Scabies

Last Updated: 2021-04-30

Author(s): -

Renucci, 1835.

Seven-year itch.

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

  • Incidence (worldwide): 200-400 million cases annually
  • Prevalence (worldwide): < 1% -40% annually
  • The trigger is close physical contact
  • Clothing is only used as a carrier for Scabies norvegica
  • In the area of the body folds (toe space, elbows), genital and in general almost on the entire integument there are erythematous, pruriginous, partly urticarial, partly blister-like papules and ducts
  • The back, head and neck are usually free
  • The curved, erythematous mite ducts are sometimes visible and can be visualized with ink
  • The pruritus is particularly pronounced at night
    • In case of first disease: manifestation after 3-6 weeks
    • In case of reinfection after 24 hours, as patients are already sensitized to the mite faeces antigens
  • Medical history: Travel history
  • Clinical picture: Reflected light microscope
  • The diagnosis is made clinically. Only by the detection of the mite, the diagnosis of a scabies is clearly confirmed
  • A deep biopsy is rarely necessary, but a really good dermatologist can show the mite well with a scratch biopsy and confirm it under the microscope

Scabies infest the patients in the imaginary "Circle of Hebra": axillae, elbows, wrists, hands and crotch, which is created when the hands are supported on the hips. 

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

 General measures

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

Topical therapy

  • Apply Permethrin 5% for 8-12 hours, if necessary repeat after 2 weeks
  • Face and capillitium can be left out. Exception: Scabies norvegica

Systemic therapy

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