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group_2_presentation_1_-_scabies [2019/02/01 23:07] pateln25 [MANAGEMENT & TREATMENT] |
group_2_presentation_1_-_scabies [2019/04/05 17:50] (current) pateln25 [PRESENTATION SLIDES] |
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| ====== PRESENTATION SLIDES ====== | ====== PRESENTATION SLIDES ====== | ||
| - | [[https://drive.google.com/open?id=1IIYE1lhnmuDrRl8rCye4ybpq4uVuqnkt|External Link]] | + | [[https://drive.google.com/file/d/1uZLo4vl1WvtCZe9JtLe2xGlRjrhkZ_Jg/view?usp=sharing|External Link]] |
| ====== INTRODUCTION ====== | ====== INTRODUCTION ====== | ||
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| - | <box 50% round | > {{ :playground:1.png?550 |}} </box| Figure 1: World map of scabies age-standardized disability-adjusted life-years per 100 000 people. (Karimkhani et al., 2017)> | + | <box 50% round | > {{ :playground:1.png?550 |}} </box| Figure 1: World map of scabies age-standardized disability-adjusted life-years per 100 000 people. (Retrieved from: Karimkhani et al., 2017)> |
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| - | <box 60% round | > {{ :playground:99_3_.jpg?600 |}} </box| Figure 2: Scabies insertion site and burrow (left). Bumpy red rashes displaying scattered papules (right). (Jailman, 2018) > | + | <box 60% round | > {{ :playground:99_3_.jpg?600 |}} </box| Figure 2: Scabies insertion site and burrow (left). Bumpy red rashes displaying scattered papules (right). (Retrieved from: Jailman, 2018) > |
| ===== Itching & Rashes ===== | ===== Itching & Rashes ===== | ||
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| - | <box 39% round | > {{ :playground:image_3_.jpg?330 |}}</box| Figure 3: Microscopic views representing the different life cycle stages of Sarcoptes scabiei. (Hengge et al., 2006)> | + | <box 39% round | > {{ :playground:image_3_.jpg?330 |}}</box| Figure 3: Microscopic views representing the different life cycle stages of Sarcoptes scabiei. (Retrieved from: Hengge et al., 2006)> |
| ====== CAUSES ====== | ====== CAUSES ====== | ||
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| - | <box 60% round | > {{ :playground:3_2_.jpg?600 |}}</box| Figure 4: The 4 life cycles stages of S. scabiei. 1) The female mite creates a burrow through the skin and lays her eggs. 2) Larvae hatch from the eggs, exit the burrows and feed on the surface of the skin. 3) Larvae then develop into nymphs (protonymphs and then tritonymphs). 4) Soon afterwards they molt into male or female adults. Male mites will die after intercourse with a female mite. (Mumcuoglu, Gilead, & Ingber, 2009) > | + | <box 60% round | > {{ :playground:3_2_.jpg?600 |}}</box| Figure 4: The 4 life cycles stages of S. scabiei. 1) The female mite creates a burrow through the skin and lays her eggs. 2) Larvae hatch from the eggs, exit the burrows and feed on the surface of the skin. 3) Larvae then develop into nymphs (protonymphs and then tritonymphs). 4) Soon afterwards they molt into male or female adults. Male mites will die after intercourse with a female mite. (Retrieved from: Mumcuoglu, Gilead, & Ingber, 2009) > |
| ===== Method of Transmission ===== | ===== Method of Transmission ===== | ||
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| - | <box 30% round right | > {{ :playground:f.jpg?300|}} </box| Figure 5: Crusted scabies in a patient with a claw hand due to past experience with leprosy. (Roberts et al., 2005) >Crusted scabies, also known as Norwegian scabies, is a severe chronic form of scabies that is characterized by thick crusts of skin that can contain millions of scabies mites and eggs. (Walton //et al.//, 2008) The condition is often found in individuals with a weak immune system (Karthikeyan, 2009). As a result, these individuals are often unable to create an immune response to control the mites’ replication. In addition, it creates a fertile environment with higher hatch rates allowing the scabies infection to spread more efficiently (CDC, 2018). If left untreated, the individual can die from the condition (Karthikeyan, 2009). Individuals infected with this form of scabies can host up to two million mites, significantly increasing the risk of transmission through contact (CDC, 2018). Although the infection features exponentially higher populations of mites, virulence in comparison to typical scabies remains the same (CDC, 2018). Individuals with the condition will have skin disfigurement as a result of crusting, rotting flesh and will be in immense pain (Karthikeyan, 2009). Additionally, the thick crusts of skin protect the mites and obstruct topical skin treatments (CDC, 2018). | + | <box 30% round right | > {{ :playground:f.jpg?300|}} </box| Figure 5: Crusted scabies in a patient with a claw hand due to past experience with leprosy. (Retrieved from: Roberts et al., 2005) >Crusted scabies, also known as Norwegian scabies, is a severe chronic form of scabies that is characterized by thick crusts of skin that can contain millions of scabies mites and eggs. (Walton //et al.//, 2008) The condition is often found in individuals with a weak immune system (Karthikeyan, 2009). As a result, these individuals are often unable to create an immune response to control the mites’ replication. In addition, it creates a fertile environment with higher hatch rates allowing the scabies infection to spread more efficiently (CDC, 2018). If left untreated, the individual can die from the condition (Karthikeyan, 2009). Individuals infected with this form of scabies can host up to two million mites, significantly increasing the risk of transmission through contact (CDC, 2018). Although the infection features exponentially higher populations of mites, virulence in comparison to typical scabies remains the same (CDC, 2018). Individuals with the condition will have skin disfigurement as a result of crusting, rotting flesh and will be in immense pain (Karthikeyan, 2009). Additionally, the thick crusts of skin protect the mites and obstruct topical skin treatments (CDC, 2018). |
