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What is scabies ? What are the symptoms of scabies?

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The scabies beetle of the arthropod class ( Sarcoptes scabiei var.) occurs due to skin implantation. It is a common parasitic disease that causes itching all over the body. The annual number of cases in the world is around 200-300 million. The world health organization included scabies on the list of neglected tropical diseases in 2017. It causes epidemics even in developed societies such as Canada and Germany. Although the last 3 years the incidence is very common in Turkey has increased 5-10 fold. The scab beetle, which is the cause of the disease, is 0.3-0.5 mm in size and has eight legs and is difficult to see with the naked eye. The parasite, which is indispensable to humans, is only transmitted from person to person. The disease can be seen at any age and in all walks of life. It spreads faster, especially in public living areas and crowded family environments. It increases in autumn and winter. Close contact and shared items are important in contamination.It is typical to have severe itching in the body, enough to wake up at night. Complaints in more than one member of the family are generally observed. Typical rashes of scabies on the skin and sores due to scratching are observed along with itching on the body.

WHAT İS SCABİES?
“What causes scabies?” “How long does scabies live in the body?” Questions are frequently asked by patients. The scab beetle is Sarcoptes scabiei, which completes its entire life cycle in humans . hominisIt is a parasitic skin disease that occurs when the insect named as the insect enters the body and progresses with itching in the body. The mange beetle, which is mandatory for human skin, can survive for a maximum of 3-4 days outside the human body at 21 degrees temperature and 40-80% humidity. The life cycle of the mange beetle begins with the mating of the male and female parasite. After mating, the male mange beetle dies, and the female mange beetles live for an average of 4-6 weeks. The female insect (sarcopt) can tunnel in 30 minutes. Females lay 2-4 eggs every day in tunnels they dug under the skin. After 2-4 days, the larvae hatch from the eggs and 10-14 days later the adult parasite develops. Female sarcopte can travel 2.5 cm per minute in viable skin. The scab beetle cannot jump or fly. A person with scabies normally has 10-12 mites.Children have an average of 20 mites and are mostly settled in areas such as hands and feet. But millions of mites can be seen in people with weak immune systems, those receiving cortisone treatment, and those with crustaceans. It can be seen at any age, in all ethnic groups and socioeconomic levels. Outbreaks can be seen in public living areas such as nursing homes, dormitories, wards, camps and hospitals. It is more common in communities with low socioeconomic status and poor hygiene.It is more common in communities with low socioeconomic status and poor hygiene.It is more common in communities with low socioeconomic status and poor hygiene.

WHAT ARE THE SYMPTOMS OF SCABİES?
“How do I know if I have scabies?” questions are frequently asked by patients. The mange beetle causes sensitization in the person by settling on the skin and reproducing. This period varies between 4-6 weeks on average. The complaint of itching begins in the body due to sensitization. However, specific scab lesions on the skin and sores due to itching of the skin are observed. In the symptoms of scabies, symmetrical lesions are seen on the fingers, inner face of the wrist, armpits, back of the ears, waist region, ankles, feet, buttocks. While the nipples and genital area are frequently affected in women, wounds on the penis and scrotum are quite common in men. Involvement of the whole body, including the scalp and face, can be observed in infants, immunocompromised individuals and the elderly. It is typical to see watery blisters (vesicles) and tunnels on the palms and soles of babies.

The substances produced by the female mite to create tunnels in the skin, the excrement and the eggs it lays cause an allergic (delayed type hypersensitivity) reaction. As a result, severe itching develops. Although it affects any part of the body, it is typical to have itchy wounds in the most common areas of scabies (between the fingers, wrists, elbows, feet, around the navel, armpits, nipples in women and especially in the genital area in men). In these body parts, the fact that the skin is warm, moist and hairless creates a suitable area for the mange beetle. Severe itching due to scabies reduces the quality of life of patients. Serious infections may develop on the skin due to itching and irritation in the body. Scabies is among the most specific causes of nocturnal itching.

The most characteristic scab lesions are the gray-white or flesh-colored wavy string-like or broken letter S-shaped tunnels, about 1-10 mm in length, in which the mite also lives. In addition, tiny red blisters (papules), small blisters (vesicles) and itchy skin lesions like eczema are seen. Scratches, scaly wounds and swelling may also be observed on the skin due to itching.

HOW İS SCABİES TRANSMİTTED?
Scabies is transmitted from P2P by direct contact. At least 15 to 20 minutes of skin contact is required to pass from one person to another. Transmission is common in situations such as sexual intercourse and sleeping in the same bed. Apart from contact with the skin, it can also be transmitted through the bed, linen, towel and clothes used by a person with scabies. It spreads quickly between sexual partners and family members. Contamination is not expected in short-term contacts such as hand shaking or hugging. It is more common in autumn and winter. It can be seen in all segments of society. However, those who live in crowded environments, close contact for a long time and in poor hygienic conditions have the highest risk of contamination. Outbreaks can be seen in collective living places such as military barracks, prisons, hospitals, schools and nursing homes.Even if there are no complaints or symptoms of scabies, it is important to treat everyone in the community.

