Peculiarities of crustacean Norwegian scabies. Norwegian scabies is millions of mites under the skin and severe complications if treatment is ignored Norwegian scabies

Among the many diseases that can occur in a weakened human body, Norwegian scabies occupies a special place. Developing for a long time without external manifestations, it eventually flares up with violent symptoms, each of which is extremely unpleasant both for the suffering person and for others. The patient is cut off from society, undergoes painful treatment - and this despite the fact that it was quite easy to prevent such an outcome.

Description of the disease

Norwegian scabies is a rare skin disease caused by the scabies itch (Sarcoptes scabiei). Despite the fact that this pathogen is widespread in human populations, the discussed form is one of the most severe varieties of acariasis (tick-borne disease). The name "Norwegian" disease was given because of the place of its discovery. Other names - cortical, crustose, keratotic - appeared due to a characteristic symptom: the affected areas, in rare cases covering almost the entire body, are covered with a thick layer of dead skin, up to 2-3 centimeters.

For the first time, cases of crustose scabies were described in 1847 by dermatologists Daniel Danielsen and Karl Beck, who studied the ways of spreading leprosy in Norwegian leper colonies. One of the patients showed symptoms of a hitherto unknown skin disease, which turned out to be the most severe form of scabies.

The disease is quite rare, since no more than 150 cases have been clinically described since the discovery and until the early 1990s. Immunocompromised people are most likely to be vulnerable to Norwegian scabies. The combination of the extreme rarity of the disease with its exceptionally severe symptoms for a long time made the question of the origin and causative agent very problematic.

Classification problems

During the 19th century, it was believed that the causative agent of crusty scabies was some aggressive form of mite - if not a new unknown species, then certainly a special subspecies of the itch. This was indicated by the sluggish, prolonged course of the pathology, and special symptoms, and the circle of vulnerable persons. If the usual scab spread among the population without making class distinctions, then the disease discovered by Norwegian dermatologists affected only certain categories: patients of leper colonies, psychiatric hospitals, prisoners in prisons. Later it was shown that healthy people are easily infected from patients, but they do not suffer from Norwegian scabies, but other, milder forms: typical, children's or the so-called "clean scabies" (in the event that the infected person has previously weakened the integrity and protective properties skin by excessively thorough washing).

Notable is the case of a patient with Down's syndrome, who for two decades suffered from a strange skin pathology, presumably chronic eczema or pyoderma. Until the moment when the histological examination was made, 8 nurses of the clinic and 11 patients were infected from it. All patients showed characteristic symptoms of mild scabies.

Now the generally accepted point of view is that scabies pruritus provokes the development of pathology in both typical and crustose variants. The possibility of transition from one to another depends more on the characteristics of the human body than on the abnormal behavior of the pathogen.

Causes and development factors

The most important role in the development of the disease is played by females of scabies, since males, engaged exclusively in fertilization, die even on the surface of the skin, without penetrating deep into. Fertilized females make deep branched passages in the integument of the host, reaching the malpighian layer, where they lay their eggs. Larvae appear after 3-5 days, after another 3-7 days they become sexually mature.

Pathways for the transmission of pathogens are quite simple, their diversity is limited to three options.

Comparative table of modes of transmission of crustose scabies

Vulnerable to Norwegian scabies are people with a weakened or suppressed immune system, as well as incapable of simple self-care. Conditions that are threatening in this regard include:

  • prolonged exposure to corticosteroids, glucocorticoids, cytostatics;
  • exhaustion;
  • alcoholism;
  • taking drugs;
  • impaired sensitivity and blood supply to the limbs;
  • paralysis;
  • lupus;
  • severe fungal infections ();
  • senile dementia (senile dementia);
  • Down syndrome;
  • syringomyelia (structural damage to the spinal cord);
  • Bloom's syndrome;
  • leukemia;
  • lymphoma;
  • tuberculosis;
  • leprosy;
  • AIDS.

In people with a functional immune system, the disease occurs in the form of a typical scabies.

Symptoms of the disease

  • Illusory absence of irritation in the event that the patient is not able to independently comb the affected area (with degradation of muscle tissue, paralysis);
  • The actual absence of pain in case of damage to nerve fibers and endings (syringomyelia);
  • The immune system, weakened by a serious illness, does not perceive itch toxins as an allergen.

After the incubation period, characteristic scabies appear in the skin, while over time their number and density continue to grow. At first, they are localized between the fingers, on the bends of the elbows and knees, in the region of the mammary glands, occasionally on the abdomen, buttocks, auricles, near the genitals. Feelings of itching at this stage may occur, but only in 50% of cases. The affected areas begin to expand, a rash appears on them in many forms - nodules, vesicles, blisters, abscesses. The condition of the skin deteriorates sharply, the integument coarsens, turning into a thick (up to 3 cm) shell of several layers of brown or grayish scales. These dead elements are tightly soldered together, their separation without preliminary treatment is very painful. The feet can become covered with such a thick layer of crusts that the patient's independent movement becomes impossible.

