Modern approaches to the diagnosis and treatment of scabies

Modern approaches to the diagnosis and treatment of scabies

Scabies is a contagious parasitic skin disease caused by the scabies mite Sarcoptes scabiei, accompanied by itching, worse in the evening and at night, and papular-vesicular rashes.

Currently, scabies remains one of the most common parasitic dermatoses in our country.

An increase in the number of patients with scabies usually accompanies wars, natural disasters, and social upheavals, which is caused by population migration, economic recession, and deterioration of social and living conditions.

As mentioned above, the causative agent of scabies is the scabies mite - Sarcoptes scabiei. This species belongs to the family Sarcoptidae, group Acaridiae, suborder Sarcoptiphormes, order Acariphormes. Members of the genus Sarcoptes are currently known as parasites of more than 40 species of animal hosts belonging to 17 families of 7 orders of mammals.

The morphological appearance of scabies mites of the Sarcoptidae family is extremely unique and is due to profound adaptations to intradermal parasitism. The structure of scabies, like most mites, is characterized by strict constancy of the microstructures of the exoskeleton, which is associated with their microscopic size.

The female scabies mite resembles a turtle in appearance. Its size is 0.25–0.35 mm. Adaptations for intradermal parasitism are represented by multiple setae, triangular outgrowths of the cuticle on the dorsal surface, spines on all tarsi that serve as stops when gnawing, gnawing-type chelicerae, long elastic bristles on the tarsi of the hind pairs of legs to maintain the direction of the gait only forward. Adaptations for ectoparasitism are sticky pneumatic suckers on the front legs, waxy bristles on the body and limbs, which create an extensive mechanoreceptive sphere around the tick and allow it to navigate by touch without eyes. The speed of movement of the female during the course is 0.5–2.5 mm/day, and on the surface of the skin 2–3 cm/min. Scabies mites are characterized by sexual dimorphism. The main function of males is fertilization. They are much smaller in size - 0.15–0.2 mm, have dense bristles on the body for protection from mechanical stress and suckers also on the fourth pair of legs for attachment to the female during mating. The ratio of females to males in scabies mites is 2:1.

The life cycle of the scabies mite is clearly divided into two parts: short-term cutaneous and long-term intradermal. Intradermal is represented by two topically separated periods: reproductive and metamorphic. Reproduction is carried out by the female in the itch she gnaws, where she lays eggs. The hatching larvae emerge from the passages onto the surface of the skin through holes made by the female above the site of each clutch, settle on it and penetrate into the hair follicles and under the scales of the epidermis. Here their metamorphosis (molting) occurs: through the proto- and teleonymph stage, new individuals (females and males) are formed. Females and males of the new generation come to the surface of the skin, where they mate. Daughter females migrate to the hands, wrists, feet, penetrate the skin and immediately begin to make passages and lay eggs. In rare cases, the introduction of females is possible in other areas of the skin (buttocks, axillary areas, abdomen, etc.) due to mechanical pressure. Clinically, this corresponds to scabious lymphoplasia of the skin. Only females and larvae are infective stages and participate in infection. At room temperature and relative humidity, at least 60% of females retain mobility for 1–6 days. Even at 100% humidity, females survive on average up to 3 days, larvae - up to 2 days.

Scabies mites are characterized by a strict daily rhythm of activity. During the day, the female is at rest. In the evening and in the first half of the night, she gnaws one or two egg knees at an angle to the main direction of the stroke, in each of which she lays an egg. Before laying eggs, she deepens the bottom of the passage, and makes an exit hole in the roof for the larvae. During the second half of the night, the female gnaws the passage in a straight line, feeding intensively; during the day, she stops and freezes. The daily program is carried out by all females synchronously. As a result, the itch on the patient's skin has a convoluted shape and consists of segments of the course, called the daily element of the course. The posterior part of the tract gradually peels off, and during a clinical examination of the patient, it simultaneously consists of 4–7 daily elements and has a constant length of 5–7 mm. During her life, the female travels 3–6 cm in the epidermis; the revealed daily rhythm of activity is of great practical importance. It explains the intensification of itching in the evening, the predominance of the direct route of infection through contact in bed in the evening and at night, and the effectiveness of prescribing anti-scabies at night.

Clinical picture

The clinical picture of scabies is determined by the characteristics of the pathogen and the reaction of the host body to its introduction.

The incubation period for scabies varies in length and depends on whether the skin is an adult female or a larva. In the first case it is extremely short, and in the second it is 2 weeks. Itching, as the main symptom of scabies, appears in a period that ranges from 14 days to 6 weeks during primary infection and can be extremely short, limited to a few days during reinfection. It has also been shown that reinfection, however, may be more difficult in already sensitized individuals, and the number of detectable scabies mites in such patients is often minimal [7, 9].

