Clinical practice guidelines for the diagnosis and treatment of scabies.

Scabies, caused by the Sarcoptes scabiei var hominis mite burrowing into the skin, is a highly contagious disease characterized by intense nocturnal itching. Its global impact is considerable, affecting more than 200 million individuals annually and posing significant challenges to healthcare systems worldwide. Transmission occurs primarily through direct skin-to-skin contact, contributing to its widespread prevalence and emergence as a substantial public health concern affecting large populations. This review presents consensus-based clinical practice guidelines for diagnosing and managing scabies, developed through the fuzzy Delphi method by dermatology, parasitology, pediatrics, pharmacology, and public health experts. The presence of burrows containing adult female mites, their eggs, and excreta is the diagnostic hallmark of scabies. Definitive diagnosis typically involves direct microscopic examination of skin scrapings obtained from these burrows, although dermoscopy has become a diagnostic tool in clinical practice. Treatment modalities encompass topical agents, such as permethrin, balsam of Peru, precipitated sulfur, and benzyl benzoate. In cases where topical therapy proves inadequate or in instances of crusted scabies, oral ivermectin is recommended as a systemic treatment option. This comprehensive approach addresses the diagnostic and therapeutic challenges associated with scabies, optimizing patient care, and management outcomes.

Using ultraviolet dermoscopy in diagnosing scabies.

The latest generation ultraviolet (UV) dermatoscopes, which emit UV light at a wavelength of 365 nm and enlarge lesions, are practical devices that can facilitate the diagnosis and follow-up of some dermatological diseases with fluorescence that can be observed in skin lesions. In 305 patients, 468 tunnels were evaluated: first in polarized mode and later in UV mode. The recorded samples were compared one-to-one by the same dermatologist. Due to the study's design, images were examined in three stages: tunnel borders, tunnel content and mite appearance. In UV mode, the entire body of mites gives a bright reflex along with an oval-shaped diagnostic clue well beyond the delta sign. The borders of the tunnel reflect brightly in UV mode, with borders that are more sharply visible than in polarized mode. Although the tunnel content cannot be clearly distinguished in polarized mode, especially in people with hyperkeratotic palms, or 'working hands' (e.g. farmers, mechanics and construction workers), with the bright reflex, the tunnel borders in UV mode give a bright reflection and provide a clear view of tunnels. Tunnel content gives a bright reflection in UV mode. Our results show that UV dermatoscopes provide more effective and clearer images than polarized dermatoscopes in the diagnosis of scabies.

Quality of life and satisfaction with life in patients with skin diseases.

Individuals with skin disease may experience negative symptoms such as itching and pain, social stigma, and isolation. This cross-sectional study included 378 patients with skin diseases. The Dermatology Quality of Life Index (DLQI) score was found to be higher in individuals with skin disease. A high score indicates an impaired quality of life. Married people than single people, those who are 31 years old and older than those who are 30 years old and younger have higher DLQI scores. And also those who work than those who are unemployed, those who have diseases than those who do not have any other diseases, and those who smoke than those who are non-smokers have higher DLQI scores. In order to increase the quality of life of individuals with skin diseases, it is necessary to detect risky situations as well as symptom control and add psychosocial and psychotherapeutic interventions to the treatment plan.

Adjunctive Agent for Treating Scabies: In vitro Killing Activity of Permethrin and Tea Tree Oil on Sarcoptes scabiei Collected from Patients