The body temperature rises, the lymph nodes become inflamed, the skin becomes dry, reddened. Nails and hair fade, exfoliate, in especially neglected cases, their complete degradation is possible. A sour smell begins to emanate from the patient, the intensity of which increases with the development of the disease. Other symptoms also increase as the scabies itch increases.

Symptoms of various forms of Norwegian scabies in the photo

Severe skin lesions in a bedridden patient
The classic picture of scabies symptoms Children can become infected with scabies through contact with sick people.
Nail plates with Norwegian scabies can be completely destroyed

Features of diagnostics

Making a correct diagnosis is crucial in the treatment of Norwegian scabies. Given the complex symptoms, not always identifiable in the early stages, the disease is often mistaken for less dangerous pathologies:

  • eczema;
  • pyoderma is a purulent skin lesion.

For accurate diagnosis, it is necessary to conduct a biopsy of the affected tissues with their subsequent microscopic examination. On the preparations obtained, the characteristic moves of scabies in large numbers, filled with mites at various stages of the life cycle, are clearly distinguishable.

Informative is also a blood test showing an increased number of eosinophils and an increased erythrocyte sedimentation rate.

Norwegian scabies treatment

Given the severity of the symptoms that accompany the disease, in order to cure it, several rules should be followed:

  • Processing must be systematic. Preparations are applied not only to the lesions, but also to the entire surface of the body: hair, skin, under the nails;
  • The impact should be made on clean, scale-free areas of the skin. Horny scabs are pre-soaked in warm baths with a weak solution of potassium permanganate, after which they are scraped off;
  • The action of drugs must be long, more than 12 hours, and regular - every day during the course of treatment.
  • Secondary infection must not be allowed. The patient's clothing and underwear should be changed daily, followed by their processing.

Medical therapy

High efficiency in the treatment of crustacean scabies is demonstrated by the use of Wilkinson's ointment containing 30% sulfur and 30% tar. The active ingredients quickly suppress the activity of itching, but given the frequent side effects of the drug in the form of dermatitis and allergies, it is recommended to alternate it periodically with other drugs.

An effective remedy is Demyanovich's liquid, consisting of 60% sodium thiosulfate and 6% hydrochloric acid successively rubbed into the skin. The products of the interaction of these substances - sulfur compounds - cause the death of ticks in the affected areas.

A more gentle treatment method for the patient is the use of a 25% water-soap emulsion of benzyl benzoate. In the treatment of children, the drug is used in a low concentration - 10%. The emulsion is easily absorbed into the skin, the risk of side effects is lower than when using Wilkinson's ointment.

Lindane is considered one of the most effective anti-scabies drugs. The use of its 1% ointment (for children - 0.3%) leads to remission of the disease in the shortest possible time. It should be remembered, however, that the active substance of Lindane - hexachloran - is a strong poison, as a result of which it must be taken in strict dosage, and only as prescribed by a doctor. The use of Lindane for the treatment of pregnant women is prohibited.

Treatment of Norwegian scabies involves taking immunomodulators, tonics, vitamin complexes. These measures help to improve the general condition and well-being of the patient, partially restore the body's resistance, and increase tissue regeneration.

Video of scabies

Folk remedies

Folk remedies that are effective against typical scabies are not those in the treatment of the crusty form. The mild effect of plant components is not able to overcome the severe symptoms of the disease. The rate of reproduction of itching far exceeds their losses, which negate the positive results of treatment. On the contrary, in combination with drug therapy, folk remedies show a distinct supportive effect that can become a significant help in the rehabilitation of the patient.

Traditional compositions of sulfuric and tar ointments on melted fat, vegetable oils, and resins are known. These include the Greek balm. In terms of composition and effect, these compounds are close to Wilkinson's ointment. The content of active components in them ranges from 10 to 40%.

For the speedy exfoliation of scabs and healing of the skin, warm baths with herbal infusions are used. As a plant base, elecampane root, calendula, chamomile, sage flowers can be used. To prepare the bath, 250 grams of dry grass should be brewed, strained, diluted to the desired volume. The resulting infusion is suitable for compresses and bathing.

Painful symptoms are relieved by oatmeal baths. A few tablespoons of pure, without impurities, oatmeal should be poured into a linen rag, tightly tied, lowered into freshly boiled water with a volume of about 10 liters. As soon as the temperature of the liquid drops to a tolerable level, the extraction can be considered complete. A bag of oatmeal can also be placed directly into a hot bath.

Forecast and consequences

A sluggish disease can develop over decades. The patient not only suffers himself, but also serves as a constant source of infection for others. With a timely diagnosis and correctly prescribed treatment, the prognosis is completely favorable, remission is achieved as soon as possible. The only reminder of the suffering suffered is darkening and scars on the surface of the body.

A completely different result is observed if the therapy was not performed on time. Large-scale skin lesions serve as an excellent breeding ground for pathogens, and a weakened immune system is unable to resist infection. Concomitant infections can lead to such diseases:

  • infectious;
  • streptococcal pyoderma;
  • microbial eczema;
  • sepsis.