The typical form of scabies is characterized by the presence of itchy skin, which is most pronounced in the evening and during sleep. However, the itching can also be constant. It can be localized to individual areas of the skin or spread throughout the body, with the exception of the facial skin and scalp. An extremely important sign is the presence of itching among family or team members.

During the examination, specific rashes are revealed. The main clinical symptoms of scabies are scabies, polymorphic rashes outside the tracts, characteristic sites of rashes, as well as symptoms named after the authors Ardi (presence of pustules and purulent crusts on the elbows and in their circumference), Gorchakov (presence of bloody crusts there), Michaelis (presence of bloody crusts and impetiginous rashes in the intergluteal fold with transition to the sacrum), Sezari (detection of scabies in the form of a slight elevation on palpation).

Typical localization sites for rashes are predominantly the flexor surface of the joints (wrist and elbow), as well as the anterolateral surface of the abdomen, lower back, buttocks, and genital area, while they are absent on the upper half of the back. Scabies and rashes are well expressed in the interdigital and axillary folds, on the areola of the breast of women, in the navel area. The rashes are represented by paired papules and vesicles, scabies, eczematous pseudovesicles (pearly vesicles) on the skin of the lateral surfaces of the fingers and palms; scabious ulcers, with crusts on the surface; as well as scabious nodules.

It seems to us advisable to classify and present atypical forms of scabies

• scabies without skin lesions;
• urticarial scabies;
• scabies during corticosteroid therapy;
• nodular (with postscabiosis nodules) scabies;
• eczematized scabies;
• scabies complicated by pyoderma;
• Norwegian scabies;
• infant and childhood scabies.

The first two forms are caused primarily by allergic reactions.

Scabies without skin lesions can represent the beginning forms of the disease in people who observe standards of body hygiene, but more often it manifests itself as an allergic reaction to mite antigens during the period of the disease or after its treatment. This form of the disease is more often detected during an active examination of persons who have been in contact with a patient with scabies.

Urticarial scabies is represented by small blisters caused by sensitization to both mites and their metabolic products. They occur more often on the front of the torso, thighs, buttocks and forearms.

Scabies with local corticosteroid therapy, also called latent scabies, as a result of suppression of the immune reactions of the skin, leads to the loss of specific symptoms of scabies. The disease acquires papulosquamous, papulovesicular, and sometimes even hyperkeratotic rashes.

Nodular scabies (scabious lymphoplasia) is characterized by the appearance of itchy nodules that are red, pink or brown. Scabies can be found on the surface of new nodules. Typical localization: penis, scrotum, axillary and intergluteal folds, areola. The nodules are usually few in number. Sometimes they are the only diagnostic sign of scabies [2, 4].

Eczematized scabies usually occurs in people with an allergic predisposition. Foci of lichenification may appear at the sites of scratching. However, eczematous lesions usually come to the fore and the diagnosis of scabies may not always be suspected. Rashes appear on the hands, armpits, legs, and hands. In advanced cases, the rash can become disseminated, leading to the development of erythroderma.

In persons with reduced body resistance, eczematized lesions at the sites of scratching may be accompanied by a secondary bacterial infection in the form of impetigo or ecthyma; staphylococcal folliculitis, boils and abscesses may occur.

Norwegian scabies (crustic, crusted) in the initial stages is presented as ordinary scabies or disguised as atopic dermatitis, psoriasis, seborrheic dermatitis. Characterized by keratinization, the formation of scales or thick crusts. In case of severe immunodeficiency, the process can be generalized; in case of neurological diseases, it can manifest itself in a limited area of ​​sensory impairment.

Infant and childhood scabies are characterized by rashes resembling urticaria or infant pruritus in the form of a large number of scratched and crusty blisters with a predominant localization in the perineum on the scrotum, in the axillary folds. Characteristic scabies can be found on the soles.

Diagnostics

Diagnosis of scabies, in addition to clinical data, is based on microscopic confirmation of the diagnosis. However, this procedure requires considerable skill, an experienced microbiologist, and is not feasible in some clinical forms. The minimal clinical manifestations of scabies also make it difficult to obtain sufficient biological material for research. The technique has advantages in specialized institutions. There are several methods for laboratory diagnosis of scabies: removing the mite with a needle, the method of thin sections, scrapings, alkaline skin preparation.

Treatment

For the treatment of scabies, various preparations of sulfur, benzyl benzoate, Peruvian balsam, etc. were previously proposed. In recent years, new drugs have begun to be used, such as Spregal, crotamiton, lindane, malathion, permethrin, Prioderm, Tetmosol, thiobendazole, prescribed in the form of ointments, creams, solutions , shampoos, emulsions and aerosols. The main requirements for anti-scabies are the speed and reliability of the therapeutic effect, the absence of irritating effects on the skin and contraindications for use, ease of preparation and use, stability during long-term storage, availability for mass use, hygiene and low cost [8, 9] . In addition, various forms of scabies, such as postscabiosis, eczematized or urticarial, require the addition of pathogenetic therapy.

