101
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Putra IB, Jusuf NK. Scabies with Secondary Infection Resembling Kerion-Type Tinea Capitis. Int J Gen Med 2021; 14:163-167. [PMID: 33488115 PMCID: PMC7815080 DOI: 10.2147/ijgm.s290648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 12/23/2020] [Indexed: 11/23/2022] Open
Abstract
Scabies is an infestation caused by the mite Sarcoptes scabiei var hominis. The clinical picture can vary and in children, scabies occurs in locations that are not usually found in adults. Complications can occur due to secondary impetiginization of scabies lesions. We presented a case of 8-year-old boy with painful red lumps, pus discharge, and alopecia on the back of the head since 2 weeks ago. Dermatological examination revealed multiple erythematous nodules with sinuses in the scalp of the parieto-occipital area and alopecia. Through microscopic examination we found the Sarcoptes scabiei mite; therefore, we conclude that the diagnosis in this patient was impetigenic scabies. Treatment with topical permethrin 5%, oral antihistamine and oral antibiotics resulted in good outcome.
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Affiliation(s)
- Imam Budi Putra
- Department of Dermatology and Venerology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Nelva Karmila Jusuf
- Department of Dermatology and Venerology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
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102
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Weill A, Bernigaud C, Mokni M, Gil S, Elefant E, Chosidow O. Scabies-infested pregnant women: A critical therapeutic challenge. PLoS Negl Trop Dis 2021; 15:e0008929. [PMID: 33411710 PMCID: PMC7790223 DOI: 10.1371/journal.pntd.0008929] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Amandine Weill
- Service de Dermatologie, Hôpital Henri Mondor, AP-HP, Université Paris-Est, Créteil, France
- Groupe de recherche Dynamyc, EA7380, Faculté de Santé de Créteil, École nationale vétérinaire d’Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
- Fondation PremUp, Paris, France
- * E-mail: (AW); (CB)
| | - Charlotte Bernigaud
- Service de Dermatologie, Hôpital Henri Mondor, AP-HP, Université Paris-Est, Créteil, France
- Groupe de recherche Dynamyc, EA7380, Faculté de Santé de Créteil, École nationale vétérinaire d’Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
- * E-mail: (AW); (CB)
| | - Mourad Mokni
- Service de Dermatologie, Hôpital La Rabta, Faculté de Médecine, Université al Manar 2, Laboratoire de Recherche Infection et Santé Publique LR18SP01, Tunis, Tunisie
| | - Sophie Gil
- Fondation PremUp, Paris, France
- Université de Paris, INSERM, UMR-S 1139, 3PHM, Paris, France
| | - Elisabeth Elefant
- Centre de Référence sur les Agents Tératogènes (CRAT), Hôpital Armand Trousseau, AP-HP, Sorbonne Université, Paris, France
| | - Olivier Chosidow
- Service de Dermatologie, Hôpital Henri Mondor, AP-HP, Université Paris-Est, Créteil, France
- Groupe de recherche Dynamyc, EA7380, Faculté de Santé de Créteil, École nationale vétérinaire d’Alfort, USC ANSES, Université Paris-Est Créteil, Créteil, France
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103
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Koley S, Datta J, S K SA, Tarafdar D. Scabies involving palms in older children and adults: a changing scenario. Int J Dermatol 2021; 60:605-610. [PMID: 33393684 DOI: 10.1111/ijd.15383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/31/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
Scabies is a highly contagious, intensely pruritic skin infestation caused by Sarcoptes scabiei var hominis. It has high prevalence in many tropical countries where crowded people live in resource-poor settings. The rash is distributed differently in adults and children. Adults manifest lesions primarily on the interdigital web spaces of the hands, flexor aspects of the wrists, dorsal feet, axillae, elbows, waist, buttocks, and genitalia. Palms (along with soles and head) are commonly involved in infants and very young children but typically absent in older age groups. Here, we report 25 older children and adult patients with scabies including involvement of the palms. If patients are left untreated for long periods of time in hot tropical climates, scabies may produce severe infestation with involvement of palms in older children and adults. We should acknowledge palms as potential body sites whose involvement warrants early and aggressive treatment in scabies.
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Affiliation(s)
- Sankha Koley
- Department of Dermatology, Bankura Sammilani Medical college, Bankura, India
| | - Jayanti Datta
- Department of Dermatology, Bankura Sammilani Medical college, Bankura, India
| | - Shahriar Ahmed S K
- Department of Dermatology, Bankura Sammilani Medical college, Bankura, India
| | - Dhiman Tarafdar
- Department of Dermatology, Bankura Sammilani Medical college, Bankura, India
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104
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Neumaier LFT, Chemello D, Chemello RML. Disseminated crusted scabies in an elderly patient. Rev Soc Bras Med Trop 2021; 54:e03482020. [PMID: 33338113 PMCID: PMC7747813 DOI: 10.1590/0037-8682-0348-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/11/2020] [Indexed: 11/22/2022] Open
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105
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Ankad B, Koti V, Mahajabeen S, Nikam B. Dermoscopic evaluation of crusted scabies: A case report. INDIAN JOURNAL OF DERMATOPATHOLOGY AND DIAGNOSTIC DERMATOLOGY 2021. [DOI: 10.4103/ijdpdd.ijdpdd_42_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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106
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Li FZ, Chen S. Diagnostic Accuracy of Dermoscopy for Scabies. THE KOREAN JOURNAL OF PARASITOLOGY 2020; 58:669-674. [PMID: 33412771 PMCID: PMC7806431 DOI: 10.3347/kjp.2020.58.6.669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 10/25/2020] [Indexed: 12/03/2022]
Abstract
The diagnostic accuracy of dermoscopy (DS) for scabies, a highly contagious parasitic disease, remains disputed. This study aimed to assess the diagnostic accuracy of DS in scabies, analyze the factors influencing DS, and explore its role in post-treatment evaluation. Patients with suspected scabies were randomly divided into 2 groups: 71 patients in the skin scraping (SS) group and 73 patients in the DS group. The diagnostic efficiencies of SS and DS in these groups were calculated. We also analyzed the influence of body part and investigator competence on the accuracy of DS. Then 16 body parts with typical signs of scabies were monitored by DS 2 and 4 day after sulfur ointment treatment. The sensitivity and specificity of DS were 98.3% and 88.5%, respectively. Hands, arms, and the abdomen had higher positivity rates than other body parts (P<0.001). The accuracy of dermatologists’ interpretations of images negative for scabies in the intermediate- and high-level groups was higher than that in the low-level group (P<0.001). At follow-up, the mites were still visible on 43.8% to 62.5% of the skin lesions 2 and 4 day after sulfur ointment treatment. These results showed that DS could significantly increase the accuracy of diagnosing scabies owing to its high sensitivity and specificity. Therefore, it may be useful for monitoring clinical responses to anti-parasitic treatment.
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Affiliation(s)
- Feng-Zeng Li
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Shuang Chen
- Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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107
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A scabies outbreak in the North East Region of Ghana: The necessity for prompt intervention. PLoS Negl Trop Dis 2020; 14:e0008902. [PMID: 33351803 PMCID: PMC7787682 DOI: 10.1371/journal.pntd.0008902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 01/06/2021] [Accepted: 10/19/2020] [Indexed: 02/05/2023] Open
Abstract
Background There is a dearth of data on scabies from Ghana. In September 2019, local health authorities in the East Mamprusi district of northern Ghana received reports of scabies from many parts of the district. Due to on-going reports of more cases, an assessment team visited the communities to assess the effect of the earlier individual treatment on the outbreak. The assessment team furthermore aimed to contribute to the data on scabies burden in Ghana and to demonstrate the use of the International Alliance for the Control of Scabies (IACS) diagnostic tool in a field survey in a resource limited setting. Methodology/Principal findings This was a cross sectional study. Demographic information and medical history was collected on all participants using a REDCap questionnaire. A standardised skin examination of exposed regions of the body was performed on all participants. Scabies was diagnosed based on the criteria of the International Alliance for the Control of Scabies (IACS). Participants were mostly female (61.5%) and had a median age of 18.8 years (IQR 13–25). Two hundred out of 283 (71%) of participants had scabies with most (47%) presenting with moderate disease. Impetigo was found in 22% of participants with scabies and 10.8% of those without scabies [RR 2.27 (95% CI 1.21–4.27)]. 119 participants who received scabies treatment in the past months still had clinical evidence of the disease. 97% of participants reported a recent scabies contact. Scabies was commoner in participants ≤16 years compared to those >16 years [RR 3.06 (95% CI 1.73–5.45)]. Conclusion/Significance The prevalence of scabies was extremely high. The lack of a systematic approach to scabies treatment led to recurrence and ongoing community spread. The IACS criteria was useful in this outbreak assessment in Ghana. Alternative strategies such as Mass drug administration may be required to contain outbreaks early in such settings. Scabies, recently categorised as a Neglected Tropical Disease by the WHO is caused by infestation with Sarcoptes scabiei and is characterised by intense pruritus and rash that typically involves the genitalia and the web spaces of the fingers and toes. It has a large global burden and is associated with significant morbidity and socio-economic burden. Secondary bacterial infections following scabies can lead to significant complications including chronic kidney disease from glomerulonephritis and possibly rheumatic heart disease. An outbreak of scabies was reported in Ghana’s East Mamprusi district in September 2019. Despite earlier treatment of individual cases, scabies prevalence was 71%. About 19% of participants had impetigo which was mostly mild in severity. Absence of a systematic approach to treat scabies led to recurrence and ongoing community spread. The recently published IACS criteria for diagnosing scabies proved useful in this outbreak assessment in Ghana. Alternative strategies such as Mass drug administration may be required to contain outbreaks in such settings.