A streptococcal infection that has developed in the skin can affect the filtration system of the kidneys, causing infectious glomerulonephritis. When streptococci enter the connective tissue, they initiate acute rheumatic fever, which can cause myocardial pathology.

Prevention

A set of preventive prescriptions that prevent infection with various forms of scabies includes:

  • compliance with the rules of personal hygiene;
  • regular replacement, cleaning and temperature treatment of linen;
  • constant monitoring of their health.

In the event that cases of illness are found in the communication environment, these measures should be tightened by limiting social and household contacts, conducting preventive examinations, and timely isolation of the infected.

Norwegian scabies is a dangerous and serious disease with a chronic course. Needless to say, this disease is rare. In medical practice, about 150 cases of the disease were registered. The disease is accompanied by deep skin lesions and, in the absence of proper therapy, can lead to dangerous complications up to the death of the patient.

Exciter characteristic

It was believed that the causative agent of this disease is Sarcoptes scabiei var hominis, which is infected by contact with a sick person. But with further research, scientists were able to find out that the disease also develops against the background of invasion by an ordinary scabies mite. By the way, for the first time Norwegian scabies was officially registered in Norway at the end of the 19th century, which, in fact, explains the name.

Are there risk factors?

Norwegian crusted scabies develops against the background of a weakened immune system, as this allows mites to actively multiply. Scientists identify several risk factors:

  • the presence of HIV infection in the body;
  • systemic autoimmune diseases, including lupus erythematosus;
  • oncological diseases;
  • general candidiasis;
  • tuberculosis, leprosy and some other diseases;
  • exhaustion of the body that occurs against the background of nervous overstrain, severe stress, alcoholism;
  • neurological and mental disorders, including infantilism, dementia, dementia;
  • long-term therapy with the use of cytostatics and hormonal steroid drugs;
  • paralysis, impaired sensitivity of peripheral nerves.

Ways of transmission of infection

A household route of transmission is also possible. For example, when living in the same house with a sick person, an infection can be caught using the same utensils, bedding, towels, clothes, toys, and other items.

Clinical picture: what are the symptoms of the disease?

The incubation period lasts about 2 - 6 weeks. Further, the disease can develop for years and even decades. A fever in a patient is rarely observed, but the skin becomes very dry and hot to the touch - these are the first symptoms of scabies in adults.

Due to the formation of passages, the patient's skin gradually becomes thicker and rougher. Scabs of gray, yellow and even greenish color are formed on it. In the absence of treatment, the upper skin layers take the form of a shell covered with grooves. When removing the upper crusts, you can see reddish skin with foci of erosion.

Norwegian scabies is accompanied by the appearance of scabs all over the body, including the face. The patient's nails thicken, become loose and change color - the process resembles a fungal infection of the nail plate. Human hair becomes dull, thin and brittle. A characteristic sour smell emanates from the patient, which is an important diagnostic criterion.

Diagnosis of the disease

It is very important to correctly diagnose the disease. Medicine knows the case when the patient was misdiagnosed and prescribed treatment for psoriasis. This led to the generalization of the process and the death of the patient.

Of course, taking an anamnesis and examining skin tissues should lead a specialist to the idea of ​​scabies. The epithelium is covered with crusts, and the skin on the folds of the neck, groin and armpits acquires more pronounced pigmentation. Next, the patient takes a blood test - in the samples, a specialist can detect an increase in the number of eosinophils and leukocytes. There is a more accurate method that allows you to diagnose the disease. For analysis, tissue samples are taken from the thickened stratum corneum of the skin. Norwegian scabies is characterized by the presence of scabies in the biopsy. In skin samples, eggs and larvae of mites, as well as adults, can also be seen.

Basic principles of therapy

As already mentioned, this drug is most often used to treat Norwegian scabies. What is Benzyl Benzoate? Instructions for use, price, properties - these are the questions that interest each patient.

Ointment (or emulsion) should not be used if there are abscesses on the skin. The price of the drug is not too high - a jar of cream with a volume of 50 g will cost about 60 - 100 rubles.

Sulfur ointment: simple instructions for use

The drug is used to treat scabies, acne, psoriasis, demodicosis, pediculus, dandruff. Before applying the ointment to the skin, you need to take a shower. The remains of the ointment can not be washed off during the day. The procedure is repeated for three days in a row. Sulfur ointment is a cheap and effective treatment. But today the drug is rarely used. The fact is that the product has a sharp, unpleasant odor, and stains remain on clothes and bedding.

Preventive actions

Norwegian scabies is an extremely dangerous and contagious disease. Therefore, it is worth adhering to some safety rules:

This is a serious disease - it should not be ignored or attempted to be treated on its own. Alternative methods and home remedies can only be used with the permission of the attending physician and only along with drug therapy.

Etiology and epidemiology

The daily rhythm of activity of the scabies mite explains the increased itching in the evening, the predominance of the direct route of infection through contact in bed in the evening and at night, and the effectiveness of prescribing anti-scabies drugs at night.

