk of developing bronchospasm.
Traditional methods of treating scabies
Folk remedies include Peruvian balsam (based on an extract of plants of the legume family). Such drugs have no evidence base and their effectiveness has not been studied. Therefore, traditional methods are not recommended for use.
Consultation of a specialist in case of a disease is extremely necessary for the individual selection of medicines. Also, folk remedies have a number of side effects (allergic reactions, eczema).
Forecast and prevention
The prognosis in most cases is favorable. The Norwegian form is characterized by a more serious prognosis. And also the presence of complications worsens the course of the disease.
Preventive measures are primarily aimed at early detection of patients with scabies. Timely identification and isolation of patients is the main principle of disease prevention.
Health care workers must undergo regular medical examinations, which can also be sources of infection. Parents need to take responsibility for learning personal hygiene for their children.
Conclusion
Scabies is a widespread disease. This disease has a fairly favorable prognosis, and the treatment is highly effective. But despite this, the situation around the disease is serious, because scabies is an extremely contagious disease.
Persons with rashes and itching should seek prompt medical attention. Since early detection and isolation of patients is the main preventive measure. And also half of the success of treatment depends on the timely diagnosis.
There are a large number of modern, safe and effective drugs in the world, so you should not get carried away with folk remedies.
