Atypical crusted scabies in a patient with chronic liver disease caused by hepatitis B and D viruses.

Crusted scabies is a less common variant of scabies that is highly contagious, difficult to treat and involves infestation by Sarcoptes scabiei var. hominis. The classical clinical presentation includes crusted, scaly and generally non-pruritic lesions usually located on the head, neck, palmar, plantar and periungual region. It was first described in Norway in 1848 in patients with leprosy who presented with crusted lesions. In this study, we report the case of a patient with crusted scabies with florid clinical manifestations and chronic liver disease due to hepatitis B and delta virus infection.

Atypical crusted scabies in a patient with chronic liver disease caused by hepatitis B and D viruses

Abstract: Crusted scabies is a less common variant of scabies that is highly contagious, difficult to treat and involves infestation by Sarcoptes scabiei var. hominis. The classical clinical presentation includes crusted, scaly and generally non-pruritic lesions usually located on the head, neck, palmar, plantar and periungual region. It was first described in Norway in 1848 in patients with leprosy who presented with crusted lesions. In this study, we report the case of a patient with crusted scabies with florid clinical manifestations and chronic liver disease due to hepatitis B and delta virus infection.

Scabies Among Elderly Korean Patients with Histories of Leprosy.

A scabies epidemic, traced by the hospital-based surveillance system, was reported in a Korean leprosarium. A total of 200 symptomatic cases were found during 2012-2014 among 570 elderly former leprosy patients. Most of cases were classic type scabies (87%) and aged 75 years and older (72%). Surveillance system for early diagnosis and prompt intervention was applied and the scabies epidemic was controlled effectively in this long-term care facility.

Comparative efficacy and safety of topical permethrin, topical ivermectin, and oral ivermectin in patients of uncomplicated scabies.

BACKGROUND: Ivermectin has opened a new era in the management of scabies as orally effective drug. However, topical route has been little explored for ivermectin. AIMS: To compare the efficacy and safety of topical permethrin, oral ivermectin, and topical ivermectin in the treatment of uncomplicated scabies. METHODS: This was an open-label, randomized, comparative, parallel clinical trial conducted in 315 patients, randomly allocated to 3 groups. First group received permethrin 5% cream as single application, second group received tablet ivermectin 200 mcg/kg as single dose, and third group received ivermectin 1% lotion as single application. All the patients received anti-histaminic for pruritus. The patients were followed up at intervals of 1, 2, 3, and 4 weeks. If there were no signs of cure, the same intervention was repeated at each follow up. Primary efficacy variable was clinical cure of lesions. Statistical analysis was done by chi square test and one way ANOVA test using SPSS version 12. RESULTS: At the end of first week, cure rate was 74.8% in permethrin group, 30% in oral ivermectin group, and 69.3% in topical ivermectin group (P < 0.05). At the end of second week, cure rate was 99% in permethrin group, 63% in oral ivermectin group, and 100% in topical ivermectin group (P < 0.05). At the end of third week, 100% cure rate was observed in permethrin and topical ivermectin group while 99% in oral ivermectin group (P = 0.367). No serious adverse events were observed. CONCLUSIONS: Permethrin and topical ivermectin were equally effective against scabies while oral ivermectin was significantly less effective up to 2 weeks. Topical ivermectin can be used as an alternative to permethrin.

Topical permethrin and oral ivermectin in the management of scabies: a prospective, randomized, double blind, controlled study.

BACKGROUND: Scabies is a highly contagious and intensely pruritic parasitic infestation. It is a re-emerging infection in the new millennium especially with HIV pandemic and a significant health problem in developing countries. Various treatment modalities have been used since time immemorial but the search for an ideal scabicide is ongoing. AIMS: In this study, we compared the therapeutic efficacy of single application of topical 5% permethrin with oral ivermectin (200 µg/kg/dose) in a single-dose and a two-dose regimen in patients with scabies. METHODS: 120 clinically diagnosed cases of scabies (>5 years of age and/or >15 kg) were randomized into three treatment groups A, B, C of 40 patients each; receiving either topical 5% permethrin (group A) or oral ivermectin (200 µg/kg/dose) in a single dose (group B) or double dose regimen (group C) repeated at 2 weeks interval. Patients were followed up at 1, 2, and 4 weeks interval. At each visit, cure rate (>50% improvement in lesion count and pruritus and negative microscopy) was assessed and compared. RESULTS: Cure rate in three treatment groups at the end of 4 weeks was 94.7% (A), 90% (B), 89.7% (C), and thus all three treatment modalities were equally efficacious. However, at 1 week follow up, group A patients reported better improvement in both lesion count and pruritus. CONCLUSIONS: Both permethrin and ivermectin in both single and two dose regimen are equally efficacious and well tolerated in scabies. However, permethrin has a rapid onset of action.

Crusted scabies: clinical and immunological findings in seventy-eight patients and a review of the literature.

