Kenneth Mellanby Commander of the Order of the British Empire (CBE) (1908-1993). The facts about scabies.

Kenneth Mellanby was a distinguished biologist specialising in entomology. He helped to establish the first university in Nigeria and undertook pioneering work on the use of insecticides in agriculture. However, he will best be remembered for a series of experiments which he undertook on human volunteers during the Second World War. These experiments established the mechanism of transmission of scabies and allowed its effective control at a time when the condition had reached epidemic proportions, causing a significant adverse effect on public morale and military effectiveness. Mellanby's wartime monograph on scabies remains to this day the definitive work on the disease and is still studied by dermatologists. His subsequent book Human Guinea Pigs is a remarkable account of the privations to which wartime volunteers willingly submitted themselves in a way that would have never passed any current medical ethics committee.

Scabies ­still current medical and social problem. A retrospective analysis of 193 cases

INTRODUCTION: Scabies is a parasitic skin disease caused by Sarcoptes scabiei. About 200 million casesworldwide each year in people of all ages are reported. AIM OF STUDY: Retrospective analysis of records of patients hospitalized at the Department with scabies. MATERIALS AND METHODS: Six-year retrospective analysis of medical records of patients hospitalized with scabies at the Department of Dermatology. Gender, age of patients, comorbidities, clinical course of the disease and treatment were considered. RESULTS: In this period 193 patients were hospitalized with scabies, 96 females (49.7%) and 97 males (50.3%), including 33 children (17%). Mean age of patients was 52.9. Skin lesions persisted 142 days in average; reoccurrence was noted in 14% of cases. Lesions were observed most often in winter (31%). The most common manifestations were erosions (80.8%), excoriations (73.6%), papules (72.6%) and crusts (24.3%), localized mainly on trunk (92%), lower (91%) and upper (86%) limbs. 181 patients (93.8%) reported pruritus which intensified at night in 35.8%. Previous contact with people with scabies reported 41 patients (21%). The most common comorbidity was hypertension, diabetes mellitus and coronary heart disease. Accompanying dermatoses were eczema, secondary superinfection and psoriasis. 85 patients (44%) were overweight or obese. Patients received mostly topical permethrin (57%), crotamiton (29%), glicocorticosteroids (73%) and antibiotics (11%), also oral antihistamines (91%). CONCLUSIONS: Analysis revealed more frequent occurrence in adults with no evident sex prevalence. Greater incidence in winter may be caused by people's tendency to spend more time indoors closer to each other at this time of year. Pruritus, the most common subjective symptom, typically worsens at night.

Assessing skin disease and associated health-related quality of life in a rural Lao community.

BACKGROUND: Skin diseases are common and often have an impact on an individual's health-related quality of life. In rural communities where access to healthcare may be limited and individuals rely on farming for food and income, the impact of skin diseases may be greater. The objectives for this study were to perform an assessment of skin disease prevalence in a rural village in Laos and assess the associated impact of any skin disease found using the Dermatology Life Quality Index (DLQI). METHODS: A rural village was purposively selected and 340 participants examined by dermatologists over a four day period. Brief questionnaires were performed, followed by full body skin examinations and DLQI questionnaires completed were relevant. The data were analysed using chi square and Wilcoxon signed rank tests. RESULTS: One hundred and eighty-one participants were found to have a skin disease (53%). The six most common skin diseases were: eczema (22%), dermatophyte infections (19%), acne (10%), scabies infestation (9%), melasma (8%) and pityriasis versicolor (4%). Just over half of those with skin disease (51%) completed the DLQI, with scores ranging from 0 to 24. Those with skin problems on examination were significantly more likely to be farmers, have had a previous skin problem, be older or live in a smaller family. Conclusions This study represents the first formal documentation of skin disease prevalence in Laos and establishes the high rate of skin disease in the rural community and the associated impact these diseases have on health-related quality of life.

Consensus criteria for the diagnosis of scabies: A Delphi study of international experts.