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108
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Morgado-Carrasco D, Fustà-Novell X, Rizo D, Alsina M. Slowly Spreading Scabies With a Diagnosis Confirmed by Confocal Reflectance Microscopy: New Technologies for Diagnosis. ACTAS DERMO-SIFILIOGRAFICAS 2020; 112:271-273. [PMID: 33130014 DOI: 10.1016/j.ad.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 09/20/2019] [Accepted: 10/05/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- D Morgado-Carrasco
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - X Fustà-Novell
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - D Rizo
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España
| | - M Alsina
- Servicio de Dermatología, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, España.
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109
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Engelman D, Yoshizumi J, Hay R, Osti M, Micali G, Norton S, Walton S, Boralevi F, Bernigaud C, Bowen A, Chang A, Chosidow O, Estrada‐Chavez G, Feldmeier H, Ishii N, Lacarrubba F, Mahé A, Maurer T, Mahdi M, Murdoch M, Pariser D, Nair P, Rehmus W, Romani L, Tilakaratne D, Tuicakau M, Walker S, Wanat K, Whitfeld M, Yotsu R, Steer A, Fuller L. The 2020 International Alliance for the Control of Scabies Consensus Criteria for the Diagnosis of Scabies. Br J Dermatol 2020; 183:808-820. [PMID: 32034956 PMCID: PMC7687112 DOI: 10.1111/bjd.18943] [Citation(s) in RCA: 109] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Scabies is a common parasitic skin condition that causes considerable morbidity globally. Clinical and epidemiological research for scabies has been limited by a lack of standardization of diagnostic methods. OBJECTIVES To develop consensus criteria for the diagnosis of common scabies that could be implemented in a variety of settings. METHODS Consensus diagnostic criteria were developed through a Delphi study with international experts. Detailed recommendations were collected from the expert panel to define the criteria features and guide their implementation. These comments were then combined with a comprehensive review of the available literature and the opinion of an expanded group of international experts to develop detailed, evidence-based definitions and diagnostic methods. RESULTS The 2020 International Alliance for the Control of Scabies (IACS) Consensus Criteria for the Diagnosis of Scabies include three levels of diagnostic certainty and eight subcategories. Confirmed scabies (level A) requires direct visualization of the mite or its products. Clinical scabies (level B) and suspected scabies (level C) rely on clinical assessment of signs and symptoms. Evidence-based, consensus methods for microscopy, visualization and clinical symptoms and signs were developed, along with a media library. CONCLUSIONS The 2020 IACS Criteria represent a pragmatic yet robust set of diagnostic features and methods. The criteria may be implemented in a range of research, public health and clinical settings by selecting the appropriate diagnostic levels and subcategories. These criteria may provide greater consistency and standardization for scabies diagnosis. Validation studies, development of training materials and development of survey methods are now required. What is already known about this topic? The diagnosis of scabies is limited by the lack of accurate, objective tests. Microscopy of skin scrapings can confirm the diagnosis, but it is insensitive, invasive and often impractical. Diagnosis usually relies on clinical assessment, although visualization using dermoscopy is becoming increasingly common. These diagnostic methods have not been standardized, hampering the interpretation of findings from clinical research and epidemiological surveys, and the development of scabies control strategies. What does this study add? International consensus diagnostic criteria for common scabies were developed through a Delphi study with global experts. The 2020 International Alliance for the Control of Scabies (IACS) Criteria categorize diagnosis at three levels of diagnostic certainty (confirmed, clinical and suspected scabies) and eight subcategories, and can be adapted to a range of research and public health settings. Detailed definitions and figures are included to aid training and implementation. The 2020 IACS Criteria may facilitate the standardization of scabies diagnosis.
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110
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Deleuran M, Georgescu V, Jean-Decoster C. An Emollient Containing Aquaphilus dolomiae Extract is Effective in the Management of Xerosis and Pruritus: An International, Real-World Study. Dermatol Ther (Heidelb) 2020; 10:1013-1029. [PMID: 32666271 PMCID: PMC7477020 DOI: 10.1007/s13555-020-00415-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Xerosis and pruritus are common manifestations of numerous dermatologic and systemic diseases. We evaluated the effectiveness of an emollient containing an Aquaphilus dolomiae extract (ADE-G1) for the management of pruritus and xerosis in patients of all age with a range of dermatologic and systemic diseases. METHODS This open-label, real-world study involved 5910 patients from 33 European, South American, Asian, and North and South African countries, who applied the product for 7 days twice daily to the face and body after the skin had been cleansed and dried. The physician assessed xerosis severity and patients assessed pruritus severity, the duration of itch, sleep quality, and the impact of their skin disease on their quality of life, using scales derived from the SCORing Atopic Dermatitis (SCORAD) index and questionnaires, at inclusion and after 7 days of use. RESULTS The 7-day care regimen resulted in 56% and 60% reductions in xerosis and pruritus severity, respectively, regardless of the underlying pathology (p < 0.0001), with the largest decreases observed for patients with ichthyosis for xerosis and for patients post scabies treatment for pruritus. The mean sleep disturbance and mean total Dermatology Life Quality Index (DLQI) scores were also reduced by 58% and 60% (p < 0.0001), respectively. The emollient was effective whether the product was used alone or in combination with topical or systemic treatments and was well tolerated. CONCLUSION Our study shows that the 7-day regimen with the emollient was a universally effective treatment for pruritus and xerosis, regardless of the underlying pathology.
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Affiliation(s)
- Mette Deleuran
- Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark
| | - Victor Georgescu
- Laboratoires Dermatologiques Avène, Pierre Fabre Dermo-Cosmétique, Lavaur, France
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111
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Abstract
BACKGROUND Scabies is globally ubiquitous and is a significant health issue for institutions, the economically disenfranchised, resource-poor areas, and for those with weakened immune systems. Topicals are usually effective, but are cumbersome and expensive to use in large populations and for those nonadherent to topicals. Oral ivermectin became available in Canada for the off-label treatment of scabies in the fall 2018. OBJECTIVES To review the diagnosis and management of scabies. Dose schedules and concomitant management measures are outlined for scabies simplex and for crusted scabies. Ivermectin use is outlined. METHODS Medline, colleague discussions, practice review, and experience from managing scabies in institutions. RESULTS Oral ivermectin is safe, easier to use, cheaper, more effective, and more economical than topicals in widespread institutional scabies, for those nonadherent to topicals, and in crusted scabies. CONCLUSIONS Oral ivermectin is the treatment of choice in large populations, the nonadherent, and for crusted scabies. Oral ivermectin is produced by Merck Canada as Stromectol 3 mg. The treatment dose for noncrusted scabies is 200 µg/kg, taken in a single dose with food. For example, 15 mg (5 tablets) for a 70 kg person. Retreat in 10-14 days to enhance effectiveness, and perhaps to reduce scabicide resistance.
