[7] Scabies Flashcards

1
Q

What is scabies?

A

An itchy rash caused by the parasitic mite Sarcoptes scabiei

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2
Q

How do scabies mites colonise the skin?

A

They mate on the skin surface, the male dies and the female tunnels into the epidermis and deposits eggs along the burrow

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3
Q

How long does it take for scabies mite eggs to develop from eggs to adult mites?

A

10-15 days

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4
Q

What happens once scabies mites develop into adults?

A

They return to the surface and mate again

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5
Q

What is the life-span of scabies mites?

A

4-6 weeks

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6
Q

How are scabies mites classically transmitted?

A

Via direct skin contact

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7
Q

How can crusted scabies be transmitted?

A

Via bedding, towels, clothes and furniture

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8
Q

What causes the symptoms of scabies?

A

Allergic reaction to the host’s body to mite proteins

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9
Q

What are the risk factors for scabies?

A
  • Overcrowding
  • Poverty and poor nutritional status
  • Homelessness
  • Poor hygiene
  • Dementia
  • Sexual contact
  • Immunosuppression
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10
Q

What is the first period of scabies infection?

A

Asymptomatic infection

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11
Q

After what period do scabies symptoms develop in primary infection?

A

3-4 weeks

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12
Q

What are the characteristic features of scabies?

A
  • Intense itching

- Superficial burrows

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13
Q

When is the itching due to scabies worst?

A

At night and when the person is warm

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14
Q

How do the burrows of scabies mites often appear?

A

As linear lesions with rows of erythematous papular or vesicular lesions

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15
Q

What additional skin lesions can be seen in scabies?

A
  • Widespread, symmetrical, itchy, papular eruptions around axillae, peri-areolar, abdomen, buttocks and thighs
  • Excoriation marks
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16
Q

What is crusted scabies also known as?

A

Norwegian scabies

17
Q

What is crusted scabies?

A

A hyper-infestation of mites which presents as exfoliating scales

18
Q

Who is most at risk of crusted scabies?

A
  • Elderly
  • Immunocompromised
  • Decreased peripheral sensation
19
Q

How does crusted scabies appear?

A

Hyperkeratotic lesions affecting the hands, feet, nails, scalp and ear

20
Q

What secondary symptoms may be associated with crusted scabies?

A
  • Lymphadenopathy
  • Eosinophilia
  • Secondarily infected lesions
21
Q

Why is crusted scabies more concerning than classical scabies?

A
  • Very contagious

- More difficult to eradicate

22
Q

How is scabies diagnosed?

A

Clinically

23
Q

What additional techniques may help identify scabies?

A
  • Magnifying lens of burrows

- Ink burrow test

24
Q

How can diagnosis of scabies be confirmed?

A

Take skin scraping form the affected areas

25
What are the differentials for scabies?
- Seborrhoeic dermatitis - Dermatitis herpetiformis - Pediculosis - Atopic dermatitis
26
What is the primary method of scabies treatment?
Topical application of parasiticidal preparation overnight on the whole body (including between fingers, toes and under nails)
27
When should parasiticidal preparation be re-applied for scabies?
A week after first application
28
What is the first-line parasiticidal preparation for scabies?
Permethrin 5% dermal cream
29
How does permethrin treatment differ for crusted scabies?
May require 2 or 3 applications on consecutive days to penetrate hyperkeratotic areas
30
What further steps should be taken to eradicate scabies?
Wash towels, clothes and bed-linen
31
Who else should be treated for scabies in addition to the index patient?
- Household members - Close contacts - Sexual contacts
32
When should contacts of the index patient be treated for scabies?
Simultaneously to reduce risk of re-infestation
33
When should treatment failure for scabies be assumed?
If symptoms persist beyond 6 weeks from first applications
34
What are the potential complications of scabies?
- Flaring or reactivation of eczema or psoriasis - Secondary bacterial infection - Social stigma and psychological harm