BACKGROUND: Scabies was added to the WHO Neglected Tropical Diseases portfolio in 2017, and further understanding of the disease burden is now required. There are no uniformly accepted test methods or examination procedures for diagnosis, which limits the interpretation of research and epidemiological findings. The International Alliance for the Control of Scabies (IACS) designated harmonization of diagnostic procedures as a priority for the development of a global control strategy. Therefore, we aimed to develop consensus criteria for the diagnosis of scabies. METHODOLOGY / PRINCIPAL FINDINGS: We conducted an iterative, consensus (Delphi) study involving international experts in the diagnosis of scabies. Panel members were recruited through expression of interest and targeted invitation of experts. The Delphi study consisted of four rounds of anonymous surveys. Rounds 1 and 2 involved generation and ranking an extensive list of possible features. In Rounds 3 and 4, participants were presented results from previous rounds and indicated agreement with a series of draft criteria. Panel participants (n = 34, range per Round 28-30) were predominantly highly experienced clinicians, representing a range of clinical expertise and all inhabited continents. Based on initial rounds, a draft set of criteria were developed, incorporating three levels of diagnostic certainty-Confirmed Scabies, Clinical Scabies and Suspected Scabies. Consensus was reached in Round 4, with a very high level of agreement (> 89%) for all levels of criteria and subcategories. Adoption of the criteria was supported by 96% of panel members. CONCLUSIONS / SIGNIFICANCE: Consensus criteria for scabies diagnosis were established with very high agreement. The 2018 IACS Criteria for the Diagnosis of Scabies can be implemented for scabies research and mapping projects, and for surveillance after control interventions. Validation of the criteria is required.

Treatment of Scabies and Pediculosis in Health Education Publications and Folk Medicine of Eastern Croatia - Slavonija, Baranja, and Western Srijem County.

Scabies and pediculosis are common parasitic infestations of the skin and hair, manifesting with intense pruritus and effectively treated with modern medications. Because of the attached social stigma linking it with poverty and poor hygiene, patients will often attempt alternative folk-based remedies before confiding in their physicians. We conducted a comprehensive bibliographical study of historic folk literature and interviewed 70 individuals experienced in everyday application of folk medicine in order to categorize available remedies and provide a modern, scientific comment on their effectiveness and dangers. Compositions containing sulfur, copper sulfate, petroleum, coal, tar, and highly alkaline soaps and washing solutions undoubtedly have scabicidal and pediculicidal properties, but they are used either in high concentrations with greater possibility of intoxication and irritation or lower concentrations with questionable therapeutic benefit. These remedies, extracted from historical-cultural frameworks, are poorly adapted to modern standards and can lead to side-effects and complications. Physicians today have to be aware of the reasons their patients seek alternative remedies and know the substances and procedures they may use in self-healing, so as to be able to provide the help that may be needed if those complications occur.

Increased risk of bipolar disorder in patients with scabies: A nationwide population-based matched-cohort study.

Both scabies and bipolar disorder (BD) are common and troublesome disorders. There are several similarities in both diseases: pruritus, a higher prevalence in crowded environments, and cytokine-mediated inflammatory processes in the pathophysiology. We conducted this nationwide population-based study to investigate the possible relationship between scabies and BD. Based on the National Health Insurance Research Database (NHIRD) of Taiwan, a total of 7096 patients with scabies were identified as a study group and 28,375 matched patients as a control. We tracked the patients in both groups for a 7-year period to identify those newly diagnosed with BD. The demographic characteristics and comorbidities of the patients were analyzed, and Cox proportional hazard regressions were performed to calculate the hazard ratio (HR) of BD. Of the 35,471 patients in this study, 183 (0.5%) patients with newly diagnosed BD were identified, with 58 (0.8%) from the scabies group and 125 (0.4%) from the control group. The patients with scabies had a higher risk of subsequent BD, with a crude hazard ratio of 1.86 and an adjusted hazard ratio of 1.55 (95% confidence interval: 1.12-2.09, P < 0.05). This study shows there is an increased risk for BD among patients with scabies. Immunopathology may contribute to this association.

Impaired quality of life in adults and children with scabies from an impoverished community in Brazil.