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Affiliation(s)
- Robert N Richards
- 8613 Departments of Medicine, North York General Hospital and Baycrest Health Sciences, Courtesy Staff Dermatology, Toronto, ON, Canada
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112
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Kim M, Kim SK, Hong MJ, Kwak SH, Kim EO, Bae M, Kim MJ, Lee WJ, Kim SH, Jung J, Chang SE. Importance of Follow-Up Microscopic Examination in Hospitalized Patients with Confirmed Scabies. Am J Trop Med Hyg 2020; 103:2539-2541. [PMID: 32996448 DOI: 10.4269/ajtmh.20-0318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We investigated the duration of positive microscopic examination in hospitalized patients with confirmed scabies in an acute care hospital. We included hospitalized patients who were diagnosed with scabies between January 2015 and June 2019. From the study period, a total of 31 patients with confirmed scabies were identified. Median age was 75 years. Of a total of 31 patients with confirmed scabies, six were discharged or transferred before getting a negative microscopic test result. Of the remaining 25 patients with negative microscopic test results, the median duration from diagnosis to a negative microscopic test result was 14 days (interquartile range, 9-17). Given that nosocomial outbreaks lead to high workload and considerable resource consumption, adequate treatment, sufficient follow-up examination, and confirmation of cure are warranted before releasing contact isolation.
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Affiliation(s)
- Miseo Kim
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - Sun-Kyung Kim
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - Min Jee Hong
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - Sun Hee Kwak
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - Eun Ok Kim
- Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - Moonsuk Bae
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Min Jae Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - Jiwon Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.,Office for Infection Control, Asan Medical Center, Seoul, Republic of Korea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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113
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Heo JY, Park TH, Kim WI, Cho MK, Kim S. Debulking scales can be helpful in treating recalcitrant crusted scabies. Dermatol Ther 2020; 33:e14113. [PMID: 32735071 DOI: 10.1111/dth.14113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/22/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Jae Young Heo
- Department of Dermatology, Soonchunhyang University Hospital, Seoul, South Korea
| | - Tae Heum Park
- Department of Dermatology, Soonchunhyang University Hospital, Seoul, South Korea
| | - Woo Il Kim
- Department of Dermatology, Soonchunhyang University Hospital, Seoul, South Korea
| | - Moon Kyun Cho
- Department of Dermatology, Soonchunhyang University Hospital, Seoul, South Korea
| | - Sooyoung Kim
- Department of Dermatology, Soonchunhyang University Hospital, Seoul, South Korea
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114
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Melo ED, Ribas CBDR, Encarnação ICL. Digital dermoscopy: a complementary method in the diagnosis of scabies. An Bras Dermatol 2020; 95:638-640. [PMID: 32651044 PMCID: PMC7563001 DOI: 10.1016/j.abd.2019.11.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/30/2019] [Indexed: 11/18/2022] Open
Abstract
Scabies is an ectoparasitosis caused by Sarcoptes scabiei var. hominis, characterized clinically by pruritic lesions in typical locations; the crusted form is a rare manifestation. The diagnosis is usually established based on the clinical picture, but dermoscopy can be an important complementary method, as it allows the observation of a brownish triangular structure with a hang-glider appearance. A case of crusted scabies is reported; the magnification of the images obtained by digital dermoscopy allowed the demonstration of a structure usually observed only with videodermoscopy.
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Affiliation(s)
- Elaine Dias Melo
- Teaching and Research Department, Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil.
| | - Carla Barros da Rocha Ribas
- Pediatric Dermatology Clinic, Fundação de Dermatologia Tropical e Venereologia Alfredo da Matta, Manaus, AM, Brazil
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115
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Arora P, Rudnicka L, Sar-Pomian M, Wollina U, Jafferany M, Lotti T, Sadoughifar R, Sitkowska Z, Goldust M. Scabies: A comprehensive review and current perspectives. Dermatol Ther 2020; 33:e13746. [PMID: 32484302 DOI: 10.1111/dth.13746] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/17/2020] [Accepted: 05/28/2020] [Indexed: 02/06/2023]
Abstract
Human scabies is a contagious skin infestation caused by the parasitic mite Sarcoptes scabiei var. hominis. It is a common skin disease worldwide that occurs not only in the underprivileged sections of society but also in developed countries. In 2009, World Health Organization (WHO) recognized scabies as "neglected tropical disease (NTD)" or NTD thus emphasizing the need for community awareness and proper treatment strategies. This review attempts to summarize the varied clinical presentation of the disease and describes the advances in diagnosis and management including the ongoing search for novel agents to overcome the problems associated with conventional treatments. The literature research includes peer-reviewed articles (clinical trials or scientific reviews). Studies were identified by searching electronic databases (MEDLINE and PubMed) till February 2020 and reference lists of respective articles. Only articles published in English language were included.
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Affiliation(s)
- Pooja Arora
- Department of Dermatology, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Marta Sar-Pomian
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital of the Technical University of Dresden, Dresden, Germany
| | - Mohammad Jafferany
- College of Medicine, Central Michigan University, Saginaw, Michigan, USA
| | - Torello Lotti
- University of Studies Guglielmo Marconi, Rome, Italy
| | | | - Zuzanna Sitkowska
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Mohamad Goldust
- University of Rome G. Marconi, Rome, Italy.,Bidar Skin Center, Tehran, Iran.,Department of Dermatology, University Medical Center Mainz, Mainz, Germany.,Department of Dermatology, University Hospital Basel, Basel, Switzerland
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116
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Sechi A, Chessa MA, Patrizi A, Savoia F, Neri I. Periungual scabies in infants: a tough reservoir of mites presenting with lamellar desquamation. Arch Dis Child 2020; 105:703. [PMID: 30850380 DOI: 10.1136/archdischild-2019-316890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Andrea Sechi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Marco Adriano Chessa
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Francesco Savoia
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Iria Neri
- Division of Dermatology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
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117
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Ständer S, Kirschstein DJ, Kohl-Sobania M, Zillikens D, Ludwig RJ, Anemüller W. Effectiveness and adverse events of ivermectin treatment for scabies in 30 infant patients: report from a German single centre. J Eur Acad Dermatol Venereol 2020; 34:e736-e737. [PMID: 32339346 DOI: 10.1111/jdv.16554] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/15/2020] [Accepted: 04/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
- S Ständer
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - D J Kirschstein
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - M Kohl-Sobania
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | - D Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany.,Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
| | - R J Ludwig
- Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany.,Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - W Anemüller
- Department of Dermatology, University of Lübeck, Lübeck, Germany
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118
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[Increase of scabies and therapy resistance among German military personnel : An 8-year follow-up study in the Department of Dermatology of the Armed Forces Hospital Berlin, Germany (2012-2019)]. Hautarzt 2020; 71:447-454. [PMID: 32430543 DOI: 10.1007/s00105-020-04608-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The diagnosis of scabies has become surprisingly frequent in Germany in recent years and the use of scabicides has risen significantly. OBJECTIVE The aim of our survey was to determine whether this trend can also be detected among military personnel of the German Armed Forces (Bundeswehr). METHODS The study was conducted as a retrospective single-center study over a period of 8 years from 2012 to 2019 in the Department of Dermatology of the Armed Forces Hospital Berlin, Germany. Data were generated from the hospital information system (KIS), which was searched for all scabies-coded diagnoses according to ICD10 code B86 both as outpatients and inpatients. Only first presentations with scabies diagnosis confirmed by dermoscopy or microscopy by a dermatologist were included. Inpatient treatment was required if a patient was not cured after at least three antiscabies treatment cycles in the outpatient setting. RESULTS The data show that there has been a steady increase in the diagnosis of scabies in Bundeswehr personnel. Moreover, our data show that the number of unsuccessfully treated outpatients increased and required in-hospital treatment. CONCLUSION We observed an increase of scabies among German military personnel who represent a typical at-risk group. These results support the observations of an increased incidence of scabies in Germany in general and especially in an at-risk population. With the general increase in scabies cases, there are also increasing numbers of German military personnel who are refractory to treatment, which was largely attributed to inadequate treatment of contact persons and individual treatment errors. Nevertheless, the data also emphasize the low overall prevalence of scabies; therefore, all diagnoses should be confirmed by dermoscopy or microscopy after 14 days whenever possible to rule out the bias of overreporting due to false-positive cases diagnosed only by clinical examination.