Infection with scabies occurs mainly through close bodily contact, usually during a joint stay in bed and an intimate relationship. The infective stages are females and larvae of the tick.

The focus of scabies is defined as a group of people in which there is a patient - the source of infection and the conditions for the transmission of the pathogen. In the irradiation of the focus, the decisive role is played by contact with the patient in bed at night during the period of maximum activity of the pathogen (direct route of infection transmission).

The second place in terms of epidemic significance is occupied by invasive-contact groups - groups of people living together, having a common bedroom (dormitories, orphanages, boarding schools, nursing homes, barracks, "surveillance" wards in neuropsychiatric hospitals, etc.) in the presence of close household contacts with a friend in the evening and at night.

There is no generally accepted classification.

Symptoms of scabies

The incubation period for infection with scabies mite females is practically absent. When invading by larvae, we can talk about the incubation period, which corresponds to the time of tick metamorphosis (about 2 weeks).

There are the following clinical varieties of scabies:

  • typical;
  • scabies without moves;
  • scabies "clean" or "incognito";
  • scabious lymphoplasia of the skin;
  • scabious erythroderma;
  • Norwegian scabies;
  • complicated scabies (secondary pyoderma, allergic dermatitis, less often - microbial eczema and urticaria);
  • pseudosarcoptic mange.

Typical scabies is the most common, its clinical picture is represented by various variants of scabies, follicular papules on the trunk and extremities, non-inflammatory vesicles near the moves, scratching and bloody crusts disseminated throughout the skin. Typical scabies is characterized by the absence of rashes in the interscapular region.

Itching is a characteristic subjective symptom of scabies, due to sensitization of the body to the pathogen. With primary infection, itching appears after 7-14 days, and with reinvasion - one day after infection. Increased itching in the evening and at night is associated with the daily rhythm of the activity of the pathogen.
Rashes in scabies are caused by the activity of the mite (scabies, follicular papules, non-inflammatory vesicles), an allergic reaction of the body to its waste products (miliary papules, scratches, bloody crusts), pyogenic microflora (pustules).



Scabies are the main clinical symptom of scabies. There are three groups of moves, including their various clinical variants:

  • The initial (intact) type of burrow and variants of burrows, the formation of which is associated with the ability of the skin to respond with the appearance of certain primary morphological elements to the introduction of a female tick.
  • The burrows formed from the clinical variants of the burrows of the first group in the process of natural regression of the burrows themselves and/or the transformation of the primary morphological elements associated with them into secondary ones.
  • Strokes due to the addition of a secondary infection to the exudate of the cavity elements of the first group of passages.

Typical passages look like a slightly elevated line of whitish or dirty gray color, straight or curved, 5–7 mm long. The so-called "paired elements" cannot be identified with moves and considered as a diagnostic sign of the disease.


Papules, vesicles, scratching and bloody crusts often dominate the clinical picture of the disease. Immature stages of development of the scabies mite, young females and males are found in 1/3 of papules and vesicles. Papules with mites are characterized by a follicular location and small sizes (up to 2 mm). Vesicles are usually small (up to 3 mm), without signs of inflammation, located in isolation mainly on the hands, less often on the wrists and feet.

Diagnostic symptoms for scabies are:

  • Ardi's symptom - pustules and purulent crusts on the elbows and in their circumference;
  • Gorchakov's symptom - bloody crusts in the area of ​​\u200b\u200bthe elbows and in their circumference;
  • symptom of Michaelis - bloody crusts and impetiginous rashes in the intergluteal fold with a transition to the sacrum;
  • Cesari's symptom - palpation of the itching course in the form of a slight strip-like elevation.


Scabies without burrows is recorded less often than typical scabies, it is detected mainly when examining persons who have been in contact with patients with scabies, occurs when infected with larvae, exists in its original form for no more than 2 weeks, is clinically characterized by single follicular papules and non-inflammatory vesicles.

Scabies "clean" or "incognito" occurs in people who often take water procedures, especially in the evening, corresponds in its clinical picture to a typical scabies with minimal manifestations.

Scabious lymphoplasia of the skin is clinically manifested by severely itchy lenticular papules, localized on the trunk (buttocks, abdomen, axillary region), genitals of men, mammary glands of women, elbows. Scabious lymphoplasia of the skin persists after full treatment of scabies from 2 weeks to 6 months. Scraping the epidermis from its surface accelerates resolution. With reinvasion, it recurs in the same places.



Scabious erythroderma occurs in cases of prolonged (2-3 months) use of systemic and topical corticosteroids, antihistamines, psychotropic drugs. Itching is mild and diffuse. Patients, as a rule, do not comb, but rub the skin with their palms. The main symptom of the disease is severe erythroderma. Scabies occur not only in places of typical localization, but also on the face, neck, scalp, in the interscapular region. In this case, they are usually short (2–3 mm). In places subject to pressure (elbows and buttocks), hyperkeratosis is expressed.
Norwegian (crustal) scabies is a rare and highly contagious form of the disease. It occurs with immunosuppressive conditions, long-term use of hormonal and cytostatic drugs, impaired peripheral sensitivity, constitutional anomalies of keratinization, in patients with senile dementia, Down's disease, in patients with AIDS, etc. The main symptom of the disease is erythroderma, against which massive grayish-yellow or brown-black crusts are formed with a thickness of several millimeters to 2-3 cm, limiting movement and making them painful. Between the layers of crusts and under them, a huge number of scabies mites are found. There are many scabies on the hands and feet. Nails are often affected, lymph nodes increase, hair falls out, and body temperature rises. Patients emit an unpleasant odor. Often, micro-epidemics occur in the environment of such patients - family members, medical workers, patients who are in the same ward become infected.