| In 2005, researchers looked at 78 patients with crusted scabies (Roberts //et al.//, 2005). This was the largest reported case series of crusted scabies. They found that individuals had identifiable immunosuppressive risk factors such as elevated IgE levels and eosinophilia in 96% and 58% of patients, respectively. A major risk factor for crusted scabies is a past history of leprosy, and this was indeed found in 17% of the individuals in this study. Susceptibility to lepromatous leprosy has been shown to relate to a Th2 type of T helper immune response. This group of patients may, therefore, represent natural Th2 type responders rendering them susceptible to both leprosy and crusted scabies. | In 2005, researchers looked at 78 patients with crusted scabies (Roberts //et al.//, 2005). This was the largest reported case series of crusted scabies. They found that individuals had identifiable immunosuppressive risk factors such as elevated IgE levels and eosinophilia in 96% and 58% of patients, respectively. A major risk factor for crusted scabies is a past history of leprosy, and this was indeed found in 17% of the individuals in this study. Susceptibility to lepromatous leprosy has been shown to relate to a Th2 type of T helper immune response. This group of patients may, therefore, represent natural Th2 type responders rendering them susceptible to both leprosy and crusted scabies. | ||
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| Scabies can be prevented by avoiding direct skin-to-skin contact with an infected person or their personal items. If an individual has had prolonged skin-to-skin contact with an infected person, they should seek treatment immediately even if they do not exhibit any signs or symptoms in order to prevent the disease from taking form (CDC, 2018). For control measures, the Centers for Disease Control and Prevention recommend laundering the items of an infected person at a temperature of about 60°C (140°F) and drying them in a hot dryer (CDC, 2018). For items that cannot be laundered or dry-cleaned, they should be isolated in a plastic bag for at least 72 hours since the mites are incapable of surviving more than 2 to 3 day away from a hosts’ skin. A person with crusted scabies should be treated quickly, along with anyone they have had close contact with to prevent the disease from taking on a more serious form and to prevent its spread or reemergence. Rooms used by infected individuals should also be thoroughly cleaned and vacuumed. Institutional outbreaks of scabies are challenging to control and treat and require a rapid and aggressive response. Environmental disinfestation measures using pesticide sprays, powders, or fogs is unnecessary and discouraged (CDC, 2018). | Scabies can be prevented by avoiding direct skin-to-skin contact with an infected person or their personal items. If an individual has had prolonged skin-to-skin contact with an infected person, they should seek treatment immediately even if they do not exhibit any signs or symptoms in order to prevent the disease from taking form (CDC, 2018). For control measures, the Centers for Disease Control and Prevention recommend laundering the items of an infected person at a temperature of about 60°C (140°F) and drying them in a hot dryer (CDC, 2018). For items that cannot be laundered or dry-cleaned, they should be isolated in a plastic bag for at least 72 hours since the mites are incapable of surviving more than 2 to 3 day away from a hosts’ skin. A person with crusted scabies should be treated quickly, along with anyone they have had close contact with to prevent the disease from taking on a more serious form and to prevent its spread or reemergence. Rooms used by infected individuals should also be thoroughly cleaned and vacuumed. Institutional outbreaks of scabies are challenging to control and treat and require a rapid and aggressive response. Environmental disinfestation measures using pesticide sprays, powders, or fogs is unnecessary and discouraged (CDC, 2018). | ||
| - | Medication used for treating scabies is called scabicide and is only available with a doctor’s prescription. Currently, no “over-the-counter” products have been tested or approved. The medication is generally applied topically or taken orally (CDC, 2018). | + | Medications used for treating scabies are called scabicides and are only available with a doctor’s prescription. Currently, no “over-the-counter” products have been tested or approved. The medication is generally applied topically or taken orally (CDC, 2018). |