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119
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Senterre Y, Jouret G, Collins P, Nikkels AF. Risankizumab-Aggravated Crusted Scabies in a Patient with Down Syndrome. Dermatol Ther (Heidelb) 2020; 10:829-834. [PMID: 32378153 PMCID: PMC7367983 DOI: 10.1007/s13555-020-00386-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Indexed: 12/20/2022] Open
Abstract
Risankizumab, an interleukin (IL)-23 antagonist, is a highly effective treatment for moderate to severe psoriasis. Crusted scabies (CS) is a rare and severe form of scabies, occurring mainly in immunosuppressed patients and/or neurologically or mentally ill patients. A young girl with Down syndrome was diagnosed with a hyperkeratotic form of psoriasis. As treatment with topical dermocorticosteroids, UVB-phototherapy and acitretin for 6 weeks did not improve the lesions, two injections of risankizumab were administered. Following these injections, the lesions became rapidly even more severely crusted, and new lesions appeared on the extremities and the face of the patient. There was histological evidence of a high charge of scabies, leading to a diagnosis of CS. The patient was hospitalized and successfully treated by local permethrine and systemic ivermectine. This case suggests that even though anti-IL23 antagonists display an excellent overall safety profile, a particular caution for infections should still be respected in patients with underlying risk factors.
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Affiliation(s)
- Yseult Senterre
- Department of Dermatology and Venerology, CHU Sart Tilman, University of Liège, 4000, Liège, Belgium
| | - Gaëlle Jouret
- Department of Dermatology and Venerology, CHU Sart Tilman, University of Liège, 4000, Liège, Belgium
| | - Patrick Collins
- Department of Dermatopathology, CHU Sart Tilman, University of Liège, 4000, Liège, Belgium
| | - Arjen F Nikkels
- Department of Dermatology and Venerology, CHU Sart Tilman, University of Liège, 4000, Liège, Belgium.
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120
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Spitzmüller D, Lautenschlager S. [CME Dermatology 21: Scabies - Clinical Manifestation, Diagnosis and Therapy]. PRAXIS 2020; 109:411-417. [PMID: 32345172 DOI: 10.1024/1661-8157/a003459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
CME Dermatology 21: Scabies - Clinical Manifestation, Diagnosis and Therapy Abstract. Scabies is a common contagious skin infestation found in all parts of the world affecting individuals of all ages. Its worldwide prevalence is estimated at about 200 million people at any one time. Typical manifestations consist of severe itch that is aggravated at night, and disseminated, excoriated, erythematous papules on the trunk and limbs. Diagnosis can be confirmed by microscopic examination of skin scrapings taken from skin lesions. Recommended treatments consist of Permethrin 5 % cream applied once with repetition after 7-14 days or oral ivermectin 200 µg/kg as two doses 1 week apart. Additionally, written instructions on how to behave, decontaminate textiles and apply medications should be provided to suspected cases, and all the patient's close personal contacts should be treated simultaneously. As the disease can be sexually transmitted, screening for sexually transmitted diseases is recommended in sexually active patients.
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Affiliation(s)
- David Spitzmüller
- Institut für Dermatologie und Venerologie, Stadtspital Waid und Triemli, Zürich
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121
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Ivermectin—a drug and a tool. Eur J Clin Microbiol Infect Dis 2020; 39:599-600. [DOI: 10.1007/s10096-019-03806-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 11/26/2022]
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122
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Pallesen K, Lassen JA, Munk NT, Hartmeyer GN, Hvid L, Bygum A. In vitro survival of scabies mites. Clin Exp Dermatol 2020; 45:712-715. [PMID: 32112428 DOI: 10.1111/ced.14209] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/11/2020] [Accepted: 02/24/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The correct treatment and management of scabies is expensive and time-consuming, and may have a negative impact on patients and their families. AIM To investigate the effects of permethrin 5% cream on scabies mites, and explore mite survival times outside the human body. METHODS We performed a nonrandomized controlled study. In total, 20 petri dishes were coated with permethrin 5% cream (treatment group) and 20 plain petri dishes (control group) each had one scabies mite placed in them, and were then observed at baseline and 3, 4, 5, 6, 7, 8 and 12 h from baseline. In the second part of our study, 30 scabies mites from infested patients were investigated in an observational experiment in 30 plain petri dishes at days 0, 3 and 4. RESULTS Our data showed that 65% of scabies mites survived after 8 h in the treatment group compared with 75% of mites in the control group. After 12 h, 25% of mites in the treatment group and 60% in the control group were still alive. Data from the observational survival study showed that one mite was alive on day 3, but all mites were dead by day 4. CONCLUSIONS This study showed no significant effects of mite survival times with 5% topical permethrin after 8 h, while its efficacy was stronger and significant after 12 h. We recommend the isolation of all mite-infested items for at least 4 days.
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Affiliation(s)
- K Pallesen
- Department of Dermatology, Odense University Hospital, Odense, Denmark
| | - J A Lassen
- Department of Dermatology, Odense University Hospital, Odense, Denmark
| | - N T Munk
- Department of Dermatology, Odense University Hospital, Odense, Denmark
| | - G N Hartmeyer
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - L Hvid
- Department of Dermatology, Odense University Hospital, Odense, Denmark
| | - A Bygum
- Department of Dermatology, Odense University Hospital, Odense, Denmark
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123
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Rosumeck S, Nast A, Dressler C. Evaluation of Ivermectin vs Permethrin for Treating Scabies-Summary of a Cochrane Review. JAMA Dermatol 2020; 155:730-732. [PMID: 31017622 DOI: 10.1001/jamadermatol.2019.0279] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Clinical Question Is the use of ivermectin in patients infested with scabies associated with improved clinical and safety outcomes compared with permethrin? Bottom Line Both ivermectin and permethrin treatment were associated with high clearance rates. There is low-certainty evidence that ivermectin was associated with slightly lower rates of complete clearance after 1 week compared with permethrin, 5%, cream (relative risk [RR], 0.65; 95% CI, 0.54-0.78). After 2 weeks, there was no difference in efficacy (RR, 0.91; 95% CI, 0.76-1.08; low-certainty evidence), or in the number of participants with adverse events (week 4: RR, 1.30; 95% CI, 0.35-4.83; low-certainty evidence).
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Affiliation(s)
- Stefanie Rosumeck
- Division of Evidence-Based Medicine, Department of Dermatology, Venereology, and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Alexander Nast
- Division of Evidence-Based Medicine, Department of Dermatology, Venereology, and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Corinna Dressler
- Division of Evidence-Based Medicine, Department of Dermatology, Venereology, and Allergology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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124
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Bataille P, Welfringer-Morin A, Leclerc-Mercier S, Hadj-Rabia S, Bodemer C. An unsual case of palmoplantar keratoderma. Pediatr Dermatol 2020; 37:e17-e19. [PMID: 31997441 DOI: 10.1111/pde.14038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Pauline Bataille
- Department of Dermatology, Reference Centre for Genodermatoses and Rare Skin Disease (MAGEC), Hopital Universitaire Necker-Enfants Malades, APHP, Paris, France.,Université de Paris Descartes, Paris, France
| | - Anne Welfringer-Morin
- Department of Dermatology, Reference Centre for Genodermatoses and Rare Skin Disease (MAGEC), Hopital Universitaire Necker-Enfants Malades, APHP, Paris, France.,Université de Paris Descartes, Paris, France
| | - Stéphanie Leclerc-Mercier
- Department of Dermatology, Reference Centre for Genodermatoses and Rare Skin Disease (MAGEC), Hopital Universitaire Necker-Enfants Malades, APHP, Paris, France.,Université de Paris Descartes, Paris, France
| | - Smail Hadj-Rabia
- Department of Dermatology, Reference Centre for Genodermatoses and Rare Skin Disease (MAGEC), Hopital Universitaire Necker-Enfants Malades, APHP, Paris, France.,Université de Paris Descartes, Paris, France
| | - Christine Bodemer
- Department of Dermatology, Reference Centre for Genodermatoses and Rare Skin Disease (MAGEC), Hopital Universitaire Necker-Enfants Malades, APHP, Paris, France.,Université de Paris Descartes, Paris, France
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125
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Leung AKC, Lam JM, Leong KF. Scabies: A Neglected Global Disease. Curr Pediatr Rev 2020; 16:33-42. [PMID: 31544694 DOI: 10.2174/1573396315666190717114131] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/08/2019] [Accepted: 07/09/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Scabies is a skin disease caused by an obligate human parasite mite Sarcoptes scabiei var. hominis. Children under the age of two and elderly individuals are at the greatest risk. Knowledge of this condition is important for an early diagnosis to be made and treatment to be initiated. OBJECTIVE The review aimed to familiarize physicians with the clinical manifestations, diagnosis, evaluation, and management of scabies. METHODS A search was conducted using Pubmed with the built-in "Clinical Queries" tool. The search term "Scabies" was used. The categories of "epidemiology", "diagnosis", "therapy", "prevention" and "prognosis" had a limited scope for primary clinical studies. Meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews were included. Only papers published in the English language were included. A descriptive, narrative synthesis was provided of the retrieved articles. RESULTS Worldwide, scabies affects 200 to 300 million individuals annually. The average prevalence is estimated to be 5 to 10% in children of developing countries. Transmission usually occurs after close prolonged skin-to-skin contact. Classic scabies is characterized by an erythematous papular eruption, serpiginous burrows, and intense pruritus. Sites of predilection include the webs of the fingers, volar wrists, lateral aspects of fingers, extensor surfaces of elbows and knees, waist, navel, abdomen, buttocks, groins, and, genitals. A clinical diagnosis of classic scabies can be made on the basis of the history and clinical findings. Other clinical variants include crusted scabies, nodular scabies, and bullous scabies. Finding the mite, ova, or fecal pellets on microscopic examination of scrapings taken from skin lesions confirms the diagnosis of scabies infestation. For eradication of scabies mites, the drugs of choice are topical permethrin and oral ivermectin. CONCLUSION Scabies is a highly contagious parasitic cutaneous disease that is stigmatising and debilitating. Increased awareness, accurate diagnosis, and prompt treatment are essential for the effective control of scabies and for the prevention of the spread of the disease.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kin F Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
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126
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Gopinath H, Karthikeyan K. Genital scabies: Haven of an unwelcome guest. Indian J Sex Transm Dis AIDS 2020; 41:10-16. [PMID: 33062975 PMCID: PMC7529175 DOI: 10.4103/ijstd.ijstd_69_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/10/2018] [Accepted: 12/30/2019] [Indexed: 11/04/2022] Open
Abstract
The itch mite Sarcoptes scabiei var. hominis has been a menace to humanity for ages. Diagnosing scabies can be a challenge in view of the varied presentations of the disease. The male genitalia are an important area of predilection of the mite. Examination of this often overlooked area is essential as it may reveal both characteristic and atypical manifestations of scabies. Genital involvement also attains special relevance in view of the possible sexual transmission of the mite. In addition to the morbidity caused by itching, patients may have to deal with myths, stigma, and embarrassment.