Complicated scabies. Scabies is often complicated by secondary pyoderma and dermatitis, less often by microbial eczema and urticaria. Among the nosological forms of pyoderma, staphylococcal impetigo, ostiofolliculitis and deep folliculitis predominate, boils and ecthyma vulgaris occur less frequently. Impetigo prevails in places of frequent localization of passages (hands, wrists, feet), ostiofolliculitis - in places of metamorphosis of ticks (anterolateral surface of the body, thighs, buttocks). Microbial eczema is more often observed in the localization of scabious lymphoplasia of the skin, especially in the buttocks.


Scabies in children is characterized by a greater prevalence of the process involving the skin of the face and scalp. Reactive variants of scabies near exudative morphological elements predominate, scabious lymphoplasia of the skin is common, and complications of the disease are not uncommon. The process, especially in infants, may involve the nail plate.


Scabies in the elderly has certain features: scabies are single, their intact variants predominate; vesicles and papules are few. Among the rashes, bloody crusts and scratching are often found. Of the complications, allergic dermatitis and microbial eczema often develop.

Features of the course of scabies in combination with other dermatoses. With scabies against the background of atopic dermatitis, ichthyosis vulgaris (severe dry skin), single scabies are observed; against the background of hyperhidrosis, dyshidrotic eczema, epidermophytosis (increased skin moisture) - multiple. With scabies on the background of psoriasis and lichen planus, as a rule, the isomorphic Koebner reaction is pronounced.

Pseudosarcoptic mange is a disease that occurs in humans when infested with scabies mites of animals (dogs, pigs, horses, rabbits, wolves, foxes, etc.). The incubation period of the disease is several hours, there are no scabies, since the mites do not multiply on an unusual host and only partially penetrate the skin, causing severe itching. Rashes are localized in open areas of the skin, represented by urticarial papules, blisters, bloody crusts and scratching. The disease is not transmitted from person to person.

Diagnosis of scabies

The diagnosis of scabies is established on the basis of a set of clinical and epidemiological data, confirmed by instrumental and laboratory studies aimed at detecting the pathogen.
The diagnosis of scabies must be confirmed by the detection of the pathogen.

The staining method is used to verify scabies. An element suspected of scabies is lubricated with an alcohol solution of iodine or aniline dyes.

The method of oil vitropressure allows you to quickly detect scabies. Due to the bleeding of the capillary bed when pressed with a glass slide, the visualization of superficial skin inclusions improves. The clarifying effect is enhanced after the preliminary application of mineral oil to the intended scabies.



The method of extracting the tick with a needle. For this purpose, sterile disposable injection needles are used. The blind end of the passage is opened with a needle at the site of a brownish dotted inclusion corresponding to the localization of the female scabies mite. The tip of the needle is advanced in the direction of travel. The tick, which is fixed to the needle with its suction cups, is removed and placed on a glass slide in a drop of water or 40% lactic acid, covered with a coverslip and microscopic examination is carried out.


The scraping method allows you to detect the contents of the scabies, papules and vesicles. A drop of 40% lactic acid is applied to the scabies, papule, vesicle or crust. After 5 minutes, the loosened epidermis is scraped off with a scalpel until a drop of blood appears. The material is transferred to a glass slide in a drop of the same lactic acid, covered with a coverslip and microscopic examination is carried out. The result of laboratory diagnostics is considered positive if a female, male, larva, nymph, eggs, empty egg shells, molted skins are found in the preparation. The presence of excrement indicates the need to study scrapings from other areas of the skin.

Dermatoscopy is a mandatory method in the examination of a patient with scabies. With typical scabies, dermatoscopy allows you to get a positive result in all cases, with scabies without moves - in 1/3 of cases, while the detection of scabies increases by a third compared to examining a patient without optical devices. In the presence of destroyed passages and the absence of females of the scabies mite in them, an externally unchanged skin is examined near the passage on an area of ​​at least 4 cm 2.

Differential diagnosis of scabies

Scabies is differentiated from pseudosarcoptic mange, allergic contact dermatitis, urticaria, toxicoderma, rat tick-borne dermatitis, pediculosis, phlebotoderma, dyshidrotic eczema, atopic dermatitis, skin itching, in children with pruritus, chickenpox, etc. To make a differential diagnosis, all of the above clinical, epidemiological and laboratory criteria for the diagnosis of scabies should be taken into account.