General principles: rubbing anti-scab preparations into the skin, especially carefully into the mite’s favorite localization areas. After each forced hand washing, it is necessary to re-treat them with an anti-scabies agent. In the presence of complications (primarily pustular skin lesions), lubrication rather than rubbing is performed. Before starting treatment, it is advisable to take a hot shower or bath, using a washcloth and soap to mechanically remove mites from the surface of the skin, as well as to loosen the surface layer of the epidermis, which simplifies the penetration of antiscabiotic drugs. In the presence of secondary pyoderma, water procedures are contraindicated. Regardless of the method of therapy, the entire skin is treated with an anti-scabies drug. Avoid contact of the drug with the eyes and mucous membranes. The dosage of the acaricidal agent should not be too large, and other skin preparations should not be used at the same time. The patient should be given clear and precise recommendations.

Medicines used to treat scabies:

1. Preparations containing sulfur

It has long been used to treat scabies. Examples of such products are: 10–33% sulfur ointment, 10% sulfur vaseline, Demyanovich’s method, Wilkinson ointment, 5–10% polysulfide liniment, Sulfodecortem, Helmerica ointment, Milian paste.

Currently, the use of such drugs is limited, since the therapeutic effect of some of them is questioned. In addition, they have a number of undesirable properties: medications have an unpleasant odor, stain clothes and underwear, and have an adverse effect on the skin (dermatitis, eczematization).

Sulfur ointment - a 33% concentration is used to treat adults, and 10–15% to treat children. The ointment is rubbed daily, preferably at night, over the entire skin for 5–7 days. On the 6th or 8th day, the patient washes, changes his underwear and bed linen.

Sulfodecortem is a drug containing 10% precipitated sulfur and hydrocortisone acetate. Apply after washing for 5–7 days. Repeated washing and change of linen are carried out after the end of the course of treatment.

The Demyanovich method was widely used in our country. It is based on the acaricidal effect of sulfur and sulfur dioxide, released during the interaction of sodium thiosulfate and hydrochloric acid.

A 60% solution of sodium thiosulfate (solution No. 1) and a 6% solution of concentrated hydrochloric acid (solution No. 2) are successively rubbed into the skin of the torso and limbs; for children, the concentration is 40% (No. 1) and 4% (No. 2). Apply solutions for 3 days. Before use, solution No. 1 is slightly warmed up and rubbed into the skin with your hands in a certain sequence: starting with simultaneous rubbing of the drug into the skin of both hands, then the limbs, then the skin of the torso (chest, abdomen, back, gluteal region, genitals) and finally skin of the lower extremities to the toes and soles. Rubbing into each area lasts 2 minutes, the entire procedure should take at least 10 minutes. The second rubbing is carried out with the same solution in the same way as the first. After a 10-minute break, they begin to rub in solution No. 2 in the same sequence, 1 minute for each area 3-4 times with 5-minute breaks for drying. At the end of rubbing and after the skin has dried, the patient puts on clean underwear and does not wash for 3 days, but rubs it into the hands again after each wash. After 3 days, the patient washes and changes his underwear again.

Solution No. 1 Rp.: Natrii thiosulfatis 120.0 Aq. Destil. Rub 80.0 M.DS into the skin Solution No. 2 Rp.: Ac.hidrochlorici puri 12.0 Aq. Destil. 200.0 MDS rub into skin

Today, the use of this drug is limited due to the ever-decreasing number of pharmacies that have production departments. In addition, this method is very labor-intensive and is accompanied by the release of an unpleasant odor of sulfur and sulfur dioxide.

2. Peruvian balsam

This balm is made from an extract of one of the plants of the legume family (Miroxylon Periferum). One of the active ingredients is cinnamein, which contains benzyl benzoate, which apparently gives the drug an antiparasitic effect. Side effects include local allergic reactions and eczema. When applying the drug to a large surface area of ​​the body, resorptive effects with symptoms of renal intoxication are possible.

3. Benzyl benzoate preparations

Benzyl benzoate. It is used in the form of a 20% water-soap suspension; children under 3 years of age are prescribed a 10% suspension. The suspension is rubbed into the skin of the entire body, except the head, and for children under 3 years old and into the skin of the face. Rubbing is carried out in a certain sequence (see Demyanovich's method). The course requires two treatments with an interval of 3 days to affect the mobile forms of the mite and larvae. Linen is changed twice after each treatment. The cost of the drug is 100 ml for treatment and 200 ml for the course. Treatment with benzyl benzoate is contraindicated in pregnant women and during lactation. The freshly prepared drug is most effective. When stored, benzyl benzoate loses its effectiveness, which explains the failures in its use.

It is also possible to use benzyl benzoate in the form of a 10–20% ointment. In this case, the consumption of the drug is 30–40 g per application and 60–80 g per course.

