Scabies

Last Updated: 2022-03-15

Author(s): Anzengruber F., Navarini A.

ICD11: 1G04

Renucci, 1835.

Scabies.

Pruriginous, worldwide infectious disease caused by the parasite Sarcoptes scabiei hominis.

  • Incidence (worldwide): 200-400 million cases annually
  • Prevalence (worldwide): < 1% -40% annually

  • Close physical contact is causing infection.

  • In the area of the body folds (between the toes, elbows), genitals and principally almost on the entire integument, there are erythematous, pruritic, partly urticarial, sometimes vesicular papules and ducts
  • The back, head and neck are usually free
  • The curved, erythematous mite ducts are sometimes visible and can be visualised with ink
  • The pruritus is most pronounced at night
    • In case of first infection: manifestation after 3-6 weeks
    • Reinfection after 24 hours, as patients are already sensitized to the mite faeces antigens

  • Anamnesis: travel anamnesis
  • Clinical image: reflected light microscopy
  • The diagnosis is made clinically. Only the detection of the mite clearly confirms the diagnosis of scabies
  • A deep biopsy is rarely necessary, whereas a really good dermatologist can visualize the mite well with a scratch biopsy and confirm it under the microscope

In the area of the body folds (between the toes, elbows), genital and principally almost on the entire integument

Scabies afflicts patients in the imaginary "circle of Hebra": axillae, elbows, wrists, hands and crotch, this is created by resting the hands on the hips.

  • Persistent postscabial eczema, always prescribe topical class III steroids with antiseptic along with scabicidal therapy
  • Persistent post-scabial papules

Very good with correct diagnosis and treatment not only of the patient but of the relevant group that has physical contact with each other.

General measures

  • Bedding and clothing should be stored in airtight plastic bags for 4 days
  • Alternatively, bedding and clothing can be washed at > 60°C
  • The whole family and close living partners should be treated to avoid a ping-pong effect

Topical therapy

  • Apply permethrin 5% for 8-12 hrs, repeat after 2 weeks if necessary
  • Face and capillitium can be omitted. Exception: scabies norvegica

Systemic therapy

  • Ivermectin p.o. 200 μg/kg bw oncei
    • Repeat after 2-4 weeks if necessary
    • Not commercially available in Switzerland, but available in Germany