Scabies treatment

Treatment Goals

  • elimination of clinical manifestations of the disease;
  • prevention of complications;
  • preventing infection of others.

Non-specific therapies are used to treat complications associated with scabies and reduce the intensity of pruritus.

General notes on therapy

Treatment for scabies is divided depending on the goal pursued by the doctor. There are three types of therapy:

  • specific;
  • preventive;
  • trial (ex juvantibus).

Specific treatment is carried out if the patient has scabies, the diagnosis of which is confirmed clinically and laboratory by detecting the pathogen.



Preventive treatment is carried out according to epidemiological indications in the foci of scabies in persons who have no clinical manifestations of the disease.

Members of family centers (parents, children, grandparents, other relatives), as well as nannies, governesses, nurses;

  • if there are conditions for the transmission of the pathogen (close bodily contact, sexual contact, joint stay in bed in the evening and at night, etc.);
  • in the presence of children with scabies of a younger age group, with whom most family members usually contact;
  • when two or more patients are detected in the focus (irradiating focus). Members of invasive-contact teams:
  • persons who have shared bedrooms, in the presence of close bodily contact with a patient with scabies;
  • all members of groups/classes/subdivisions where several cases of scabies are registered or new patients are detected in the process of monitoring the focus.

Trial treatment (ex juvantibus) is carried out only in cases where the doctor, according to clinical data, suspects the presence of scabies, but the diagnosis is not confirmed by the detection of the pathogen. With a positive effect from the use of scabicides, a case of scabies is registered.
The principles of therapy must be followed by the physician regardless of the scabicide chosen for the treatment of scabies:

  • simultaneous treatment of all patients identified in the outbreak to prevent reinvasion;
  • application of anti-scab preparations in the evening to increase the effectiveness of therapy, which is associated with the nocturnal activity of the pathogen;
  • application of anti-scabies preparations approved for use in children under the age of 3 years on the entire skin, in other patients, the face and scalp are an exception;
  • application of scabicides with bare hands, and not with a napkin or swab, the preparations are especially carefully rubbed into the skin of the palms and soles;
  • if after applying the drug it became necessary to wash hands, then they must be re-treated with a scabicide;
  • washing before the first application of scabicide and after completion of treatment; change of underwear and bed linen - after the course of therapy;
  • exposure of the drug on the skin should be at least 12 hours, including the entire night period, it can be washed off in the morning;
  • treatment of complications simultaneously with the treatment of scabies;
  • persistent scabious lymphoplasia of the skin is not an indication for continuing specific therapy;
  • in the presence of post-scabious itching, the issue of re-treatment with scabicide is decided on an individual basis after a thorough examination of the patient;
  • after completion of therapy, it is necessary to carry out disinfestation of underwear and bed linen, towels, clothes and shoes, to carry out wet cleaning in the room where the patient was.

Indications for hospitalization

  • patients with mental, neurological or other diseases, in which the patient, in the absence of a person caring for him, cannot fully fulfill all the necessary appointments on his own;
  • patients from organized groups in the absence of the possibility of isolating them from healthy individuals (for example, in the presence of scabies in people living in boarding schools, orphanages, etc.).

An indication for referral to a hospital can also be scabies complicated by secondary pyoderma with multiple, often deep pustules (furuncles, carbuncles, ecthymas), especially in children, as well as scabies accompanied by lymphadenopathy, high fever, etc.

If scabies is detected in a patient in the somatic department, transfer to a specialized dermatovenerological hospital is not required. Treatment is carried out in the department where the patient is due to the underlying disease. The patient loses contagiousness after the first scabicide treatment. With a common process, Norwegian scabies and scabious erythroderma, temporary isolation of the patient in a separate ward is necessary for the duration of scabies treatment (4 days). In these cases, all patients who are in the same ward with a patient with scabies are subject to prophylactic treatment.

A patient with scabies coming for treatment from the admission department (or identified in the department) is isolated in a separate ward (isolation room). After consulting a dermatovenereologist and confirming the diagnosis, the patient (adults and children over 1 year old) is treated and items for individual use (towel, washcloth, soap in small packaging) are issued. Meals are organized in the ward. The underwear and bed linen of the patient is processed.

Manipulations in relation to patients with scabies, as well as cleaning of premises, are carried out using personal protective equipment - rubber gloves, separate gowns. Rubber gloves and cleaning equipment are disinfected after cleaning.

Preparations for the treatment of scabies:

  • Emulsion and ointment of benzyl benzoate
  • Permethrin 5% - Aqueous 0.4% emulsion
  • Sulfuric ointment
  • Piperonyl butoxide + esbiol aerosol


Special situations

Treatment of pregnant women with scabies:

For the treatment of scabies in pregnant women, an aerosol for external use of piperonyl butoxide + esbiol and a solution of permethrin prepared from a 5% emulsion concentrate in ethanol are used with caution.