Askabiol is a drug containing equal amounts of benzyl benzoate, solid soap and ethyl alcohol.

Benzoseptol is a preparation containing equal amounts of benzyl benzoate, mild soap and isopropyl alcohol.

Novoscabiol is a drug containing benzyl benzoate - 30.0, methyl ester - 1.0, paraffin oil - 69.0.

Nbin is a preparation containing benzyl benzoate - 68 parts, Tween-80-14 parts, anesthesin - 12 parts, DDT (insecticide - trichloromethyldi(p-chlorophenyl)methane)) - 6 parts.

4. Lindane or gammabenzenehexachlorane

This organochlorine insecticide is used in the form of a 1% lotion, which is applied once to the entire surface of the body and left for 6 hours, then washed off. In hot climates, it is possible to use lindane in powder form. The drug can also be used in the form of cream, shampoo and ointment. The drug is not used during pregnancy and lactation, in infancy, as well as in patients with eczema and atopic dermatitis, as it can cause exacerbation (Latin exacerbo - irritate, aggravate) the process.

5. Crotamiton (Yurax)

Apply as 10% cream, lotion or ointment. The active ingredient crotamiton, in addition to its acaricidal effect, has the ability to relieve itching, which is very important for patients with scabies. Apply the drug after washing 2 times a day at daily intervals or four times every 12 hours for 2 days. The drug is interesting because it does not cause side effects and can be used to treat children, pregnant women and patients with allergic dermatoses. At the same time, its effectiveness is not absolute.

6. Permethrin preparations

The mechanism of action is based on disruption of the permeability of membranes of insect nerve cells to cations, which has an acaricidal effect. Affects adult larvae and eggs.

Medifox is a 5% concentrate of the synthetic pyrethroid permethrin in alcohol and castor oil. Available in ampoules of 2 ml, glass bottles of 24 ml, polymer containers from 0.1 to 5.0 l. It is applied externally in the form of a freshly prepared 0.4% emulsion. To do this, 8 ml of a factory-packaged 5% solution should be added to 100 ml of water. Rubbing is done once a day at night for 3 days. Shelf life of the working emulsion is 8 hours.

Nittifor is a solution for external use in a 60 ml bottle, containing permethrin and cytylperidinium bromide.

Rubbing the drug is carried out once a day at night for 3 days. On the fourth day, the remnants of the drug are washed off with cold water and bed and underwear are changed.

7. Pyrethrin group

Aerosol Spregal (esdepalletrin) is a synthetic pyrethrin (neurotoxin for small arthropod parasites), enhanced with piperonyl butoxide (an enzyme inhibitor that helps remove pyrethrin from the parasite), used as the active principle of the aerosol anti-scabies Spregal. An excipient (auxiliary substance) specially developed for it allows the solution to be applied to the entire surface of the skin and ensures the penetration of the active substances into the skin and scabies tracts with the subsequent destruction of the female mite and her eggs.

However, when using Spregal, some caution is sometimes required, for example, in the presence of a large number of excoriations, since in this case there may be a slight increase in skin itching and the appearance of dermatitis in patients who have an individual intolerance to one of the components.

The question of choosing a drug for the treatment of scabies is the main one for the practitioner.

The choice of therapeutic method for atypical forms of scabies is based on modern knowledge of its immunopathogenesis. Adding differentiated pathogenetic therapy to basic etiotropic therapy increases the effectiveness of treatment of these forms of scabies that are difficult to treat.

A special problem in the treatment of scabies is severe itching that does not disappear after treatment. The reasons for this phenomenon can be varied:

• allergy to the used medicinal drug, especially in suspicious patients who use it too often;
• a state of physiological hypersensitivity, which manifests itself in the fact that severe itching does not disappear within 8–10 days after treatment;
• incorrect diagnosis;
• improper treatment or secondary invasion;
• psychiatric problems: acarophobia (fear of scabies) or mania for parasitosis.

Thus, persistent itching can be due to various reasons and requires medical supervision; the patient should not self-medicate.

Prevention of scabies

The most important link in the prevention of scabies is early diagnosis and active identification of patients. They are carried out during preventive examinations of designated groups of patients. It is very important to identify foci of scabies and work to eliminate them. Identification and simultaneous treatment of all contact persons. Timely and thorough disinfection of clothing, underwear and bed linen. Control of cure is carried out 3 days after the end of treatment, and then every 10 days for 1.5 months. Linen is boiled, dresses and other clothes (if it is impossible to process in a disinfection chamber) are thoroughly ironed or ventilated in the air for 5 days, and in the cold for 1 day. Conducts wet cleaning with a 5% chloramine solution. Upholstered furniture is treated with the same solution. For the purpose of disinfecting an epidemiological outbreak, an aerosol agent A-PAR is recommended, which allows for high-quality disinfection at home.