Objective: Recently, there has been a serious increase in cases of scabies. The number of patients who do not benefit from the current treatment agents is also quite high. There are publications showing that scabies mites are permethrin-resistant and ivermectin. The treatment with scabicides usually lasts for several hours and usually the treatment is repeated for at least another time, which reduces the patient's compliance with the treatment, especially in pediatric patients where the toxic effects of the products are more pronounced. Therefore there is a need for treatment modalities that are less toxic to humans. To observe the in vitro effect of tea tree oil (TTO) on S. scabiei and to compare it with those of permethrin. Methods: Scabies specimens were removed from the patient and examined using a digital microscope. Parasites that were not damaged during sampling, and showed full motion were included in the study. No treatment was applied to the patients before removal of the mites. A total of 40 parasites were included in the study, with 10 parasites in each group. Immersion oil was applied to the control group, 5% permethrin to the first treatment group, while 5% and 25% TTO were used for the second and third study groups. Results: The mean survival time (ST) of scabies mites in the 5% permethrin group was 350±31.3 min, while this for 5% TTO group 180±15.1 min and 120±13.3 min in the 25% TTO group. The mean ST of the sarcoptes in the control group was 2.820±90 min. The mean ST between the control, permethrin and TTO groups was statistically significant (p=0.03). ST between 5% and 25% TTO groups was also statistically significant (p=0.04). There were no statistical differences between permethrin and 5% or 25% TTO. Conclusion: TTO has an acaricidal effect on S. scabiei. Although not used as the treatment of choise, it can be used as a supportive agent. Since it shows an acaricidal effect within a short time, it could be used as a shampoo or shower gel to enhance the acaricidal activity of another scabicide.

Can we increase the success of scabies treatment? The effect of removing tunnels from patients in the success of scabies treatment.

Recently, there has been an increase in scabies infestations. Moreover, the number of patients who do not benefit from conventional treatment regimens is increasing rapidly worldwide. This situation leads clinicians to seek new treatments. To evaluate the contribution of mechanical parasite removal to treatment success when applied prior to topical permethrin 5% treatment. The mechanical removal process was applied once during diagnosis. Two groups of 30 people each were included in the study. Permethrin treatment was given directly to the first group without any procedure. In the second group, the maximum number of tunnels that could be detected were removed from patients. After this procedure, the group received permethrin treatment. All patients were called for control after 10 days, and treatment response rates were evaluated. Sixteen (53.3%) patients who received permethrin treatment directly without any procedure responded to the treatment. In the remaining 14 (46.6%) patients, tunnels and Sarcoptes mites were still present. In the second group, which underwent tunnel removal, complete recovery was observed in 26 (86.6%) patients. The patients who did not benefit from the treatment in the study group had relatively less tunnel removal from their bodies. Removing the tunnel from the patient before the treatment increases the success of the treatment. Considering that there are 8-10 parasites on average in scabies patients, it has been determined that the tunnel removal method is not difficult and contributes to therapeutic success.

Effect of global warming on dermatology practice: The increase in cases of cutaneous larva migrans in the eastern Black Sea region of Turkey.

OBJECTIVE: Cutaneous larva migrans (CLM) is a parasitic disease seen in people in contact with soil in tropical countries. Almost all cases reported in regions without a tropical climate have a history of travel to a tropical region. AIM: In our study, we aimed to investigate the effect of climate change on CLM cases and the demographic characteristics of these cases. For this purpose, the climate information of the period in which we determined the case series and the characteristics of the patients were investigated. MATERIAL AND METHOD: The study was designed retrospectively. Patient files and pre- and post-treatment photographic archives were reviewed retrospectively. In addition, the region's weather history over the last 50 years was examined. RESULTS: The records of patients diagnosed with CLM in 2018 were reviewed retrospectively. In total, 22 cases were detected. The common feature of all cases was that they worked as tea pickers. After examining the weather conditions of the period when the cases were commonly reported, it was determined that there was a sharp temperature increase compared with previous years. CONCLUSION: Due to climate change, an increase in the number of CLM cases is observed in non-tropical regions. Since it is considered a disease-specific to tropical regions, the diagnosis may be overlooked in cases outside these regions. However, CLM should be kept in mind as a diagnostic possibility by clinicians practicing in non-tropical regions as well, especially when treating patients who work with soil, such as tea harvesters.

The comparative in vitro killing activity of tea tree oil versus permethrin on Demodex folliculorum of rosacea patients.

