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Scabies.(case report)
History: A mother and her 9-month-old baby both presented with complaints of pruritus, pustules, papules, and excoriations on the palms and soles.
Description: Scabies is a very contagious and pruritic skin condition caused by the arachnid mite Sarcoptes scabiei. It is often called "the itch" or "the 7-year itch." It is characterized by a papular eruption over small, raised, sinuous burrows produced by the digging of the egg-laying female mite into the epidermis. Intense pruritus associated with excoriations from scratching and secondary bacterial infections occur subsequently.
Location: The pruritus can occur anywhere on the body but spares the head and neck in adults. In infants, however, the lesions occur on the face, neck, trunk, palms, and soles.
Etiology: Scabies are usually transmitted by direct contact with an affected individual of the arachnid mite Sarcoptes scabiei, variety hominis.
Hallmark of the Disease: A delayed type IV hypersensitivity reaction to the mites and their products occurs within 30 days from infestation. This reaction is responsible for the intense pruritus, which occurs especially at night, and is the hallmark of the disease. Individuals who are already sensitized from a prior infestation can develop symptoms within hours.
Treatment: When suspected, treatment of scabies should begin as soon as possible. A variety of effective topical medications can be used, such as permethrin (Acticin[R], Elimite[R]), lindane (Kwell[R], Kildane[R], Scabene[R], Thionex[R]), malathion (Ovide[R]), and benzyl benzoate (Ascabiol[R]). The topical treatment of choice for scabies is permethrin 5% dermal cream. It is the most effective topical agent, is well tolerated, has low toxicity, and performed better than lindane in clinical trials. The oral antiparasitic drug ivermectin is an effective scabacide and is the secondline alternative to oral permethrin. However, the drug has not been evaluated in children weighing less than 15 kg, and its role in treating scabies remains unclear. Hence, this medication should not be used in this patient. An antihistamine, such as diphenhydramine, can be used to help control itching which often lasts for 1 to 2 weeks after treatment.
Other Treatment Tips: Consider using aqueous preparations in children, because alcoholic lotions may cause irritation. Permethrin 5% dermal cream ...
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