Scabies Rash

Scabies Rash - This information is aimed primarily at doctors / physicians and healthcare professionals.

Scabies Symptoms
Scabies mites are ectoparasites of host specificity for humans. They are distributed worldwide. In sporadic cases of disease mainly affects young adults, in the context of clusters - especially in family and community services of all kinds, and health care facilities - ill people of all ages, including toddlers and infants. The spread is favored by poor socioeconomic conditions and poor sanitation. In northern Europe the risk of spread of scabies in the autumn and winter is greater than at other seasons.

Transmission paths
Transmission occurs primarily through prolonged close physical contact directly, but was also detected in short contacts. Occasionally the mites are also indirectly transmitted via clothing, bedding, mattresses, towels, rugs, blankets, pillows, stuffed animals, etc..
Even the skin adhesion of a mated female mite is sufficient to develop a scab.

Development
The sexually mature female mites (size 0.2 - 0.5 mm) dig parallel to the skin surface through the stratum corneum to the lower edge of the epidermis and insert into this dead end Bohrgängen (1-10mm length) 1-2 eggs daily. The on 3-4. Days from developing larvae burrow to the outside, mature into nymphs and develop within 12-15 days to adult mites. Males and females copulate in so-called drilling ashes before the females begin with the installation of Bohrgängen. Create a day, the females 0.5-5mm Bohrgangslänge. The entire development cycle takes about 9-14 days for males and 12-21 days for females. The latter produce in their lifetime for an average of 40-50 eggs (size from 0.16 to 0.19 x 0.08 - 0.1 mm), their life at 1-2 months. As a rule, are present in infected individuals only about 10 to 50 live female mites, in cases with a particularly heavy infestation in immunocompromised (Scabies norwegica, syn. Scabies scabies scabies or scabs) but it can be several hundred. Extracorporeal survival depends strongly on temperature and humidity. Scabies mites survive at room temperature for 24-36 hours in clothing, bedding, upholstered furniture or carpeting on, at 12 ° C and humidity even up to 14 days. The Immobilitätsgrenze located at 16 ° C.

Disease
In Erstbefall occur after an incubation period of two to six weeks of intense itching and slight burning on. This is a result of the drilling activity of the mite in a warm bed, especially at night particularly distressing. The clinical presentation typically runs in two phases. Primarily it is due to local skin damage caused by the mites increase in the formation of large pin-head vesicles, pustules, erythematous papules on up. Common sites here are the hands (especially the interdigital space) flexures of the wrists, anterior axillae, breasts, groin and penis, in principle, burrows, but may occur in all parts of the body except the face and scalp. By scratching effects, it may result in bacterial superinfection and abscess formation, and lymphangitis.
A few weeks later, a second phase of the disease can be observed by an allergic reaction to the excrement of the mites or their death is characterized by decaying bodies. This generalized skin rash (Sekundärexanthem) occurs frequently perimamillär and the back of your hand.
In the case of an impaired immune system and / or deficiency diseases are highly contagious to the image of, or not at all itchy just weak, but strong dandruff and scabs are accompanied Scabies norwegica. Their crusty lesions affecting v.a. the fingers, back and root as well as the elbow, and there are fissures on the extensor surfaces of the extremities.

Diagnosis
Scabies is suspected in any person with the above Skin lesions and inexplicably strong (nocturnal) itching. The diagnosis is made by looking for evidence of skin scrapings and mites Bohrgängen with the help of a strong magnifying glass. In unclear cases, a dermatologist should be consulted.

Scabies Treatment
The treatment is carried out by means of killing the mites topically or systemically administered in serious cases, anti-itch preparations.
In general, the treatment begins with a Ganzkörperbad (at p norwegica must also be a hornschichterweichende treatment). Before applying, the skin must be scabicides but dry and cool. For local therapy products are based on permethrin, allethrin, benzyl benzoate, crotamiton and Präzipitatschwefel available. You should be in accordance with manufacturer's instructions with the involvement of the whole body - with the exception of the face and scalp applied before bedtime - especially the body folds and nail region. In some cases, one or more repeat treatments may be required (see the package insert!). The treatment of pregnant women, nursing mothers, infants and young children should always be done under medical supervision.
Agent for oral therapy in Germany for the treatment of scabies is not currently registered. The insecticide ivermectin is effective antihelminthisch and therefore individual responsibility of the prescribing physician who is an international pharmacy refer to.

Additional important measures
Body and underwear and bed linen should be every 12-24 hours, towels are changed twice daily. The worn during treatment and to be renewed through the skin sleepwear must be impregnated after a few days, since the residual effect of the pesticide sufficient to make the mite infestation incompetent. For bedding, towels and clothes washing at normal 60 ° C is sufficient. Non-washable fabrics can e.g. be at least seven-day airing outdoors, chemical cleaning or treated for up to 14-day detention in plastic bags, so the mites lose their invasiveness. Upholstered furniture, beds and floor coverings should be thoroughly cleaned with a powerful vacuum cleaner. Stuffed animals, shoes and other small items can be made free of mites by freezing.
This o.g. Measures are almost always sufficient to allow the use of chemicals for pest control the environment in general is not required.
Important principles are the information and simultaneous co-treatment of all persons with close physical contact (family members, sexual partners) and repeating the treatment after one week. After a follow-up should be done.
Within a community or health facility to isolate the affected persons to the effect of treatment (24 h after the start) is desirable, in the highly contagious scabies scabies should be made in each case.

Statutory provisions
According to § 34 of the Infection Protection Act (Infection Protection Act), no person with scabies infected or that are suspicious in institutions for the care of infants, children and young people (community facilities in accordance with § 33 of the Infection Protection Act), no teaching, education, care, supervision or perform other activities in which they have contact with their care there is to the physician's judgment (certificate) is a risk of further spread of scabies not through it. The same applies to the unit assisted in the community, which may not enter the operation of the facility serving spaces and not participating in events organized by the Community body, even to them poses no proliferation danger. The granting of permission to re-visit the institution, the absence of viable infestation scabies mites is crucial. Proven mites and finding freedom is only lethal damaged mites therefore the surest criterion for ending the danger of infection. If for example are already within half a day after the first application of a suitable means of proof Scabies mites do not live longer, and the recommended support measures were implemented properly, there is no reason, the person concerned to visit the community to deny establishment of longer than one day. Provided the proper continuation of the treatment and hygiene measures, after a performance review to be certified in an appropriate distance, the final mites freedom by the attending physician. The healing of skin lesions, however, can still take days to weeks after completion of therapy in antiscabiösen claim.
Upon notification of the occurrence of scabies is suspected, or the person concerned or worried owners have to immediately inform the leadership of the Community body. The latter in turn informed by providing personal information without delay the competent health authority. The health department may impose on the management of the Community body does not order a roll-call announcement of the suspected disease or scabies. Persons in the public areas according to teaching, education, nursing, exercise supervisory or other activities on a regular basis and contact with the then assisted have are before first taking up their duties, and thereafter at least every two years from their to educate employers about the health requirements and obligation to cooperate under.
Community facilities, outpatient and inpatient medical care and nursing homes, dormitories, and correctional facilities put in hygiene plans in-house procedures to determine infection hygiene and thus protect against scabies. The infection-hygienic monitoring of these facilities lies with the relevant health authority

Scabies Pictures