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Affiliation(s)
- Hima Gopinath
- Department of Dermatology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | - Kaliaperumal Karthikeyan
- Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
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127
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Spitzmüller D, Lautenschlager S. [CME Dermatology 21/Answers: Scabies - Clinical Manifestation, Diagnosis and Therapy]. PRAXIS 2020; 109:548-550. [PMID: 32456590 DOI: 10.1024/1661-8157/a003460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- David Spitzmüller
- Institut für Dermatologie und Venerologie, Stadtspital Waid und Triemli, Zürich
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128
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Sheele JM, Ridge G, Li X, Schlatzer D, Lesser E. The Benefit of a Single Oral Dose of Ivermectin in Humans: The Adverse Effects on Cimex lectularius L. Populations and Fecundity. Cureus 2019; 11:e6098. [PMID: 31886039 PMCID: PMC6901371 DOI: 10.7759/cureus.6098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective To measure the population size and fecundity of the common bed bug Cimex lectularius L. (C. lectularius) after feeding it with the blood obtained from human subjects who have consumed a single dose of ivermectin. Methods Serial blood samples were obtained from two human subjects at hour 0 (control) and 4-96 hours after they received a single 0.2 mg/kg dose of ivermectin. The blood samples were then fed to 2,273 bed bugs. Bed bug incapacitation rates, fecundity, and population sizes were recorded over a 54-day period. Whole blood ivermectin levels were measured in the human subjects and the insects. Results The fold change in the size of the control group population over the course of the experiment was found to be 2.16. This was significantly greater (p: <.001) than for all the post-ivermectin feeding groups (range: -11.04-1.43). Two weeks after the experiment, the number of eggs laid per live adult female bed bug per day was 10.74 for controls, which was significantly different (p: <0.001) compared to all the post-ivermectin feeding groups (range: 0-4.28). Conclusions There were significant reductions in C. lectularius population size and fecundity in insects that fed on blood obtained from human study subjects up to 96 hours after they have consumed a single oral dose of ivermectin.
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Affiliation(s)
| | - Gale Ridge
- Entomology, The Connecticut Agricultural Experimental Station, New Haven, USA
| | - Xiaolin Li
- Nutrition Proteomics and Small Molecule Mass Spectrometry, Case Western Reserve University, Cleveland, USA
| | - Danie Schlatzer
- Nutrition Proteomics and Small Molecule Mass Spectrometry, Case Western Reserve University, Cleveland, USA
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129
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Spinner CD. [Ancient and modern plagues: Sexual transmitted diseases (STD)]. MMW Fortschr Med 2019; 161:44-47. [PMID: 30778965 DOI: 10.1007/s15006-019-0185-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Christoph D Spinner
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Ismaninger Str. 22, D-81675, München, Deutschland.
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130
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Ede C, Gunduz O, Modi D. Crusted scabies in a pediatric renal transplant recipient on immunosuppressants. Transpl Infect Dis 2019; 22:e13193. [PMID: 31605666 DOI: 10.1111/tid.13193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/27/2019] [Accepted: 09/29/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Crusted scabies (CS) is a rare, severe and highly contagious form of scabies, which has been reported in immunosuppressed patients. A high index of suspicion and awareness of CS is essential to treat this infestation. CASE A 13-year-old boy presented with pruritic hyperkeratotic squamous plaques located on both inner wrists, the web spaces of both his hands and his feet, and the genital area of 12 months duration. He was diagnosed with focal segmental glomerulosclerosis at the age of 5 and received a kidney transplant at the age of 9. He has been on a maintenance dose of prednisone (5 mg/d) and mycophenolate mofetil (250 mg/d) for the past 2 years. He had a contact history with a school friend with similar lesions. A skin punch biopsy demonstrated the presence of multiple mites in the stratum corneum confirming the diagnosis of CS. Ivermectin, the recommended drug of choice for crusted scabies, is not available in South Africa. The patient was commenced on topical benzoyl benzoate lotion but discontinued its use because of intolerable irritation. We subsequently prescribed the daily application of topical 5% sulfur in petrolatum to which his pruritus subsided significantly after 2 weeks with resolution of all skin lesions at the end of 8 weeks. CONCLUSION This case is the first documented report of CS in a pediatric renal transplant patient. Our management highlights that classic formularies of magistral drugs are still effective treatment options and can be used especially when standard therapies cannot be tolerated or when optimum treatments are not available.
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Affiliation(s)
- Chioma Ede
- Division of Dermatology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ozge Gunduz
- Division of Dermatology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Deepak Modi
- Division of Dermatology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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131
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Levy M, Martin L, Bursztejn A, Chiaverini C, Miquel J, Mahé E, Maruani A, Boralevi F. Ivermectin safety in infants and children under 15 kg treated for scabies: a multicentric observational study. Br J Dermatol 2019; 182:1003-1006. [DOI: 10.1111/bjd.18369] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2019] [Indexed: 11/30/2022]
Affiliation(s)
- M. Levy
- Paediatric Dermatology Unit, Children's Hospital Bordeaux University Hospital Bordeaux France
- Centre d'Investigation Clinique Pédiatrique 1401 Module Plurithématique Bordeaux University Bordeaux France
| | - L. Martin
- Department of Dermatology Angers University Hospital Angers France
| | - A.‐C. Bursztejn
- Department of Dermatology Nancy University Hospital Nancy France
| | - C. Chiaverini
- Department of Dermatology Nice University Hospital Nice France
| | - J. Miquel
- Paediatric Dermatology Unit Saint‐Pierre University Hospital Saint‐Pierre la Réunion France
| | - E. Mahé
- Department of Dermatology Hôpital Victor Dupouy Argenteuil France
| | - A. Maruani
- Department of Dermatology Tours University Hospital Tours France
| | - F. Boralevi
- Paediatric Dermatology Unit, Children's Hospital Bordeaux University Hospital Bordeaux France
- Centre d'Investigation Clinique Pédiatrique 1401 Module Plurithématique Bordeaux University Bordeaux France
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Abstract
Scabies, an ectoparasitic infestation of the skin by the mite Sarcoptes scabiei, is a clinical problem of particular significance in the elderly population because of unique vulnerability factors. Such factors include reduced mobility, residency in grouped living facilities, and difficulty with implementation of certain treatments. There is also risk of transmission to nearby caretakers and cohabitants. Furthermore, the diagnosis of scabies can be difficult, as this condition can closely resemble other dermatologic diseases. Complicating the diagnosis in this group is the variety of medical settings in which these patients are evaluated, some of which may not be equipped to follow diagnostic guidelines. The diagnosis itself can be complex because of varying clinical presentation and mite burden. Finally, the transmissibility of scabies, especially in grouped living arrangements, makes prompt and proper treatment of this condition paramount. All of these factors present a unique challenge for the clinician treating elderly patients. This article aims to describe the susceptibility factors, clinical presentation, diagnosis, and management considerations specific to elderly adults with scabies.