BACKGROUND: Scabies is highly prevalent in resource-poor communities in developing countries and is associated with considerable morbidity in this setting. How the parasitic skin disease impairs the quality of life of patients has rarely been investigated. METHODOLOGY: A modified Dermatology Life Quality Index (mDLQI) was developed to assess the quality of life in adults and children with scabies living in an urban slum in Fortaleza, capital of Ceará State, Brazil. A total of 105 patients with scabies (58 children and 57 adults) were included in the study. The diagnosis was made by dermatoscopy, skin scraping, and adhesive film test. RESULTS: Feelings of shame was the restriction most frequently noted (adults 77.2% and children 46.6%). Other types of quality of life impairment were the need to dress differently (35.1 vs. 29.3%), restriction on leisure activities (24.6 vs. 36.8%), social exclusion (24.6 vs. 17.9%), stigmatization (21.1 vs. 25.0%), teasing (only children: 26.3%), and problems with sexual partners (only adults: 10.9%). Women and girls perceived more restrictions than men and boys. mDLQI scores indicated that 13.9% of the patients noticed a large or very large effect on their life, 65.2% considered their quality of life lightly or moderately reduced by scabies, and 20.9% did not feel any restrictions. The degree of impairment increased parallel to the degree of itching and severity of scabies (P=0.003). LIMITATIONS: Owing to active case finding, most of the patients were in an early phase of scabies, and clinical pathology was not very pronounced. CONCLUSION: Scabies considerably impaired the quality of life in adults and children living in poverty in an urban slum. Females particularly suffered from restrictions.

Quality of life of patients with scabies.

BACKGROUND: Scabies is a highly contagious disease caused by the mite Sarcoptes scabiei, and the disease is still a major public health problem in many resource-poor regions. Apart from the skin lesions or substantial morbidity, scabies also leads to social stigma. However, quality of life (QoL) has not been investigated in patients with scabies. OBJECTIVES: The aim of this study was to assess the impact of scabies on patients' QoL using the Dermatology Life Quality Index (DLQI) questionnaire, and assess its feasibility and internal consistency. METHODS: One hundred consecutive outpatients seeking treatment for scabies in the Department of Dermatology, the Second Hospital of Xi'an Jiaotong University, were assessed for eligibility for this prospective study from 8 August 2008 to 20 December 2008. Sulphur (10%) was selected in the treatment of scabies. RESULTS: A total of 96 patients completed the study. Among them, 78 (81.25%) of patients were considered cured at the end of the study. The mean ± SD DLQI score in our study was 10.09 ± 5.96. QoL of most of (71.9%) our patients has moderately affected. Questions 1 (symptoms), 2 (embarrassment), 7 (work or study) and 9 (sexual difficulties) had the most impact on patients with scabies. Domain 1 (symptoms and feelings) and 5 (personal relationships) scored higher than other domains. There was significant progress of QoL after treatment in our patients. No strong relationship between disease-related characteristics and QoL could be found. CONCLUSION: Scabies moderately affected the QoL of the patients. Sulphur could be considered as an effective treatment for patients with scabies.

[Parasitophobic patient suffering from scabies treated with ivermectin--a case report]. / Inwazja swierzbem konskim leczona ivermektyna u osoby z parazytofobia. Opis przypadku.

We present a case of an atypical, difficult to diagnose crusted scabies caused by the invasion of non-human parasite (probably horse scabies Psoroptes equi) treated successfully by a rarely used in Europe antiparasitic agent-ivermectin. This inconvenient parasitemia additionally triggered parasitophobia--all of that together complicates the approach.

Delusional parasitosis: folie à deux and attempted murder of a family doctor.

A 58-year-old woman suffering from delusional parasitosis tried to kill her general practitioner. Her husband shared in her beliefs but lost all delusional conviction after she was compulsorily admitted to a special hospital. The case illustrates the intractable nature and potential dangerousness of some of these cases, and their affinity to paranoia.

Managing noncompliance in a schizophrenic patient with chronic skin disorders.

A schizophrenic-diagnosed woman with a long-term history of scratching and skin problems was referred for behavioral treatment because she was not responding well to medical care and was often described as noncompliant. The treatment of noncompliance consisted of four phases: (I) direct habit modification, (II) compliance training, (III) controlling anxiety precipitants and (IV) follow-up monitoring and evaluation. After several months of treatment, the maladaptive behaviors decreased and the skin condition improved. Follow-up at six month intervals for three years indicated no recurrence of skin problems.

Diagnosis and treatment of monosymptomatic hypochondriacal psychosis in chronic renal failure.

The authors describe a case of a patient who presents with a delusional interpretation of a somatic symptom, uremic pruritus. The literature on the diagnosis and treatment of monosymptomatic hypochondriacal psychosis (MHP) is reviewed and discussed. There is an effective treatment available for this disabling condition--a neuroleptic agent called pimozide, which appears to have a selective ability to block central dopaminergic receptors.