HOW İS SCABİES DİAGNOSED?
Complaints and physical examination findings of the patient are usually sufficient in the diagnosis of scabies. Scabies is diagnosed with nocturnal itching, typical skin rash and distribution of the rashes. The worsening of itching at night, with a hot shower or bath, supports scabies. If there is suspicion in the diagnosis of scabies, enlarging the lesions with a dermatoscopy device or microscopic evaluation can help the diagnosis. At the ends of the tunnels where the scab beetle settled, dirt accumulation and black spot-like formations are observed.

Apart from the classic scabies, the table called crusted scab or Norwegian scabies and containing millions of parasites is slightly heavier. This form of scabies can be seen in infants, elderly or sick people with a weak immune system. A large number of mange beetles and eggs are found in the shells. It is a more contagious scabies than normal scabies due to its high density.

WHAT İS THE TREATMENT FOR SCABİES?
“How does scabies go?”, And “What is the definitive solution to scabies?” questions are frequently asked by patients. For the definitive solution to scabies, first of all, the treatment process should not be interrupted and the hygiene rules should be strictly followed. It is important to initiate simultaneous treatment, if possible, for anyone who has scabies symptoms and shares the same living environment with the person diagnosed with scabies. Drugs that kill parasites are used in scabies. In the first step in the treatment of scabies, locally applicable antiparasitic lotions (scabies cream with permethrin active ingredient) or classical magistral drugs (scabies cream) containing sulfur-tar are given. Some drugs such as benzyl benzoate and Lindan (scabies cream) are no longer preferred due to their toxic and irritant effects. Treatment methods have been modified due to the increase in resistant scabies cases in recent years.By increasing the application time of the drugs and the number of repetitions, successful scabies treatment can be achieved. However, there may be situations where no response can be obtained to locally applied medications. In this case, systemic antiparasitic drugs (with ivermectin active ingredient) can be used in tablet form taken orally.

In addition to the use of antiparasitic drugs in the treatment of scabies, some hygiene measures should also be taken into account. The person with scabies should first take a bath by rubbing before applying the medication. After bathing, the skin should be dried and then scabies should be applied to the whole body, including the toes, starting from the back of the ear. If the nails are long, they should be cut short. The duration of drug waiting varies depending on the type of drug administered, the age of the patient, and the presence of pregnancy. Waiting time for scabies medication should be at least 24 hours. At the end of 24 hours, the patient should take a shower again. All clothes, towels and bed linen used by the patient should be washed at a temperature of at least 60 degrees and ironed with a steam iron after drying. This treatment should be done by all family members and should be repeated a week later.In the treatments applied as a mixture, it is generally recommended to apply 3 consecutive days and take a shower and repeat it in the same way after a week. Clean clothes should be worn after application. Antihistamine pills or topical steroids can be used for itching. Creams containing tea tree and aloe vera, crotamiton lotion can be used to relieve itching. When scabies is not treated adequately, serious skin infections may occur due to sleep problems, decrease in work and school performance, deterioration in quality of life, depression and itchy lesions in scabies.Creams containing tea tree and aloe vera, crotamiton lotion can be used to relieve itching. When scabies is not treated adequately, serious skin infections may occur due to sleep problems, decrease in work and school performance, deterioration in quality of life, depression and itchy lesions in scabies.Creams containing tea tree and aloe vera, crotamiton lotion can be used to relieve itching. When scabies is not treated adequately, serious skin infections may occur due to sleep problems, decrease in work and school performance, deterioration in quality of life, depression and itchy lesions in scabies.

FREQUENTLY ASKED QUESTİONS ABOUT SCABİES
How should the house be cleaned in the treatment of scabies?

In order to be protected from scabies, skin contact with the person diagnosed with scabies should be avoided, and items such as clothes, towels and sheets should not be used without washing and ironing. Rugs and beds that cannot be washed should be swept, the broom bowl should be cleaned after use. Bleach and steam cleaners can be used for floor cleaning.

Is the scab beetle transmitted by animals?

Pets can have scabies. However, the scab mite species observed in animals and the human scab mite are different. Therefore, even if scabies pass from animal to human, it does not cause any parasite infection other than short-term itching.

When do scabies symptoms occur?

When the scab parasite infects a healthy person, it enters under the skin, opens tunnels and begins to reproduce rapidly. If he has had scabies before, the symptoms of scabies appear in a short time like 1-3 days.

How long will scabies itch pass?

Although the scabies (mites) and their eggs are gone with antiparasitic treatment, the itching does not stop immediately. Sensitization (allergy) in the skin continues for a while. This period is on average 2-6 weeks.

At what temperature should the items be washed in scabies treatment? What should be applied to items that cannot be washed in the treatment of scabies?

All clothes, linen and bedding used in the last week should be washed and ironed at least 60 degrees. It is sufficient to store the items that cannot be washed for 7 days without taking air.

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