BACKGROUND: Demodex mites have been implicated in several cutaneous disorders compelling the research efforts for effective anti-Demodex therapy. OBJECTIVE: Compare the survival time (ST) of Demodex folliculorum exposed to six different concentrations of tea tree oil (TTO) versus a positive control (permethrin 5%) and a negative control (immersion oil) group. MATERIALS AND METHODS: The wastes of rosacea patients' standardized superficial skin biopsy samples were recruited for the trial. The primary outcome measure of this study was the survival time, defined as the period between the exposure of study agents to the complete cessation of Demodex movements. RESULTS: All differences between the mean survival times of 2.5% (54.0 ± 6.1), 5% (39.0 ± 3.9), 10% (22.0 ± 2.5), 25% (13.0 ± 2.5), 50% (7.8 ± 0.6), and 100% TTO (3.3 ± 1.3) were significant (p < 0.05). The ST of the negative control group was 196.0 ± 23.6 min. The ST of permethrin 5% was 12.5 ± 1.9 that did not show a statistically significant difference from the ST of TTO 25% (p = 0.628). CONCLUSION: The survival times of the six different TTO groups confirmed a dose-related pattern, all of which had survival times shorter than the negative control (immersion oil). TTO 25% had comparable efficacy to the positive control agent (permethrin 5%).

Is there a really resistance to scabies treatment with permethrin? In vitro killing activity of permethrin on Sarcoptes scabiei from patients with resistant scabies.

Recently, there have been increased scabies infestations but many patients do not respond to treatment. Clinicians are hesitant to use permethrin despite the fact that treatment failure may be due to noncompliance with the treatment rather than permethrin resistance. We aimed to investigate the permethrin resistance of mites collected from patients who have endured scabies for at least 3 months despite permethrin treatment. Parasites in patients who had scabies for at least 3 months despite permethrin treatment were collected. Only parasites that were not damaged during sampling, not fragmented and had full motion were included. Parasites were divided into four groups, each with 15 parasites. Immersion oil was dripped on the control group and 5%, 7%, and 10% permethrin was added to the study groups. The responses of the parasites to the applied agents were examined using a digital microscope. All solutions, except the control group, killed the scabies mite. The mean survival time (ST) in the 5%, 7%, and 10% permethrin groups was 360 ± 33.2, 340 ± 31.4, and 320 ± 30.2 min, respectively. There was no statistically significant difference in the mean ST in the permethrin groups. The mean ST in the control group was 46 ± 1.5 h. The mean ST difference between the control and permethrin-treated groups was significant (p = 0.03). There was no resistance to permethrin, which should maintain its place as first line treatment of scabies. Treatment noncompliance, rather than permethrin resistance, seems to be the underlying factor in the chronicity of scabies.

Anti-TNF agent etanercept augments UV-induced skin cancer development in SKH-1 mice.

BACKGROUND: Despite being employed in the treatment of inflammatory disorders for more than 20 years all over the world, data regarding photocarcinogenic risks of anti-TNF agents is scarce. OBJECTIVE: To assess photocarcinogenic potential of anti-TNF agents. METHODS: This was a placebo controlled, split-body (UVB-treated versus -untreated) study on mice. Treatment groups were infliximab (n = 11), etanercept (n = 11), cyclosporine (n = 11) and vehicle control (n = 11). Agents were introduced on the 10th week of phototherapy and continued through 24th week. The macroscopic, histological and immunohistochemical analysis of test sites were carried out. RESULTS: Overall 132 tumors were detected on test sites. All of these tumors developed on UV-exposed sides. Histologic examination of these tumors was compatible with keratinocytic neoplasia in 128, mastocytosis in 3, epidermal cyst in 1. Median tumor burden in the UVB exposed areas for ETN, IFX, CYC, and control groups were 14.91, 10.20, 6.28, and 3.14 cm2, respectively. ETN group demonstrated both higher tumor burden and keratinocytic neoplasia numbers than controls (p = .03, p = .025). Although there were 1.8 and 1.7 times more keratinocytic neoplasms in IFX and CYC groups compared to controls, these differences didn't reach statistically significant levels (p = .14; p = .19). CONCLUSION: This study points out to a significant photocarcinogenic potential of anti-TNF agent etanercept.