  1. Agathos M. Skabies. Der Hautarzt 1994;45:889-903.
  2. Fölster-Holst R, Rufli T, Christophers E. Die Skabiestherapie unter besonderer Berücksichtigung des frühen Kindesalters, der Schwangerschaft und Stillzeit. Der Hautarzt 2000;51:7-13.
  3. Paasch U, Haustein UF. Behandlung der endemischen Skabies mit Allethrin, Permethrin und Ivermectin. Der Hautarzt 2001;52:31-7.
  4. Shacter B. Treatment of scabies and pediculosis with lindane preparations: An evaluation. Journal of the American Academy of Dermatology 1981;5:517-27.
  5. Burkhart CG. Scabies: An Epidemiologic Reassessment. Annals of Internal Medicine 1983;98:498.
  6. Glover R, Young L, Goltz RW. Norwegian scabies in acquired immunodeficiency syndrome: Report of a case resulting in death from associated sepsis. Journal of the American Academy of Dermatology 1987;16:396-9.
  7. Taplin D, Meinking TL, Chen JA, Sanchez R. Comparison of Crotamiton 10% Cream (Eurax) and Permethrin 5% Cream (Elimite) for the Treatment of Scabies in Children. Pediatric Dermatology 1990;7:67-73.
  8. Taplin D, Meinking TL, Porcelain SL, et al. Community control of scabies: a model based on use of permethrin cream. The Lancet 1991;337:1016-8.
  9. Meinking TL, Taplin D, Herminda JL, Pardo R, Kerdel FA. The Treatment of Scabies with Ivermectin. New England Journal of Medicine 1995;333:26-30.
  10. Barkwell R, Shields S. Deaths associated with ivermectin treatment of scabies. The Lancet 1997;349:1144-5.
  11. Karrer S, Szeimies R-M, Wlotzke U, Stolz W, Hohenleutner U, Landthaler M. Steroidinduzierte Scabies norvegica. Der Hautarzt 1997;48:343-6.
  12. Tzenow I, Wehmeier M, Melnik B. Orale Behandlung der Scabies mit Ivermectin. Der Hautarzt 1997;48:2-4.
  13. Mancini AJ, Frieden IJ, Paller AS. Infantile acropustulosis revisited: history of scabies and response to topical corticosteroids. Pediatric Dermatology 1998;15:337-41.
  14. Chosidow O. Scabies and pediculosis. The Lancet 2000;355:819-26.
  15. Bezold G, Lange M, Schiener R, et al. Hidden scabies: diagnosis by polymerase chain reaction. British Journal of Dermatology 2001;144:614-8.
  16. Madan V, Jaskiran K, Gupta U, Gupta DK. Oral Ivermectin in Scabies Patients: A Comparison with 1% Topical Lindane Lotion. The Journal of Dermatology 2001;28:481-4.
  17. Victoria J, Trujillo R. Topical Ivermectin: A New Successful Treatment for Scabies. Pediatric Dermatology 2001;18:63-5.
  18. Chouela E, Abelda??o A, Pellerano G, Hern??ndez MaIs. Diagnosis and Treatment of Scabies. American Journal of Clinical Dermatology 2002;3:9-18.
  19. Katsumata K, Katsumata K. Norwegian Scabies in an Elderly Patient Who Died after Treatment with .GAMMA.BHC. Intern Med 2003;42:367-9.
  20. Orion E, Matz H, Wolf R. Ectoparasitic sexually transmitted diseases: Scabies and pediculosis. Clinics in Dermatology 2004;22:513-9.
  21. Perna AG. Localised genital Norwegian scabies in an AIDS patient. Sexually Transmitted Infections 2004;80:72-3.
  22. Scheinfeld N. Controlling Scabies in Institutional Settings. American Journal of Clinical Dermatology 2004;5:31-7.
  23. Wong SSY, Woo PCY, Yuen Ky. Unusual Laboratory Findings in a Case of Norwegian Scabies Provided a Clue to Diagnosis. Journal of Clinical Microbiology 2005;43:2542-4.
  24. Hengge UR, Currie BJ, Jäger G, Lupi O, Schwartz RA. Scabies: a ubiquitous neglected skin disease. The Lancet Infectious Diseases 2006;6:769-79.
  25. Dupuy A, Dehen L, Bourrat E, et al. Accuracy of standard dermoscopy for diagnosing scabies. Journal of the American Academy of Dermatology 2007;56:53-62.
  26. Kristjansson AK, Smith MK, Gould JW, Gilliam AC. Pink pigtails are a clue for the diagnosis of scabies. Journal of the American Academy of Dermatology 2007;57:174-5.
  27. Hu S, Bigby M. Treating Scabies. Arch Dermatol 2008;144.
  28. Bergstrom FC, Reynolds S, Johnstone M, et al. Scabies Mite Inactivated Serine Protease Paralogs Inhibit the Human Complement System. The Journal of Immunology 2009;182:7809-17.
  29. Hicks MI, Elston DM. Scabies. Dermatologic Therapy 2009;22:279-92.
  30. Kneisel A, Mittag H. Scabies norvegica sive crustosa. Aktuelle Dermatologie 2009;35:398-402.
  31. Mounsey KE, Holt DC, McCarthy JS, Currie BJ, Walton SF. Longitudinal Evidence of Increasing In Vitro Tolerance of Scabies Mites to Ivermectin in Scabies-Endemic Communities. Arch Dermatol 2009;145.
  32. Braun-Falco`s Dermatologie, Venerologie und Allergologie, 7. Auflage