A-PAR is an anti-itch preparation, the excipient of which, safe for humans, allows you to disinfect clothing and bedding without leaving stains on clothing and, in addition, is intended for treating furniture, hard surfaces, door handles, children's toys, and shoes.

Final disinfection is carried out after the end of treatment, in children's groups twice: after identifying a patient in the group and at the end of treatment. In large, long-term, intensively operating teams, it is advisable to carry out final treatment of premises using the preparations Medifox (0.2% aqueous emulsion), Medifox-super (0.2% aqueous emulsion), Tsifox (0.5% aqueous emulsion).

Literature

1. Gebra F. Guide to the study of skin diseases: trans. with him. Ed. A. A. Polotebny. St. Petersburg: O. I. Bakst, 1876. T. 1.
2. Daria J. Fundamentals of dermatology: trans. from French Ed. A. A. Sakhnovskaya. M.–L.: State. publishing house, 1930.
3. Demyanovich M. P. Scabies. M.: Medgiz, 1947.
4. Korotky N. G. Modern external therapy of dermatoses. Tver: Provincial Medicine, 2001.
5. Savchak V., Galnikina S. Practical dermatology. K.: Ukrmedkniga, 1998. pp. 14–22.
6. Samtsov A.V. Contagious dermatoses and venereal diseases (modern methods of treatment). St. Petersburg: Special literature, 1997. pp. 30–33.
7. Sergeev Yu. V. Modern clinical and immunological features of scabies and new approaches to its diagnosis and therapy // Immunopathology, allergology, infectology. 2000, No. 4, p. 102–107.
8. Sokolova T.V., Fedorovskaya R.F., Lange A.B. Scabies. M.: Medicine, 1989.
9. Sokolova T.V., Lopatina Yu.V. Parasitic dermatoses: scabies and mite-borne dermatitis. M.: Binom, 2003.
10. Fedorov S. M., Selissky T. D. Scabies. In the book: Skin diseases. M.: Medicine, 1998. pp. 164–172.
11. Belyab P., Jean-Pastor M. J. Scabies. SCAT. 1996, Marseille. R. 22–26.
12. Ackerman B. Histopathology of human scabies. Ed. Lippincott Compagny, 1997, Philadelphia. R. 88–95.
13. Saurat JA Risques systemiques des medicaments topiques chez l'enfant // Sem. Hop. Paris. 1982, 58, 26–27, 1643–1649.
14. Shakter B. Treatment of scabies and pediculosis with linden preparation: an evalution // J. Am. Acad. Dermatol. 1981, 5, 517–527.
15. Van Neste D. Immuno — allergological aspects of scabies: a comparative study of spontaneous blastogenesis in the dermal infiltrates of common and hyperkeratotic scabies? Allergic contact dermatitis and irritant dermatitis // Arh. Dermatol. Res. 1982, 274, 159–167.

I. V. Verkhoglyad, Doctor of Medical Sciences, Associate Professor I. Ya. Pinson, Doctor of Medical Sciences

GBOU DPO RMAPO Ministry of Health and Social Development of Russia, Moscow

Contact information for authors for correspondence

This disease is characterized by the development of a characteristic rash in the area of ​​the trunk and limbs in the form of scabies, nodules and blisters, scratching and the formation of bloody crusts against the background of infection with a parasite such as Sarcoptes scabiei (scabies mite). If the disease is caused by parasites common among animals, the disease is called pseudosarcoptosis. Specific complications of the disease are secondary bacterial and fungal infections, as well as the layering of allergic dermatitis.

The causative agent of scabies is the parasite Sarcoptes scabiei - the scabies mite. The pathogen is transmitted through close intimate contact, when living together, or through skin-to-skin contact while in bed. Transmission usually occurs in a focus, which is characterized by a group of people in which there is a source of the pathogen and transmission routes - the maximum activity of the pathogen is observed at night, so the direct route of transmission is through close intimate contact. Transmission of the pathogen is also possible through close household contact with household items of infected patients, but this route of transmission is only possible if the patient has a large number of scabies. It is especially dangerous to have two or more sources of scabies in a group that were infected under different circumstances. Persons living together in restrictive conditions (shared dormitories, boarding schools, nursing homes, barracks and many other situations) also play a particularly important role in the transmission of this disease. There are rarely cases of scabies infection in public places with limited crowds of people - in baths, saunas, swimming pools, trains, hotels). The main reasons for the spread of scabies are failure to comply with sanitary and hygienic standards, contact with a source of infection, and severe somatic diseases (such as diabetes), which facilitate the penetration of the pathogen into the skin. The main manifestation of scabies is the appearance of a scabies tract - a chronic inflammatory area with a predominance of lymphocytes in the stratum corneum of the skin. Depending on the clinical symptoms, there are typical scabies, scabies without burrows, Norwegian scabies, scabies without burrows, scabies lymphoplasia of the skin, complicated scabies with the addition of bacterial or fungal flora, as well as pseudosarcoptosis (infection with scabies mites from animals).

