Scabies Alternative Treatment
The mite that causes scabies, Sarcoptes scabiei, is colorless and less than 1 mm long (2,3). It perpetuates solely in human skin, forming sinuous burrows in the stratum corneum. Adult females periodically emerge from their burrows to crawl over the skin surface. The mites die within two days of isolation from a human host transmission results mostly from direct contact between human hosts rather than fomite transfer through contaminated clothing or bedding. Crowding, common in migrant labor housing, promotes outbreaks. Thirty-eight percent of household contacts experience a secondary attack, arguing for presumptive community treatment, which in the agricultural setting includes coworkers and fellow household members. Pandemics occur about every three decades (4), meaning physicians should again be prepared for a large number of patients with this disease. Scabies frequently burdens African villagers, but black people are generally less susceptible than are others (5). For the treating...
Superscabies in anergic individuals (Norwegian scabies) (7) presents as widespread erythema, hyperkeratosis, and crusting with little or no itching. No burrows are evident. Nail involvement is common. Alopecia, generalized hyperpigmentation, pyoderma, and eosinophilia may also occur. It may be induced by steroid administration but is most commonly seen in immuno-compromised or mentally impaired patients (8,9). Scabies of the cultivated, which develops in patients with a high level of hygiene (10), has burrows in only 7 of cases. Steroids may suppress the symptoms, resulting in a misdi-agnosis of a fungal infection or impetigo. In nodular scabies, indurated, often pigmented, tumors lie in the groin or axilla infestations may continue for more than a year despite therapy. Aside from the specific variant of Sarcoptes scabeie that only affects humans, a number of specific variants infest a variety of domestic and companion animals. These include strains that occur on dogs and other...
Parasitic Infections Scabies Common to medical personnel, home care workers, and sex workers, scabies is also common to people who live in rural areas and practice poor hygiene. The mite Sarcoptes scabiei burrows into skin causing papules, eczematous rashes, and excoriations. The disease is often confused by agricultural workers with rashes due to pesticides and other chemicals. The diagnosis is by visualization of eggs and parts of the mite on a KOH preparation. Treatment with a topical permethrin treatment is usually curative, although more than one treatment may be necessary (19).
The physical examination may not be helpful in determining if an exposure occurred. Rashes need to be carefully described and secondary changes due to scratching, infection, or treatment documented. Halogenated hydrocarbons can produce chloracne that may be confused with acne vulgaris in adolescents. Anhydrous ammonia can cause a characteristic hyperpigmented area after a burn heals. Petroleum products may cause irritative dermatitis. Scabies is common among farm workers. Allergic contact dermatitis may have a variety of causative agents (Table 13.3) (1,13).
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