OBJECTIVES: To describe the clinical and immunological features of crusted scabies in a prospectively ascertained cohort of 78 patients. METHODS: All patients requiring inpatient treatment for crusted scabies in the 'top end' of the northern territory of Australia over a 10 year period were prospectively identified. Demographics, risk factors, and immunological parameters were retrospectively compiled from their medical records and pathology databases. RESULTS: More than half the patients with crusted scabies had identifiable immunosuppressive risk factors. Eosinophilia and elevated IgE levels occurred in 58% and 96% of patients, respectively, with median IgE levels 17 times the upper limit of normal. Seventeen percent had a history of leprosy but 42% had no identifiable risk factors. There was a decrease in mortality after the introduction of a treatment protocol consisting of multiple doses of ivermectin combined with topical scabicides and keratolytic therapy. CONCLUSIONS: Crusted scabies often occurs in patients with identifiable immunosuppressive risk factors. In patients without such risk factors, it is possible that the crusted response to infection results from a tendency to preferentially mount a Th2 response. The treatment regime described was associated with a reduction in mortality. This is the largest reported case series of crusted scabies.

Definition of an algorithm for the management of common skin diseases at primary health care level in sub-Saharan Africa.

In order to help primary health care (PHC) workers in developing countries in the care of common skin diseases, an algorithm for the management of pyoderma, scabies, superficial mycoses, contact dermatitis and referral of early leprosy cases (based on the identification of diseases through the presence of objective key signs, and on treatments by generic drugs) was elaborated. One thousand patients were seen by trained dermatologists, who established diagnoses and treatments; in addition, there was systematic recording of each key sign, according to the successive algorithm steps. We compared the diagnostics and treatments obtained for several combinations of diagnostic signs, with those of the dermatologists. Sensitivity, specificity, positive predictive value and negative predictive value of defined combinations were high for pyoderma, scabies and superficial mycoses. Values were less exact for dermatitis and leprosy, but were considered sufficient for the level of health care targeted. The apportionment of treatments between the algorithm and the dermatological approaches was considered appropriate in more than 80% of cases; mismanagement was possible in 7% of cases, with few predictable harmful consequences. The algorithm was found satisfactory for the management of the dermatological priorities according to the standards required at the PHC level.

Importancia de la atención de enfermería en la sarna Noruega / Importance of nursing care in the Norwegian Scabies

La sarna noruega fue descrita inicialmente en enfermos leprosos en 1848. Se reporta esta variedad de escabiosis en pacientes cubanos. La muestra se compone de 9 enfermos atendidos en el Instituto de Medicina Tropical "Pedro Kourí" en el período enero de 1994 a junio de 1996, la cual ocasionó epidemia en sus áreas de procedencia. Es objetivo de este trabajo indicar la labor de Enfermería en la prevención y cura de esta enfermedad; se destaca el prurito severo observado en estos enfermos, el cual es usualmente ligero o está ausente. Se señala la importancia de la labor de Enfermería, en el tratamiento y control epidemiológico de cada enfermo diagnosticado. Se recomienda el aislamiento dermatológico y las medidas profilácticas en el personal que está en contacto directo con estos pacientes. El método utilizado fue la revisión clínica epidemiológica y la observación directa y quedó evidenciada la reemergencia de esta afección, la importancia de la labor de Enfermería y el aislamiento dermatológico en la prevención y tratamiento de los enfermos con sarna noruega(AU)

Norwegian scabies was initially described in lepers in 1848. This variety of scabies is reported in Cuban patients. The sample is composed of 9 patients, who caused an epidemic in their areas of origin and were attended at "Pedro Kouri" Institute of Tropical Medicine from January, 1994, to June, 1996. The objective of this paper is to make emphasis on the role played by nursing care in the prevention and cure of this disease. The severe pruritus observed in these patients, which is usually mild or is absent, is stressed. The importance of nursing care in the treatment and epidemiological control of every diagnosed patient is underlined. The dermatological isolation of these patients is recommended, as well as the taking of prophylactic measures on the part of the personnel treating them directly. The method used consisted in the clinical and epidemiological review and in the direct observation, which allowed to prove the reappearance of this affection and the importance of nursing care and of the dermatological isolation in the prevention and treatment of those patients suffering from Norwegian scabies(AU)

Importancia de la atención de enfermería en la sarna Noruega / Importance of nursing care in the Norwegian Scabies

La sarna noruega fue descrita inicialmente en enfermos leprosos en 1848. Se reporta esta variedad de escabiosis en pacientes cubanos. La muestra se compone de 9 enfermos atendidos en el Instituto de Medicina Tropical "Pedro Kourí" en el período enero de 1994 a junio de 1996, la cual ocasionó epidemia en sus áreas de procedencia. Es objetivo de este trabajo indicar la labor de Enfermería en la prevención y cura de esta enfermedad; se destaca el prurito severo observado en estos enfermos, el cual es usualmente ligero o está ausente. Se señala la importancia de la labor de Enfermería, en el tratamiento y control epidemiológico de cada enfermo diagnosticado. Se recomienda el aislamiento dermatológico y las medidas profilácticas en el personal que está en contacto directo con estos pacientes. El método utilizado fue la revisión clínica epidemiológica y la observación directa y quedó evidenciada la reemergencia de esta afección, la importancia de la labor de Enfermería y el aislamiento dermatológico en la prevención y tratamiento de los enfermos con sarna noruega(AU)

[Current status of the therapy of granulomatous skin infections]. / Derzeitiger Stand der Therapie granulomatöser Hautinfektionen.

We report on granulomatous infections of the skin, as well as the current state of therapeutics. Cutaneous tuberculosis and presently desired therapeutic regiments are treated in detail. Diseases regarded as eradicated in Germany, such as brucellosis and listeriosis, do still occur. Their recognition and cure are discussed from a modern point of view.