The symptoms of the disease depend on the form of the course. The most common form of scabies is the typical one, in which it is customary to allocate an incubation period (from the moment of infection to the appearance of the first signs of the disease) - about 2 weeks. When the disease manifests itself, scabies burrows form, nodules form on the torso and limbs, blisters, pronounced scratches and bloody crusts form in their place. A characteristic specific symptom is the absence of rashes in the interscapular space. Among the subjective changes, patients usually complain of severe itching, usually worsening at night. The rash is caused by a pronounced reaction of the body to the waste products of the tick. The main morphological element is “itch burrows,” which can be of several types: typical burrows are represented by white lines on the limbs and genitals, which are combined with a large number of nodules, vesicles and crusts. Diagnostically significant symptoms can be identified: pustules and crusts in the elbow area (Ardi's symptom), bloody crusts in the elbow area (Gorchakova), bloody crusts in the buttocks area (Michaelis), scabies in the form of an elevation (Sezary). When diagnosing “scabies without passages,” small nodules and blisters are detected. One of the most severe variants of the disease is Norwegian scabies. This is a rare and highly contagious form that occurs as a result of a pronounced decrease in immunity. The manifestation of the disease is a generalized lesion of the skin with the appearance of massive gray-white or dark dense crusts that limit movement. In children, the course of the disease is characterized by damage to the skin of the face and scalp.

A dermatovenerologist is involved in the diagnosis and treatment of scabies. If, based on the examination, the nature of the disease can be assumed, then it can be confirmed in several ways. The causative agent must be identified: to stain the “scabies tracts”, an iodine solution is used, as well as oil vitropressure; Using a needle, the scabies mite is removed, when applying lactic acid, the contents of the skin are “scraped off”, and dermatoscopy (examination of the skin through a microscope) is carried out to identify scabies mites.

For treatment, methods are used to destroy the causative agent of scabies. Treatment regimens include benzyl benzoate preparations (ointments, emulsions), permethrin, sulfur ointment, esdepalletrin with the addition of piperonyl butoxide. Treatment for Norwegian is somewhat different - in the evening the patient is treated with a scabicide, in the morning with one of the keratolytic drugs - products with salicylic acid (5% sulfur-salicylic ointment, 5-10% salicylic ointment) and urea. Treatment is carried out until the crusts are completely removed. The prognosis with correctly prescribed treatment is favorable.

Scabies. How to heal quickly? (as well as causes and symptoms of the disease)

In modern dermatology and parasitology, scabies is classified as an STD - a sexually transmitted disease. Since scabies, or more precisely its causative agent, Sarcoptes Scabiei (scabies mite), is most likely and most often transmitted through the closest and longest (at least 10 minutes) skin contact.

The essence of the disease is that this tick, less than 1 mm in size (observed with the naked eye as a tiny whitish grain), entering the epidermis, quickly (after 15-20 minutes) bites to a depth of 0.7-2 mm (depending on the location of the invasion) , after which it lays eggs (females cause symptoms). After a couple of days, the eggs turn into larvae, and after another 10-12 days into adults.

Scabies is called so because this whole process causes unbearable itching in the patient, as well as skin inflammation with all the ensuing consequences - purulent papules, after which weeping erosions and blood crusts remain. After all, a tick is a foreign body, which also secretes its own waste products that are allergenic to the body. It is not surprising that in the initial stages, scabies is disguised as prurigo, dermatitis or eczema. However, the disease can be identified fairly quickly.

Scabies reveals itself against the background of other skin pathologies with one very recognizable symptom - scabies. These are unevenly convex, in some places whitish paths up to 1 cm long - passages made by ticks. The easiest and fastest way to detect them is to smear a suspicious area of ​​skin with 2% iodine solution. The tracks will turn brown on a dark yellow background. The professional and most accurate medical diagnostic method is videodermatoscopy with 600x magnification.

In 90% of all cases, scabies begins on the forearms and hands, especially in the areas between the fingers. Later, the tick can spread to the abdomen, buttocks, groin area, and ankles. So, how to quickly recover from this disease? Moreover, it will be cured 100%, without relapses. Scabies, unless any complications arise, does not require systemic treatment. Only local, external. For severe skin inflammation, antihistamines (Suprastin, Loratadine, Erius) and hormonal ointments (Triderm, Akriderm, Dermovate) are used. The standard therapeutic regimen involves the use of the following drugs:

1. Benzyl benzoate. Cream or emulsion. A standard tube is 150 ml, which is enough for an adult for 3 procedures. And the essence of the procedure is that after taking a shower/bath, you need to lubricate the entire body with the product, except for the face and scalp. It is clear that it is better to do this before bed. Do not shower for the next 24 hours. After 4 days, repeat the same procedure, since the last generation of mites may hatch (the product does not destroy eggs). And it is strongly recommended to change bedding, although infection through it is unlikely. In Russia, this is the most common and cheapest remedy to cure scabies mites.
2. Permethrin. Cream, ointment, spray. Apply to the entire body before going to bed for 3 days in a row. On the fourth day, wash thoroughly and change bed linen.
3. Spregal. An expensive French analogue (aerosol) based on esbiol and piperonyl butoxide. One package is also designed for 3 treatments. But the big plus is that one full application is usually enough to eliminate the parasite 100%. 12 hours after spraying, wash thoroughly.
4. Lindan. This product is based on chlorine-containing hydrocarbons, which is a pesticide. The application is similar.