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Affiliation(s)
- Jodi Raffi
- Department of Dermatology, University of California San Francisco, Divisadero St. 1701, San Francisco, CA, 94110, USA
- School of Medicine, University of California Irvine, 1001 Health Sciences Road, Irvine, CA, 92617, USA
| | - Raagini Suresh
- Department of Dermatology, University of California San Francisco, Divisadero St. 1701, San Francisco, CA, 94110, USA
| | - Daniel C Butler
- Department of Dermatology, University of California San Francisco, Divisadero St. 1701, San Francisco, CA, 94110, USA.
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133
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Thomas C, Coates SJ, Engelman D, Chosidow O, Chang AY. Ectoparasites: Scabies. J Am Acad Dermatol 2019; 82:533-548. [PMID: 31310840 DOI: 10.1016/j.jaad.2019.05.109] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/16/2019] [Accepted: 05/22/2019] [Indexed: 12/26/2022]
Abstract
Scabies is an ectoparasitic dermatosis caused by Sarcoptes scabiei var. hominis and is a public health issue in all countries regardless of socioeconomic status. In high-income countries, delays in diagnosis can lead to institutional outbreaks; in low- and middle-income countries, poor access to health care contributes to disease undertreatment and long-term systemic sequelae. With scabies now recognized as a neglected tropical disease by the World Health Organization, increased awareness and systematic efforts are addressing gaps in diagnosis and treatment that impede scabies control. This review summarizes the available data and provides an update on scabies epidemiology, clinical features, diagnosis, management, and public health considerations.
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Affiliation(s)
- Cristina Thomas
- Departments of Dermatology and Internal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sarah J Coates
- Department of Dermatology, University of California, San Francisco, San Francisco, California
| | - Daniel Engelman
- International Alliance for the Control of Scabies, Parkville, Australia; Tropical Diseases, Murdoch Children's Research Institute, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Australia; Department of General Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Olivier Chosidow
- International Alliance for the Control of Scabies, Parkville, Australia; Department of Dermatology, Assistance Publique - Hôpitaux de Paris, University Paris-Est Créteil, Créteil, France
| | - Aileen Y Chang
- Department of Dermatology, University of California, San Francisco, San Francisco, California; International Alliance for the Control of Scabies, Parkville, Australia.
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134
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Engelman D, Cantey PT, Marks M, Solomon AW, Chang AY, Chosidow O, Enbiale W, Engels D, Hay RJ, Hendrickx D, Hotez PJ, Kaldor JM, Kama M, Mackenzie CD, McCarthy JS, Martin DL, Mengistu B, Maurer T, Negussu N, Romani L, Sokana O, Whitfeld MJ, Fuller LC, Steer AC. The public health control of scabies: priorities for research and action. Lancet 2019; 394:81-92. [PMID: 31178154 PMCID: PMC11257500 DOI: 10.1016/s0140-6736(19)31136-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/14/2019] [Accepted: 04/25/2019] [Indexed: 12/16/2022]
Abstract
Scabies is a parasitic disease of the skin that disproportionately affects disadvantaged populations. The disease causes considerable morbidity and leads to severe bacterial infection and immune-mediated disease. Scientific advances from the past 5 years suggest that scabies is amenable to population-level control, particularly through mass drug administration. In recognition of these issues, WHO added scabies to the list of neglected tropical diseases in 2017. To develop a global control programme, key operational research questions must now be addressed. Standardised approaches to diagnosis and methods for mapping are required to further understand the burden of disease. The safety of treatments for young children, including with ivermectin and moxidectin, should be investigated. Studies are needed to inform optimum implementation of mass treatment, including the threshold for intervention, target, dosing, and frequency. Frameworks for surveillance, monitoring, and evaluation of control strategies are also necessary.
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Affiliation(s)
- Daniel Engelman
- Tropical Diseases Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Department of General Medicine, Royal Children's Hospital, Melbourne, VIC, Australia.
| | - Paul T Cantey
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Michael Marks
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Anthony W Solomon
- Department of Control of Neglected Tropical Diseases, World Health Organization, Geneva, Switzerland
| | - Aileen Y Chang
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Olivier Chosidow
- Department of Dermatology, Hôpital Henri-Mondor, Assistance Publique Hôpitaux de Paris, Créteil, France; Université Paris-Est Créteil Val-de-Marne, Créteil, France
| | - Wendemagegn Enbiale
- Department of Dermatovenerology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Dirk Engels
- Uniting to Combat Neglected Tropical Diseases, Switzerland
| | - Roderick J Hay
- Department of Dermatology, King's College London, London, UK
| | - David Hendrickx
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Peter J Hotez
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, USA
| | - John M Kaldor
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Mike Kama
- Ministry of Health and Medical Services, Suva, Fiji
| | | | - James S McCarthy
- QIMR Berghoefer Medical Research Institute, Brisbane, QLD, Australia
| | - Diana L Martin
- Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Toby Maurer
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | | | - Lucia Romani
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Oliver Sokana
- Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Margot J Whitfeld
- Department of Dermatology, St Vincent's Hospital, University of New South Wales, Sydney, NSW, Australia
| | - L Claire Fuller
- Chelsea and Westminster Healthcare National Health Service Foundation Trust, London, UK; International Foundation for Dermatology, London, UK
| | - Andrew C Steer
- Tropical Diseases Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Department of General Medicine, Royal Children's Hospital, Melbourne, VIC, Australia
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135
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Thadanipon K, Anothaisintawee T, Rattanasiri S, Thakkinstian A, Attia J. Efficacy and safety of antiscabietic agents: A systematic review and network meta-analysis of randomized controlled trials. J Am Acad Dermatol 2019; 80:1435-1444. [DOI: 10.1016/j.jaad.2019.01.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 01/07/2019] [Accepted: 01/09/2019] [Indexed: 11/26/2022]
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136
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Park J, Park SY, Han J, Lee SY, Kim GE, Jeong YS, Kim JH, Lee EJ, Lee E, Kim TH. Identifying the time to cure for patients with classic scabies after infection control intervention in acute care hospital settings. Am J Infect Control 2019; 47:588-590. [PMID: 30527284 DOI: 10.1016/j.ajic.2018.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/11/2018] [Accepted: 10/11/2018] [Indexed: 11/26/2022]
Abstract
Scabies is a re-emerging parasitic disease, particularly in hospitalized patients. This is a retrospective study analyzing adult patients with scabies admitted to a referral university hospital between 2008 and 2018. All patients were treated an average of 3times using scabicides; the median isolation period and time to cure were 14 and 15days, respectively.
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137
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Sanders KM, Nattkemper LA, Rosen JD, Andersen HH, Hsiang J, Romanelli P, Bernigaud C, Guillot J, Chosidow O, Yosipovitch G. Non-Histaminergic Itch Mediators Elevated in the Skin of a Porcine Model of Scabies and of Human Scabies Patients. J Invest Dermatol 2019; 139:971-973. [DOI: 10.1016/j.jid.2018.09.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/12/2018] [Accepted: 09/27/2018] [Indexed: 11/28/2022]
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138
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Mueller SM, Gysin S, Schweitzer M, Schwegler S, Haeusermann P, Itin P, Bart T, Denz RS, Steffen T, Kuehl R, Widmer AF, Brandt O. Implementation and evaluation of an algorithm for the management of scabies outbreaks. BMC Infect Dis 2019; 19:200. [PMID: 30819115 PMCID: PMC6394030 DOI: 10.1186/s12879-019-3818-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 02/13/2019] [Indexed: 11/28/2022] Open
Abstract
Background Infestations with scabies mites are a global burden affecting individuals of all ages, classes and ethnicities. As poor sanitation and overcrowding favor the transmission of this highly contagious disease, epidemic outbreaks are frequently observed among displaced persons and asylum seekers. Due to the growing influx of refugees during the last years, public health authorities in host countries are frequently confronted with the challenge to treat individuals with diagnosed or suspected scabies promptly and effectively to avoid further spreading of the infestation. This study aimed to establish a straightforward and efficient algorithm for rapid screening and treatment of large numbers of patients with confirmed or suspected scabies infestations. Methods Forty-eight individuals (58% males, mean age 22.4 yrs.) from Syria with suspected scabies infestation were allocated to 3 colour-coded groups: (1) no signs or symptoms of infestation, (2) itch only, and (3) itch and typical skin lesions. Patients were treated with a single (group 1) or two doses of oral ivermectin at an interval of 7 days (group 2), or with a combination of 2 doses of ivermectin plus 2 applications of permethrin ointment at an interval of 7 days (group 3). Follow-ups were performed 4 weeks after initial treatments. Results All individuals with signs and/or symptoms of infestation had improved skin lesion; in 10/11 (90.9%) lesion had completely resolved. All individuals with initial itch only (n = 32) reported improvement of its intensity or complete resolution. None of the patients of group 1 developed itch or skin lesions. The algorithm was reapplied in 4 individuals (8.3%) after 4 weeks and the outbreak was completely controlled after 8 weeks. Colour-coding ensured fast flow of information between health-care providers at the interfaces of the algorithm. Conclusions Our algorithm proved to be both highly efficient for treatment of large numbers of patients with suspected or diagnosed scabies infestation as well as for prevention of spreading of the disease. Hence, this algorithm is well suited for the management of scabies mass outbreaks.