| - | A topical treatment is applied to all skin regions from the neck down, as well as the head of infants and young children (CDC, 2018). Before applying the medication, the skin should be clean, dry, and cool. The medicine should be left for the recommended amount time (8 to 12 hours) for it to be effective and the clean clothing should be worn (Karthikeyan, 2005). A second application may be required after 7 to 14 days. The doctor will also sometimes prescribe antihistamines, pramoxine lotions, and/or steroid creams to control the itching and antibiotics for infections (Karthikeyan, 2005). It is important to follow the doctor’s instructions carefully, since treating the skin more often than instructed can worsen the rash and itching. Itching and may continue for several weeks after treatment even if all the mites and eggs are killed (Karthikeyan, 2005). Retreatment may be necessary if the symptoms persist for more than 2 to 4 weeks after the first treatment or new burrows or rashes appear (CDC, 2018). Treatment failures are uncommon but may occur due to improper or inadequate application, resistance, or re-infestation. Pregnant and lactating women, infants, and young children less than 2 years of age should be treated for scabies only if the benefit exceeds the risk and if the diagnosis is confirmed (Karthikeyan, 2005). | + | A topical treatment is applied to all skin regions from the neck down, as well as the head of infants or individuals who are bald (CDC, 2018). Before applying the medication, the skin should be clean, dry, and cool. The medicine should be left for the recommended amount of time (8 to 12 hours) for it to be effective and clean clothing should be worn (Karthikeyan, 2005). A second application may be required after 7 to 14 days. The doctor will also sometimes prescribe antihistamines, pramoxine lotions, and/or steroid creams to control the itching and antibiotics for infections (Karthikeyan, 2005). It is important to follow the doctor’s instructions carefully, since treating the skin more often than instructed can worsen the rash and itching. Itching may continue for several weeks after treatment even if all the mites and eggs are killed (Karthikeyan, 2005). Retreatment may be necessary if the symptoms persist for more than 2 to 4 weeks after the first treatment or new burrows or rashes appear (CDC, 2018). Treatment failures are uncommon but may occur due to inadequate application, resistance, or re-infestation. Pregnant and lactating women, infants, and young children less than 2 years of age should be treated for scabies only if the benefits exceed the risks and if instructed by a doctor (Karthikeyan, 2005). |
| - | The drug of choice is permethrin followed by lindane and benzyl benzoate (Karthikeyan, 2005). Crusted scabies may require several treatments with scabicides and sometimes several different medications used sequentially. Ivermectin is now emerging as an effective oral drug that is safe to use adults and can also treat crusted scabies (Karthikeyan, 2005). However, Lindane and benzyl benzoate still holds popularity in the developing world since permethrin is expensive. | + | The best drug of choice is Permethrin followed by Lindane and Benzyl Benzoate (Karthikeyan, 2005). Crusted scabies may require several treatments with scabicides and sometimes several different medications used sequentially. Ivermectin is now emerging as an effective oral drug that is safe to use for adults and can also treat crusted scabies (Karthikeyan, 2005). However, Lindane and Benzyl Benzoate still holds popularity in the developing world since Permethrin is expensive. |
| - | <box 100% round | > {{ :playground:table.jpg?900 |}} </box| Figure 6:The various topical and agent currently used for treating scabies. (Karthikeyan, 2005)> | + | <box 70% round | > {{ :playground:table.jpg?700 |}} </box| Figure 6:The various topical and oral medications currently used for treating scabies. (Information retrieved from: Esdepallethrine, 2016; Ivermectin Topical, n.d.; Karthikeyan, 2005)> |
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| Dahl, M. V. (1983). The immunology of scabies. //Annals of allergy//, 51(6), 560-566. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/6419647 | Dahl, M. V. (1983). The immunology of scabies. //Annals of allergy//, 51(6), 560-566. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/6419647 | ||
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| + | Esdepallethrine. (2016) Drug Information System. Retreived from: http://www.druginfosys.com/drug.aspx?drugcode=2287&type=1 | ||
| Hay, R. J. (2009). Scabies and pyodermas–diagnosis and treatment. //Dermatologic therapy//, 22(6), 466-474. doi: 10.1111/j.1529-8019.2009.01270.x | Hay, R. J. (2009). Scabies and pyodermas–diagnosis and treatment. //Dermatologic therapy//, 22(6), 466-474. doi: 10.1111/j.1529-8019.2009.01270.x | ||
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| Hicks, M. I., & Elston, D. M. (2009). Scabies. //Dermatologic therapy//, 22(4), 279-292. doi: 10.1111/j.1529-8019.2009.01243.x | Hicks, M. I., & Elston, D. M. (2009). Scabies. //Dermatologic therapy//, 22(4), 279-292. doi: 10.1111/j.1529-8019.2009.01243.x | ||
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| + | Ivermectin Topical: MedlinePlus Drug Information. (n.d.). Retrieved from https://medlineplus.gov/druginfo/meds/a613011.html | ||
| Jailman, D. (2018). Scabies Slideshow: Symptoms, Cause, and Treatments. Retrieved from https://www.webmd.com/skin-problems-and-treatments/ss/slideshow-scabies-overview | Jailman, D. (2018). Scabies Slideshow: Symptoms, Cause, and Treatments. Retrieved from https://www.webmd.com/skin-problems-and-treatments/ss/slideshow-scabies-overview | ||