In general, in order to fully recover, during the course you must follow a number of simple rules:

• if several people living in the same area get sick, then everyone needs to be treated at the same time;
• Before applying the product, wet cleansing of the skin is necessary, because water softens the epidermis, making it looser, which will make it easier for the active substances to reach the parasites;
• all clothing should be disinfected at the end of treatment, and this can be done very easily and quickly - you need to pack things in a plastic bag, completely eliminating the flow of air if possible, or hang the clothes in the open air, you need to wait 5 days, but if it’s frosty outside, then a day is enough (well, perfectionists can be advised to boil for 10 minutes in a solution of baking soda or simple washing powder).

There are a lot of so-called folk remedies. You can try them, but a positive result is not guaranteed. Using such methods, it is possible to reliably cure in about half of all cases. One of the famous, good folk recipes:

• grate a piece of laundry soap and add a little water until you get a paste;
• Grate a fresh onion and a head of garlic in the same way;
• Place the container with the soap paste on the fire and heat until a completely homogeneous mass is formed, then add the grated onion and garlic and cool;
• You can mold a new bar of soap from the warm mass and use it for its intended purpose - this will at least be a good additional therapy.

In terms of prevention, scabies requires two rules: maintaining personal hygiene and avoiding regular casual sex. It is more difficult to recover from the described parasite than to catch it. Reminder: even after eliminating all the mites, the allergic reaction continues for some time, which means the itching persists (about a week after the last treatment).

Finally, it is worth noting that there is a special form of this pathology – Norwegian scabies. When a person is inhabited not by a couple of dozen individuals (as in the usual case), but by a couple of millions. This condition can cause allergic shock and is very dangerous. especially for children. To fully recover from this disease, it is worth undergoing therapy in a hospital.

Emulsion for treating scabies at home

Registration number

P N001773/01.

Tradename:

Benzyl benzoate

International nonproprietary or chemical name:

Benzyl benzoate

Dosage form:

Emulsion for external use.

Compound:

• Active ingredient:
  benzyl benzoate – 200.0 mg.
• Excipients:
  solid laundry soap - 10.0 mg, emulsion wax - 10.0 mg, purified water up to 1.0 g.

Description:

A homogeneous emulsion of white or almost white color with a slight specific odor. Emulsion particles are allowed to settle and disappear after shaking.

Pharmacotherapeutic group:

Anti-scabbing agent.

ATX code:

(P03AX01).

pharmachologic effect

Antiparasitic drug for external use. It has a toxic effect on various types of mites, including scabies, and exhibits anti-pediculosis activity. It passes through the chitinous cover and accumulates in the tick's body in toxic concentrations (the death of ticks occurs after 7-32 minutes). Causes the death of larvae and adults of scabies mites.

Pharmacokinetics

Penetrates the upper layers of the epidermis and is not absorbed into the systemic circulation.

Indications for use

Benzyl benzoate is used to treat scabies.

Contraindications

Hypersensitivity. Not recommended for use in children under 3 years of age.

Pregnancy and lactation

It is not recommended for use by pregnant women or during breastfeeding.

Directions for use and doses

The course of treatment lasts 5 days. Adults are prescribed a 20% emulsion, and children under 5 years old – 10% (the drug is diluted with boiled water in a 1:1 ratio).

Externally. The emulsion is thoroughly rubbed with your hands after washing at night over the entire skin, excluding the face and scalp. Hands are not washed until the morning. 50–100 g of emulsion is consumed per treatment. On the 2nd and 3rd days they take a break from treatment, while the remnants of the emulsion are not washed off from the skin, and the bed linen is not changed. On the 4th day the treatment is repeated. The emulsion is completely washed off the skin on the fifth day with warm water and soap without rubbing the skin. Underwear and bed linen are changed after each treatment.

Side effect

Allergic reactions. Local reactions: possible (especially in children) burning sensation, skin irritation. If signs of skin irritation appear, stop using the drug.

Overdose

Not identified.

Interaction with other drugs

No pharmacological interactions with other drugs have been identified; however, like all antiparasitic agents, benzyl benzoate is not recommended for use simultaneously with other external medications.

special instructions

Treatment of complications of scabies (dermatitis, eczema, pyoderma, postscabiosis lymphoplasia) should be carried out simultaneously with treatment of scabies and continue after its completion.