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Affiliation(s)
- Simon M Mueller
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland.
| | - Stefan Gysin
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland
| | - Michael Schweitzer
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland
| | - Simon Schwegler
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland
| | - Peter Haeusermann
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland
| | - Peter Itin
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland
| | - Thomas Bart
- Department of Health, Medical Services, Social Medicine, 4056, Basel, Canton of Basel-City, Switzerland
| | - Ruth Spieler Denz
- Department of Health, Medical Services, Social Medicine, 4056, Basel, Canton of Basel-City, Switzerland
| | - Thomas Steffen
- Department of Health, Medical Services, Social Medicine, 4056, Basel, Canton of Basel-City, Switzerland
| | - Richard Kuehl
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, 4056, Basel, Switzerland
| | - Andreas F Widmer
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, 4056, Basel, Switzerland
| | - Oliver Brandt
- Department of Dermatology, University Hospital Basel, Petersgraben 4, 4056, Basel, Switzerland
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139
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Dondonis FP, Jappur DMC, Pires GC, Cartell ADS, Bonamigo RR. Facial crusted scabies on renal transplant patient. Nefrologia 2019; 39:315-317. [PMID: 30718003 DOI: 10.1016/j.nefro.2018.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/02/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- Fernanda Poy Dondonis
- Dermatology Service of Hospital de Clínicas de Porto Alegre/Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
| | - Daniel Martins Costa Jappur
- Dermatology Service of Hospital de Clínicas de Porto Alegre/Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Gabriel Challub Pires
- Dermatology Service of Hospital de Clínicas de Porto Alegre/Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - André da Silva Cartell
- Dermatology Service of Hospital de Clínicas de Porto Alegre/Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Renan Rangel Bonamigo
- Dermatology Service of Hospital de Clínicas de Porto Alegre/Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
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140
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Mellon G, Hermet L, Toutain PL, Dulioust A, Lespine A. Scabies in an obese patient: How should the ivermectin dosing be adapted? Med Mal Infect 2018; 49:286-288. [PMID: 30473320 DOI: 10.1016/j.medmal.2018.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/12/2018] [Accepted: 09/18/2018] [Indexed: 11/29/2022]
Affiliation(s)
- G Mellon
- Service de médecine, établissement public de santé national de Fresnes, 1, allée des Thuyas, 94260 Fresnes, France; Service des maladies infectieuses et tropicales, hôpital Saint-Louis, assistance publique des hôpitaux de Paris, 1, avenue Claude-Vellefaux, 75010 Paris, France.
| | - L Hermet
- Service de médecine, établissement public de santé national de Fresnes, 1, allée des Thuyas, 94260 Fresnes, France
| | - P L Toutain
- INTHERES, université de Toulouse, INRA, ENVT, 23 chemin des Capelles, 31300 Toulouse, France
| | - A Dulioust
- Service de médecine, établissement public de santé national de Fresnes, 1, allée des Thuyas, 94260 Fresnes, France
| | - A Lespine
- INTHERES, université de Toulouse, INRA, ENVT, 23 chemin des Capelles, 31300 Toulouse, France
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141
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[85/m with scaly exanthema and itching : Preparation for the specialist examination: part 1]. Hautarzt 2018; 69:77-80. [PMID: 30374549 DOI: 10.1007/s00105-018-4228-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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142
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Sandoval L, Cuestas D, Velandia A, Motta A, Quevedo E, Rolon M, Sopo L. Scabies herpeticum, an emerging clinical form of crusted scabies in AIDS patient: case report and literature review. Int J Dermatol 2018; 58:1205-1209. [PMID: 30320440 DOI: 10.1111/ijd.14256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 08/25/2018] [Accepted: 09/09/2018] [Indexed: 01/26/2023]
Affiliation(s)
- Laura Sandoval
- Dermatology Program, El Bosque University, Bogota, Cundinamarca, Colombia.,Dermatology Service, Simon Bolivar Hospital, Bogota, Cundinamarca, Colombia
| | - Daniel Cuestas
- Dermatology Program, El Bosque University, Bogota, Cundinamarca, Colombia.,Dermatology Service, Simon Bolivar Hospital, Bogota, Cundinamarca, Colombia
| | - Alexander Velandia
- Dermatology Program, El Bosque University, Bogota, Cundinamarca, Colombia.,Dermatology Service, Simon Bolivar Hospital, Bogota, Cundinamarca, Colombia
| | - Adriana Motta
- Dermatology Program, El Bosque University, Bogota, Cundinamarca, Colombia.,Dermatology Service, Simon Bolivar Hospital, Bogota, Cundinamarca, Colombia
| | - Elvia Quevedo
- Dermatology Program, El Bosque University, Bogota, Cundinamarca, Colombia.,Dermatology Service, Simon Bolivar Hospital, Bogota, Cundinamarca, Colombia
| | - Mariam Rolon
- Dermatopathology Service, Simon Bolívar Hospital, Bogota, Cundinamarca, Colombia
| | - Leticia Sopo
- Medical Microbiology and Mycology Laboratory, El Bosque University, Bogota, Cundinamarca, Colombia
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143
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Affiliation(s)
- A Guertler
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, Frauenlobstr. 9-11, 80337, München, Deutschland.
| | - P Thomas
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, Frauenlobstr. 9-11, 80337, München, Deutschland
| | - T Herzinger
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München, Frauenlobstr. 9-11, 80337, München, Deutschland
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144
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Efficacy and Pharmacokinetics Evaluation of a Single Oral Dose of Afoxolaner against Sarcoptes scabiei in the Porcine Scabies Model for Human Infestation. Antimicrob Agents Chemother 2018; 62:AAC.02334-17. [PMID: 29914951 DOI: 10.1128/aac.02334-17] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 06/07/2018] [Indexed: 11/20/2022] Open
Abstract
Scabies is a major and potentially growing public health problem worldwide with an unmet need for acaricidal agents with greater efficacy and improved pharmacological properties for its treatment. The objective of the present study was to assess the efficacy and describe the pharmacokinetics profile of a novel acaricide, afoxolaner (AFX), in a relevant experimental porcine model. Twelve pigs were experimentally infested and either treated with 2.5 mg/kg single dose oral AFX (n = 4) or 0.2 mg/kg, two doses 8 days apart, oral ivermectin ([IVM] n = 4) or not treated for scabies (n = 4). The response to treatment was assessed by the reduction of mite counts in skin scrapings as well as clinical and pruritus scores over time. Plasma and skin pharmacokinetics profiles for both AFX and IVM were evaluated. AFX efficacy was 100% at days 8 and 14 posttreatment and remained unchanged until the study end (day 45). IVM efficacy was 86% and 97% on days 8 and 14, respectively, with a few mites recovered at the study end. Clinical and pruritus scores decreased in both treated groups and remained constant in the control group. Plasma mean residence times (MRT) were 7.1 ± 2.4 and 1.1 ± 0.2 days for AFX and IVM, respectively. Skin MRT values were 16.2 ± 16.9 and 2.7 ± 0.5 days for AFX and IVM, respectively. Overall, a single oral dose of AFX was efficacious for the treatment of scabies in experimentally infested pigs and showed remarkably long MRTs in plasma and, notably, in the skin.
