refrat_kel4_skabies

7/29/2019 refrat_kel4_skabies

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REFRAT PRESENTATIONSCABIES

Presented By 4th GROUP

Tutor :dr Zaenuri M. Syamsu Sp.F


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Why its important to treatscabies??

Because scabies will not go awaywithout treatment.


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Impact of Scabies

Scratching a lot can lead to serious skininfections.

Untreated skin infections can lead to kidney and

blood infections. People who have scabies for a long time can get

permanent scarring of the skin.

Children scratching a lot fi nd it hard to

concentrate and learn. Easy to spread to other

Decline Quality of Life


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Definition

Scabies is a contagious disease caused by a mite, or

can be called itch mite

The mite that causes scabies is called Sarcoptes scabiei

Mites burrow down to the deeper layers of the skinwhere the females lay eggs, which hatch in 50 to 72

hours

The larvae make new burrows, mature and the females

lay new eggs

Development from egg to adult takes about 10 to 15

days and mites die after 4 to 6 weeks

Scabies causes discomfort and intense itching, and

occasionally, it results in skin eruptions


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Epidemiology

Scabies has been reported for more than 2500

years.

Aristotle discussed "lice in the flesh," which

resulted in vesicles, and Celsus recommendedsulfur mixed with liquid pitch as a remedy for the

disease.

However, the disease was first ascribed to the

mite by Giovan Cosimo Bonomo in 1687 and

called it as Little Bladder in Water


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Epidemiology

Worldwide, an estimated 300 million cases ofscabies occur annually

Scabies is an endemic disease in tropical and

subtropical country in the world Scabies is not depend on gender, race, age, but

its influenced by poverty, poor hygiene anddensity of population

In developing country prevalence of scabiesestimated 6 27%, which occur in sexual activeage.


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Pathogenesis and Pathophysiology

Agent

Scabies cause by infected female Sarcoptes scabiei

Sarcoptes scabieiis an anthropod in arachnida class,Acarisubclass and Sarcoptidae family

Sarcoptes scabieihas a tiny shape (0,2-04 cm), ovalrounded, and 4 pair of leg.

The production of a lytic secretion and the movement ofthe legs allow the mite to penetrate the skin

The life cycle ofSarcoptes scabieihave 4 stage : eggs,larva, nymph, adult


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Cont..

Transmition

Sarcoptes scabieiare unable to fly or jump. They crawlat a rate of 2.5 cm/min

Sarcoptes scabieiis passed from an infected person to

another via prolonged skin contact (ten minutes or more,often through hand holding)

They are able to live on bedding, clothes, or othersurfaces at room temperature for about 48 hours

Sarcoptes scabieiis transmitted via clothing or bedding

(the usual wash cycle can be used when these items arelaundered)

A person can be infected for up to 2 to 6 weeks beforethe rash or itching occurs


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Cont

Pathophysiology

Eggs , feces

And adult

SarcopresScabeie

GST

Apolipoprotein

Paramiosin

Serine proteaseCystein protease

makrofag

Stimulate

TCD4+ dan

TH1

complement

Inflamation


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Sign and Symptom

Anamnesis

Four cardinal sign :

Pruritus nocturna,

occur in community or group,

present of burrow,

present of mites


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Sign and Symptom

Physical Examination

Primary lesion Burrow a appear as a thin (approximately the width of a human

hair), short (perhaps 2-3 mm in length), gray brown, wavychannel on the skin.

Occasionally, the mite is visible to the naked eye as a smallwhite dot.

A small vesicle or papule may appear at the end of the burrow oroccur independently.

Red nodules approximately 0.5 cm or larger.

Bullous lesions may be observed in immunocompromisedpatients.

Papulo-vesikulae

Erosion & excoriation + crustae


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Sign and Symptom

Site of rash between fingers

wrists

auxiliary areas

female breasts (particularly

the skin of the nipples)

the umbilical area

penis and scrotum

buttocks inside of legs

ankles


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Addition examination

The way to get the mites

1.Get the burrow with vesicle and nodule, thenpick out the end of the burrow, put down inobject glass and cover with cover glass,

notice by microscope.2.Brush the rash, catch it in white paper, notice

the mites by magnifying glass

3.Make an incision biopsy by squeeze the

lesion and make incision, then notice bymicroscop

4.By excision biopsy


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Diagnosis

Diagnosis

Ideal

Find the burrow

Prove the present of adult sarcoptes, larva,and eggs

Practice: by sign and symptom (2 in 4 cardinalsign)

Pruritus nocturnal

Predilection site and site of the rash

Family history


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Therapy

Preventive and Promotive

Personal hygiene

Environment hygene Give the clear information to community

about Scabies


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Therapy

Curative

Scabisides

Ivermectin

Permetrin

Lindane

Sulfur in petrolatum

Crotamiton

Benzyl Benzoat


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Therapy

Rehabilitative Treatment the complication

All household members and close personal contactsshould be treated, whether or not they are

symptomatic. Bedding, towels, and clothing should be washed in

60C (or higher) water and then machine dried.

If items cannot be washed, they should be isolated for

3 or more days. Patients should be reexamined 2 weeks after

treatment to evaluate effectiveness


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Complication

Treatment failure

Allergic dermatitis due to the topical medicine used

Ordinary household mites can cause a cross reactivity and can drivepersistent symptoms

Acarophobia: Delusional parasitosis; requires psychiatricintervention

Secondary infection requiring antibiotics

Reinfestation: Recurrence of the eruption usually means reinfectionhas occurred.

Resistance: Resistance to lindane has been widely reported. Less

frequently, cases of resistance to permethrin have been noted.Resistance to ivermectin is still rare but has been reported inpatients who have received multiple doses of the drug over severalyears.


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Reference


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THANK YOU

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