Treatment of patients identified in one outbreak, as well as contact persons, should be carried out simultaneously to avoid re-infection.

The persistence of itching after treatment is not an indication for prescribing an additional course of specific therapy. Itching is the body’s reaction to a killed tick and its waste products and disappears when antihistamines and ointments with glucocorticosteroids are prescribed.

All items that have come into contact with contaminated skin must be treated. Disinfection of bedding, underwear and towels can be carried out by boiling in a 1-2% solution of soda or any washing powder for 5-7 minutes from the moment of boiling or by soaking for an hour in chlorine-containing solutions. Outerwear (dresses, trousers, suits, jumpers, etc.) are disinfected by ironing on both sides with a hot iron. Some items, especially those that cannot be heat treated, can be hung out in the open air for 3 days. To disinfect some things (children's toys, shoes, clothes), you can use a method of temporarily excluding them from use, for which they are placed in hermetically sealed plastic bags for 3 days. Mattresses, pillows, blankets are excluded from use for 5 days or are subjected to chamber disinfection. Upholstered furniture can be treated with disinsection preparations. The apartment must be cleaned, the floors washed with detergents or the addition of disinfectants.

It is necessary to avoid getting the drug on the mucous membranes of the eyes, nose, mouth, and genitals. In case of contact, rinse the mucous membranes thoroughly with warm water or 1% - 2% sodium bicarbonate solution (baking soda). If the drug gets into the stomach, you must rinse it with a 1% - 2% solution of sodium bicarbonate and drink a glass of water with activated carbon (stir 6 crushed tablets of activated carbon in ½ glass of water).

The drug does not affect the ability to drive a car or perform work that requires increased concentration.

Release form

Emulsion for external use 20%.

50, 100 and 200 g in dark glass bottles with a screw neck, sealed with plastic stoppers and screw caps or screw caps complete with a sealing gasket and with or without tamper evident.

Each bottle, along with instructions for use, is placed in a cardboard pack.

Storage conditions

At temperatures from 15 to 25 °C. Keep out of the reach of children.

Best before date

3 years. Do not use after expiration date.

Conditions for dispensing from pharmacies

Available without a prescription.

Scabies doesn't go away

Julia

December 9, 2021

Hello. In September, itchy nodules began to appear. For a long time I didn’t understand what it was. The location and shape of the rash did not indicate scabies. The dermatologist stubbornly ran away that these were insect bites. The treatment didn't help. Neither antihistamines nor glucocorticosteroids worked. I took a course of dexamethasone. The result only relieved the itching. I went to another dermatologist. They did tests. They diagnosed scabies. Discovered. Sulfur ointment was prescribed for 5 days. The day after application there was a rash all over my body. Tender areas are uniformly red. Don't touch. The ointment didn’t work(((. I bought Medifox. I applied it for 3 days. There was an effect. No itching, the post-scabiosis nodes became gray and even. But a day later new tracts began to appear. In new places. Already just tracts. I tried the sulfur ointment again. I was convinced that that intolerance is evident. Again, terrible satiety and raspberry spots under the weight. I bought benzyl benzoate emulsion. I rubbed it in for 5 days. Terrible burns on the body. Plus an allergic reaction throughout the body. Most likely to the products of the death of mites. Already at the end of treatment with benzyl benzoate, new passages appear again. Treatment again. I returned to Medifox. It relieves itching well. Plus, if the itching is from allergies, I use Akriderm. The itching is unbearable and with allergic rashes over a large area. The entire apartment is treated. I sleep separately. The towels are disposable. Everything is treated 24 hours at a temperature of - 20 - wash at 60 degrees - ironing with steam on all sides to the maximum. I iron everything. Underwear, socks. Phone, remote control, etc. are processed with Medifox. But moves appear. Localization is the outer sides of the arms and shoulders and forearms, the inner surfaces and outer thighs. Hands and feet are clean. The family doesn't itch. We underwent preventive treatment with sulfur ointment once. About treatment with Medifox. After identification. Together with me. 3 days. As per instructions. Very tired. I do not know what to do. It’s confusing that moves appear. Could it be that they are manifesting themselves? And these are old moves? Now I’m on a three-day treatment with Medifox again. Is it possible to increase the concentration of the working solution? Not 0.4%, but more. Does this make sense? Is it worth repeating the course right away? Help me please!!!!!! There is no doubt that this is scabies. Laboratory confirmed. Plus characteristic features. Moves. And I'm afraid to sleep because of the itching. The treatment has been going on for a long time. Almost three weeks. With rare and weak relief. Neurosis, breakdowns. I'm afraid of infecting my family.

Age:

39
Chronic diseases:
Ait

The question is closed

scabies