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SCABIESSITY HAJAR MAMILEIRMA ARMIYAHLUSY HERAWATI ALWIMUHAMMAD FAIZ NUR ARIFAHAYU SUWARAYUSUTUPO SIDIK LAWAJOFEADYLY LOUPATTYMIFTAHUL JANNA TATAFRIYANTI MAHULETTE MUHAMMAD ALI SAMUDASVETLANA J. L.SARI RAHAYU

CASEName : Intje Abd. SaidSex : ManAge : 65 yearsJob : Pensiun PNSAddress : Unaaha,Sulawesi TenggaraStatus : MarriedReligion : IslamDiagnosis : - Scabies - Dermatitis Seborhoik - Candidiasis Cutis - Eritroderma - Diabetic foot wagner IV - Type 2 Diabetes Melitus

ANAMNESISHeteroanamnesisChief Complaints : the patient complains an itchy over his body. The Itch felt since 1 week ago and it started on his upper extremities and then spread to all of the body. The itchy accompanied with red fleck and now become black because scratched. The Itch is especially felt at the night.Previous Disease History : suffered from same disease several months ago.Another Disease History : type2 of Diabetes Melitus, Cronic Kidney Disease (3 years ago) Family History : the family members (+) wife and childrenAllergy of food and medicine (-)

Physical ExaminationBlood Pressure : 140/90 mmHgHeart rate : 88x/mRespiratory Rate : 18x/mTemperature : 36.5 CHead : - Anemis : -/- - Icterus : -/- - Cyanosis : -/- Thorax: vesicular, wheezing -, Ronchi -.Abdomen : peristaltic + (normal)Extremities : diabetic ganggren in left foot

Dermatologic StatusLocation : Regio GeneralisataDistribution : GeneralEffloresce : papule eritema, hyperpigmented, eskoriation.Located : Head and neck RegioSize : MiliarEffolosensi : papule erythema, hyperpigmented, eskoriasi.

Regio : Truncus anterior et posteriorEffolosensi : papule , eritema,hyperpigmented,eskoriation

Regio : Truncus anterior et posteriorEffolosensi : papule , eritema,hyperpigmented,eskoriationDiagnostic ExaminationRadiology (30/4/2014)Foto Pedis Ap-OBLIQ d/s:Kesan : Fasculitis plantaris sinistraOsteoporosis senilisGas Gangren on dorsum pedis sinistra.

Laboratory (10/5/2014)HGB : 8,7RBC : 2,97PLT : 451WBC : 11,9GDS : 403UR/CR: 33/1,4SGOT/SGPT : 17/17ALB: 3,0 Na: 135Cl: 107K: 46INR : 94,06THERAPYInternal therapy:Diagnosis: DM type 2

Diet 1700 Kkal/dayMeropenam 1gr/12 hours/ IVNovorapid 12-14-14 UI/SCLevemir 0-0-20 UI/SCCilostasol 2 x 50 mgLanzoprasol 1 x 30 mgDermatology :Diagnosis: Scabies

Scabimite 1x (night)Cetirizine 10 mg 1x1 Merilon cr. + Miconazole cr (morning and evening)Salycilate Acid 2% + Mesone cr. 15 gr + Fuson cr 15 % (night)

DEFINITIONETIOLOGYSarcoptes scabiei var, hominis

Obligat parasite, phylum arthropods, class arachnida, ordo accarima, family sarcoptes. : 0,2 mm long by 0,15 mm broad : 0,4 mm long by 0,3 mm broad.- cannot fly or jump but crawl at the rate 2,5 cm/minute.EPIDEMIOLOGYThe reported prevalence of scabies worldwide was about 300 million cases / year (Chosidow 2006)

Baur (2013) in india that was 20,4%

Onayemi (2005) nigeria 28,6%

Zayyid (2010) among the children 10 12 Y.O in penang malaysia

EPIDEMIOLOGYKline (2013) scabies generally endemic among aborigin at australia and the country in Oceaia that was 30%.

Heukelbach Brazil 8,8 %

HOW ABOUT INDONESIA RECENTLY???

EPIDEMIOLOGYHealth departement of Indonesia based on data from all health centre (Puskesmas) at the year of 2008 was range from 5,6 to 12,95% 3rd of 12 commonest skin disease (Azizah 2011)

Incidence and prevalence at Pesantren in Lamongan 64,2% (Marufi et al)

70% in Pondok Pesantren Pasuruan (Kuspiantoro 2005)

Sungkar (1997) Bad hygiene: Up to 78,7% and good hygiene: 3,8%.RISK FACTORPATHOGENESIS

SecretaExcretaClinical findingItchPapul, vesicle, Urticariaerotion, excoriation, crust + secondary infection)4 6 weeks 8 12 days EFFLORESENCE OF SCABIES

Papules, erithematous

CLINICAL FINDINGDIAGNOSIS2 from 4 cardinal signAdditional testTREATMENTDRUGS AND TOPICAL AGENTSDRUGDOSECOMMENTPermethrin 5% creamApplied for 8-14 h; often repeated in 7 days. First-line treatment Lindane 1%lotionApplied for 8 h then washed off, Second applicationrecommended after 1 wk.Not recommended for Children under 2 months, during pregnancy, or lactation;resistance has been increasing; banned in californiaCrotamiton 10% creamApplied on 2 consecutive days; repeated once within5 days.Antipruritic Qualities; may not be as effective as other topicals24DRUGDOSECOMMENTPrecipitated sulfur 5%-10%Applied for 3 days and then washed off.safe in children under 2mo and during pregnancy, but messy toapply and limited efficacy dataBenzyl benzoate 10% lotionApplied for 24 h then washed off.Not available in United Stateslvermectin, 200 ug/kgSingle oral dose, can be repeated in 10-14 days,Highly effective with a good safety profile; can be used along withtopical agents, particularly in crusted or resistant cases25DIFFERENTIAL DIAGNOSIS

PREVENTIONCOMPLICATIONPROGNOSISTHANK YOULITERATUREHandoko,PR. Skabies. In: Prof.Dr.dr.Adi Djuanda, editor. Ilmu penyakit kulit dan kelamin. Ed 6. Jakarta. FK UI; 2010.p.122-123Stone SP, Goldfarb JN, Bacelieri RE. Scabies, other mites, and pediculosis In: Wolff K, Lowell A, Katz GSI, Paller GAS, Leffell DJ, editors. Fitzpatricks dermatology in general medicine. 7th ed. United state of America. McGraw-Hill; 2008. p. 2029-2032.Burns DA. Diseases caused by arthropods and other noxious animals. In: Rooks textbook of dermatology. 8th ed. United kingdom. Willey-blackwell; 2010. p. 38.36 38.38.Amiruddin MD. Skabies. In. Amiruddin MD, editor. Ilmu Penyakit Kulit. Ed 1. Makassar: Bagian ilmu penyakit kulit dan kelamin fakultas kedokteran universitas hasanuddin; 2003. p. 5-10.