Treatment of children with scabies:

For the treatment of children under the age of 1 year, an aerosol for external use of piperonyl butoxide + esbiol is used; for the treatment of children aged 1 to 3 years - an aerosol for external use of piperonyl butoxide + esbiol and 5% permethrin emulsion concentrate in ethanol; for the treatment of children aged 3 to 7 years - 10% emulsion and ointment of benzyl benzoate, 5% sulfuric ointment are added to these funds; therapy for children over the age of 7 years is carried out according to the treatment regimens for adults.


Treatment for scabious lymphoplasia of the skin (SLK) can be lengthy. After a full course of any scabicide, the ticks die. SLK resolves much faster if, before starting specific therapy, the epidermis from the surface of the papules is scraped off with a sterile scalpel until drops of blood appear. The skin defect is treated with antiseptic preparations (aniline dyes, 5% potassium permanganate solution, povidone-iodine solution, chlorhexidine bigluconate, etc.). Specific treatment with scabicides (in the evening) is combined with rubbing into papules (morning and afternoon) of topical combined glucocorticosteroid drugs: diflucortalone + isoconazole, betamethasone + gentamicin + clotrimazole, hydrocortisone + neomycin + natamycin, clioquinol + flumethasone, etc.
If, after the resolution of the main clinical manifestations of scabies, SLK is observed, treatment is continued with single-component topical corticosteroids under an occlusive dressing: methylprednisolone aceponate, hydrocortisone butyrate, mometasone furoate, etc. Phono- or photophoresis with these drugs can be used, except when SLX is localized on the genitals . Superficial cryodestruction of SLK foci is also used, followed by the application of topical combined glucocorticosteroid preparations.

Treatment of scabies complicated by secondary pyoderma.

Treatment begins with rubbing scabicide to eliminate itching, which contributes to the violation of the integrity of the skin. Preference is given to scabicides, the application of which does not require intensive rubbing and does not contribute to the spread of infection on the skin (an aerosol for external use of piperonyl butoxide + esbiol and a solution of permethrin prepared from a 5% emulsion concentrate in ethanol).

With superficial pyoderma (impetigo, ostiofolliculitis, turniol, etc.), external therapy is used. Pustules are extinguished with solutions of aniline dyes, 5% potassium permanganate solution, povidone-iodine solution and other antiseptic preparations. In the presence of impetigo, its tire is pierced with a sterile needle. After the pustules have dried, ointments / creams with antibacterial action are prescribed: bacitracin + neomycin, mupirocin, fusidic acid; with antiseptics: povidone-iodine, silver sulfathiazole, chlorhexidine bigluconate, etc.; combined preparations: dioxomethyltetrahydropyrimidine + chloramphenicol, etc. Topical combined glucocorticosteroid preparations are indicated: hydrocortisone + neomycin + natamycin, hydrocortisone + fusidic acid, betamethasone + gentamicin + clotrimazole, clioquinol + flumethasone, etc.


With deep forms of pyoderma (vulgar ecthyma, deep folliculitis, boils), treatment is supplemented by the appointment of systemic broad-spectrum antibacterial drugs.

Treatment of scabies complicated by allergic dermatitis.

Before starting specific therapy, it is advisable to recommend that the patient wash with soap to improve the access of the anti-scabies drug to the passages. Treatment begins with rubbing a scabicide to eliminate the activity of the scabies mite that produces allergens. Preference is given to scabicides, the application of which does not require intensive rubbing and does not contribute to the spread of infection on the skin (an aerosol for external use of piperonyl butoxide + esbiol and a solution of permethrin prepared from a 5% emulsion concentrate in ethanol).

With a limited process, only local therapy is advisable. For this purpose, combined topical glucocorticosteroid preparations are used, for example, flucortalone + isoconazole, betamethasone + gentamicin + clotrimazole, hydrocortisone + neomycin + natamycin, clioquinol + flumethasone, etc.



With widespread allergic dermatitis, it is necessary to prescribe oral antihistamines (levoceterizine, chloropyramine hydrochloride, clemastine, cetirizine, desloratadine, etc.). In this case, external therapy is started with an aqueous shaken mixture, cindol and other indifferent agents, including products for the care of dry, irritated skin. After the transformation of a widespread process into a local one, treatment can be continued with single-component topical glucocorticosteroid drugs: methylprednisolone aceponate, hydrocortisone butyrate, mometasone furoate.

Treatment of scabies complicated by microbial eczema.

Given that microbial eczema often develops in areas of the skin where SCL is localized, its treatment includes three stages:

  • treatment of scabies with one of the scabicides;
  • treatment of microbial eczema according to the generally accepted scheme, after the resolution of infiltration and the discharge of crusts, lenticular papules (SLK) usually remain in its place, often multiple;
  • treatment of SLK according to the scheme indicated above.

Treatment of Norwegian scabies has specific features. In the evening, the patient is treated with scabicide to destroy the active stages of the pathogen and reduce the contagiousness of the patient, in the morning - with one of the keratolytic drugs - with salicylic acid (5% sulfur-salicylic ointment, 5-10% salicylic ointment) and urea. Such treatment is carried out until the complete discharge of the crusts. Further, the patient is treated in the evening only with scabicide. After specific therapy is completed, emollients or moisturizers are used to eliminate dry skin. An important condition is the regular examination of scrapings of the epidermis to identify scabies mites. If mobile individuals are found, the course of specific therapy is repeated with a change in scabicide.