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145
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Affiliation(s)
- Kumpol Aiempanakit
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
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146
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Marotta M, Toni F, Dallolio L, Toni G, Leoni E. Management of a family outbreak of scabies with high risk of spread to other community and hospital facilities. Am J Infect Control 2018; 46:808-813. [PMID: 29397231 DOI: 10.1016/j.ajic.2017.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/06/2017] [Accepted: 12/06/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND In developed countries, scabies is observed sporadically or as institutional outbreaks in hospitals and other health facilities. In the family context, outbreaks generally involve a limited number of cases. METHODS A local health authority in Emilia-Romagna (Northern Italy) carried out an epidemiologic investigation on a family outbreak of scabies that included an unusually high number of cases. Its possible connection with a nosocomial case in a long-term care facility (LTCF) and outbreak management are discussed. RESULTS Among the household members, 8 confirmed cases occurred (attack rate, 87.5%). Another case was reported in a patient of an LTCF where one of the family cases worked as a sociosanitary operator. In total, 244 contacts were placed under surveillance. The control strategy focused on a mass information campaign addressed to all contacts and the training of health care personnel. In addition, specific prophylaxis (permethrin 5%) was performed in 108 high-risk contacts and LTCF patients and staff. CONCLUSIONS The control measures were successful in preventing the spread of the outbreak. However, misdiagnosis and the tendency of people to hide the symptoms caused the late recognition and underestimation of the cases, contributing to delayed control measures and increasing the economic and human resources required for outbreak management.
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Affiliation(s)
- Manfredo Marotta
- Unit of Hygiene and Public Health, Local Health Authority of Romagna, Rimini, Italy
| | - Francesco Toni
- Unit of Hygiene and Public Health, Local Health Authority of Romagna, Rimini, Italy
| | - Laura Dallolio
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistics, University of Bologna, Bologna, Italy.
| | - Greta Toni
- Unit of Hygiene and Public Health, Local Health Authority of Romagna, Rimini, Italy
| | - Erica Leoni
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistics, University of Bologna, Bologna, Italy
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148
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Abstract
BACKGROUND Scabies is an intensely itchy parasitic infection of the skin. It occurs worldwide, but is particularly problematic in areas of poor sanitation, overcrowding, and social disruption. In recent years, permethrin and ivermectin have become the most relevant treatment options for scabies. OBJECTIVES To assess the efficacy and safety of topical permethrin and topical or systemic ivermectin for scabies in people of all ages. SEARCH METHODS We searched the following databases up to 25 April 2017: the Cochrane Infectious Diseases Group Specialized Register, CENTRAL, MEDLINE, Embase, LILACS, and IndMED. We searched the World Health Organization International Clinical Trials Registry Platform, the ISRCTN registry, CenterWatch Clinical Trials Listing, ClinicalTrials.gov, TrialsCentral, and the UK Department of Health National Research Register for ongoing trials. We also searched multiple sources for grey literature and checked reference lists of included studies for additional trials. SELECTION CRITERIA We included randomized controlled trials that compared permethrin or ivermectin against each other for people with scabies of all ages and either sex. DATA COLLECTION AND ANALYSIS Two review authors independently screened the identified records, extracted data, and assessed the risk of bias for the included trials.The primary outcome was complete clearance of scabies. Secondary outcomes were number of participants re-treated, number of participants with at least one adverse event, and number of participants withdrawn from study due to an adverse event.We summarized dichotomous outcomes using risk ratios (RR) with 95% confidence intervals (CI). If it was not possible to calculate the point estimate, we described the data qualitatively. Where appropriate, we calculated combined effect estimates using a random-effects model and assessed heterogeneity. We calculated numbers needed to treat for an additional beneficial outcome when we found a difference.We assessed the certainty of the evidence using the GRADE approach. We used the control rate average to provide illustrative clearance rates in the comparison groups. MAIN RESULTS Fifteen studies (1896 participants) comparing topical permethrin, systemic ivermectin, or topical ivermectin met the inclusion criteria. Overall, the risk of bias in the included trials was moderate: reporting in many studies was poor. Nearly all studies were conducted in South Asia or North Africa, where the disease is more common, and is associated with poverty.EfficacyOral ivermectin (at a standard dose of 200 μg/kg) may lead to slightly lower rates of complete clearance after one week compared to permethrin 5% cream. Using the average clearance rate of 65% in the trials with permethrin, the illustrative clearance with ivermectin is 43% (RR 0.65, 95% CI 0.54 to 0.78; 613 participants, 6 studies; low-certainty evidence). However, by week two there may be little or no difference (illustrative clearance of permethrin 74% compared to ivermectin 68%; RR 0.91, 95% CI 0.76 to 1.08; 459 participants, 5 studies; low-certainty evidence). Treatments with one to three doses of ivermectin or one to three applications of permethrin may lead to little or no difference in rates of complete clearance after four weeks' follow-up (illustrative cures with 1 to 3 applications of permethrin 93% and with 1 to 3 doses of ivermectin 86%; RR 0.92, 95% CI 0.82 to 1.03; 581 participants, 5 studies; low-certainty evidence).After one week of treatment with oral ivermectin at a standard dose of 200 μg/kg or one application of permethrin 5% lotion, there is probably little or no difference in complete clearance rates (illustrative cure rates: permethrin 73%, ivermectin 68%; RR 0.93, 95% CI 0.74 to 1.17; 120 participants, 1 study; moderate-certainty evidence). After two weeks of treatment, one dose of systemic ivermectin compared to one application of permethrin lotion may lead to similar complete clearance rates (extrapolated cure rates: 67% in both groups; RR 1.00, 95% CI 0.78 to 1.29; 120 participants, 1 study; low-certainty evidence).There is probably little or no difference in rates of complete clearance between systemic ivermectin at standard dose and topical ivermectin 1% lotion four weeks after initiation of treatment (illustrative cure rates: oral ivermectin 97%, ivermectin lotion 96%; RR 0.99, 95% CI 0.95 to 1.03; 272 participants, 2 studies; moderate-certainty evidence). Likewise, after four weeks, ivermectin lotion probably leads to little or no difference in rates of complete clearance when compared to permethrin cream (extrapolated cure rates: permethrin cream 94%, ivermectin lotion 96%; RR 1.02, 95% CI 0.96 to 1.08; 210 participants, 1 study; moderate-certainty evidence), and there is little or no difference among systemic ivermectin in different doses (extrapolated cure rates: 2 doses 90%, 1 dose 87%; RR 0.97, 95% CI 0.83 to 1.14; 80 participants, 1 study; high-certainty evidence).SafetyReporting of adverse events in the included studies was suboptimal. No withdrawals due to adverse events occurred in either the systemic ivermectin or the permethrin group (moderate-certainty evidence). Two weeks after treatment initiation, there is probably little or no difference in the proportion of participants treated with systemic ivermectin or permethrin cream who experienced at least one adverse event (55 participants, 1 study; moderate-certainty evidence). After four weeks, ivermectin may lead to a slightly larger proportion of participants with at least one adverse event (extrapolated rates: permethrin 4%, ivermectin 5%; RR 1.30, 95% CI 0.35 to 4.83; 502 participants, 4 studies; low-certainty evidence).Adverse events in participants treated with topical ivermectin were rare and of mild intensity and comparable to those with systemic ivermectin. For this comparison, it is uncertain whether there is any difference in the number of participants with at least one adverse event (very low-certainty evidence). No withdrawals due to adverse events occurred (62 participants, 1 study; moderate-certainty evidence).It is uncertain whether topical ivermectin or permethrin differ in the number of participants with at least one adverse event (very low-certainty evidence). We found no studies comparing systemic ivermectin in different doses that assessed safety outcomes. AUTHORS' CONCLUSIONS We found that for the most part, there was no difference detected in the efficacy of permethrin compared to systemic or topical ivermectin. Overall, few and mild adverse events were reported. Our confidence in the effect estimates was mostly low to moderate. Poor reporting is a major limitation.
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Affiliation(s)
- Stefanie Rosumeck
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthDivision of Evidence Based Medicine, Department of Dermatology, Venerology and AllergologyCharitéplatz 1BerlinBerlinGermany10117
| | - Alexander Nast
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthDivision of Evidence Based Medicine, Department of Dermatology, Venerology and AllergologyCharitéplatz 1BerlinBerlinGermany10117
| | - Corinna Dressler
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of HealthDivision of Evidence Based Medicine, Department of Dermatology, Venerology and AllergologyCharitéplatz 1BerlinBerlinGermany10117
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