Looking at the word alone would make anybody itchy and guiding the patient to a room for examination would mean removing all the unnecessary equipments and clutters in the assigned area. Then the patient is placed in a contact isolation precaution.
Scabies is a transmissible opportunistic skin problem that affects humans and other animals caused by Sarcoptes scabiei var hominis. They are minute and not usually seen by the naked eye (Chosidow & Fuller, 2017).
Incidence and Prevalence of the Disorder
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According to Mclean (2013) and Romani et al., (2015) as cited in Mila-Kierzenkowska et al. (2017), the prevalence of scabies varies from more than 2% in the Europe and Middle East, more than 70 % in Papua New Guinea and the highest incidence in poor and developing countries in the Pacific and indigenous villages in northern Australia. There are more than 300 million incidents of scabies reported worldwide annually. People with dementia, the homeless, people with poor hygiene, has poor nutritional status and are living in poverty are susceptible to contacting scabies.
Pathophysiology
Chosidow (2012) as cited by Mila-Kierzenkowska et al. (2017), stated that it only takes 15-20 minutes for the scabies mite to transfer to another person by skin-to-skin contact. After coupling, the femaleSarcoptes scabiei holes itself to the outer layer of the person’s skin, lays eggs, turns into a larva and becomes full grown in 10-14 days. Patients could remain asymptomatic in 2-4 weeks, as the incubation period is long. There would be severe itching especially at night, appearance of papules; nodules and vesicles related the body’s allergic reaction to the feces, saliva and the mites itself. Crusted scabies could contain millions of colonizing mites particularly in between spaces of the fingers, the anterior portion wrist joint, elbows, armpits, umbilicus, waistline, nipples, buttock, and shaft of the penis. In children, areas of infestation appear from the neck up, proximal areas of the hands and plantar areas of the feet.
Physical Assessment and Examination
In the naked eye, there would be papules, vesicles or dry scabs in diffuse areas of the body. A triangular formation, trailed by a hole, was deemed to indicate the presence of a mite infestation. A dermoscope is used to scrape the skin with the triangular formation after the application of one drop of mineral oil. It is done in areas where the mite burrows are often found. Sites are the digits of the hand, in between fingers, side of the wrists, armpits, palms of the hand, umbilicus, buttocks and the genital area. A person is 100% positive for scabies if mites, eggs or stool of mites are found in the scraped skin using the dermoscopic examination (Park, Kim, Kim & Her, 2015).
Evidence-Based Treatment Plan
There is no drug of choice for treating scabies at this time but for acute cases of scabies infestation, topical scabicidal agent permethrin 5 % cream is considered more effective on first and second applications. It is applied on day 1 and day 10 on affected areas and washed off with soap and water after 8 hours. It is found to be more expensive compared to crotamiton lotion, which is another alternative treatment. Crotamiton on the other hand is applied to the affected parts of the body and is washed off with soap and water after 24h. Another medication lindane is one of the medications for scabies but is found to be neurotoxic and is not safe for pregnant patients and children over two months. There is an oral alternative to topical applications, which is called ivermectin according to Mounsey and McCarthy 2013 as cited in Mila-Kierzenkowska et al. (m2017). When patients come back for follow up and there is no itching or scabs, a repeat dermoscopic examination is done. If there is no evidence of mites, feces and saliva in the skin scrapings, the patient is considered healed.
Patient Education
Patient is should see a dermatologist for follow up. If unable to book an appointment with the consultant, follow up with primary care provider after day 10 for skin check up. Patients are advised to change linens and wash it with hot water to kill the mites during active infestation. Discontinue use of permethrin if signs of difficulty breathing, appearance of rash other than the scabs in body are evident. Permethrin is safe for pregnant women and children over 2 months old (Ferri, 2018).
Evaluation
Patients should follow up with the provider 2-4 weeks after the scabies has resolved for a through skin evaluation.
References
Chosidow, O., & Fuller, L. C. (2017). Scratching the itch: Is scabies a truly neglected disease? The Lancet Infectious Diseases, 17(12), 1220-1221. http://dx.doi.org.lib.kaplan.edu/10.1016/S1473-3099(17)30469-3
Ferri, F.F. (2018). Ferri’s clinical advisor. Philadelphia, PA: Elsevier
Mila-Kierzenkowska, C., Woźniak, A., Krzyżyńska-Malinowska, E., Kałużna, L., Wesołowski, R., Poćwiardowski, W., & Owcarz, M. (2017). Comparative efficacy of topical permethrin, crotamiton and sulfur ointment in treatment of scabies. Journal Of Arthropod-Borne Diseases, 11(1), 1-9.
Park, S. E., Kim, S. S., Kim, C. W., & Her, Y. (2015). Efficacy and safety of a lindane 1% treatment regimen for scabies, confirmed by dermoscopy-guided skin scraping with microscopic examination. Clinical & Experimental Dermatology, 40(6), 611-616. doi:10.1111/ced.12643