Scabious erythroderma is treated in the same way as Norwegian scabies, but without the use of keratolytic agents.

Postscabiosis pruritus (PS) is the persistence of itching in patients after full-fledged specific therapy with one of the scabicides. The main objective clinical symptom of PZ is the presence of scabies, the length of which reaches several centimeters. The absence of openings in the roof of such passages makes it difficult for scabicide to penetrate them. The duration of the PZ corresponds to the life expectancy of the females and depends on their age at the start of therapy. If PZ persists during treatment with antihistamines and topical glucocorticosteroids for a week (the time required to exfoliate the epidermis with dead mites), it is necessary to re-treat with scabicide after thoroughly washing the patient with soap and a washcloth. Dry skin can be another cause of PZ. In this case, emollients are prescribed.

Treatment of scabies in the hot season. Preference is given to preparations in a liquid dosage form (an aerosol for external use of piperonyl butoxide + esbiol and a solution of permethrin prepared from a 5% emulsion concentrate in ethanol), which do not require intensive rubbing. The use of the ointment at high air temperatures can lead to overheating of the patient, the occurrence of dermatitis or the appearance of pyoderma.

Requirements for treatment outcomes

  • destruction of the pathogen at all stages of its development;
  • elimination of itching and disappearance of clinical manifestations of the disease.

The terms of observation of patients are individual and depend on its clinical form. With scabies without moves, typical scabies, scabies "incognito" after a full course of therapy and a full range of preventive measures in the focus, the observation period for patients is 2 weeks. The duration of dispensary observation increases with scabies complicated by pyoderma, dermatitis, microbial eczema, with scabious lymphoplasia of the skin, scabious erythroderma and Norwegian scabies. The patient is removed from the register after the complete resolution of all clinical manifestations. The prognosis for scabies is favorable.

Reasons for treatment failure:

Non-compliance with treatment regimens:

  • the use of drugs in low concentrations;
  • non-compliance with the multiplicity and terms of processing;
  • application of the drug without taking into account the daily rhythm of the activity of the scabies mite;
  • partial treatment of the skin;
  • use of expired scabicides.
  • Reinvasion in the absence or incomplete volume of anti-epidemic measures in the outbreak.
  • Tick ​​resistance to scabicides.

Drug complications from scabicides, manifested by itching and dermatitis, are often mistakenly regarded as the persistence of scabies.

Prevention of scabies

The identification of patients with scabies is carried out by medical workers of all healthcare organizations, regardless of organizational and legal forms and forms of ownership (including in preschool and general educational institutions, institutions of primary, secondary and higher professional education, during the period of conscription, etc.), as well as persons engaged in private medical practice upon application, preliminary upon admission to work and periodic, scheduled, preventive medical examinations and according to epidemiological indications.

Prevention of scabies includes several areas.

  • Registration of all identified patients with scabies.
  • Implementation of dispensary observation of patients and contact persons.
  • Identification of the source of infection and contact persons, including sexual partners.
  • Identification of foci of scabies and work on their elimination. Members of organized teams are examined by medical workers in the field.
  • Definition of groups of people subject to mandatory preventive treatment (see above).
  • Active identification of patients during preventive medical examinations of various groups of the population (declared contingents, children's groups, persons of draft and assigned age, schoolchildren at the beginning of the school year, applicants, military personnel, etc.).
  • Examination for scabies of patients who applied to polyclinics, outpatient clinics, medical units, hospitalized in medical organizations of any profile, etc.
  • If scabies is found in schoolchildren and children attending nurseries, kindergartens and schools, they are not allowed into children's groups for the duration of the full treatment. Scabious lymphoplasia of the skin is not a contraindication for the admission of children to organized groups, since the patient, after high-quality therapy, loses his contagiousness to others.

Medical workers of outpatient clinics, hospitals, orphanages, orphanages, kindergartens, general and vocational education institutions, social security institutions, medical enterprises, regardless of ownership and departmental affiliation, are required to actively identify patients with scabies in the provision of medical care and carrying out preventive examinations. Inspection for scabies are subject to:

  • Students of institutions of general and vocational education - at least 4 times a year after each vacation, monthly - selectively (at least four to five classes) and 10-15 days before the end of the academic year. Examinations are carried out by the medical staff of institutions with the possible involvement of teachers.
  • Students of boarding schools, children living in orphanages, orphanages, etc. - weekly. The examination is carried out by medical personnel with the involvement of educators.
  • Children traveling to children's health institutions, labor and recreation camps are examined by the medical staff of the polyclinic at the place of residence before departure. During their stay in places of recreation, children are examined by the medical staff of the camp before each bath (at least 1 time per week) and before returning to the city (1–3 days in advance).
  • Children attending preschool institutions are monthly examined by the medical staff of the institution (doctor, nurse).
  • Employees of enterprises, including those in rural areas, are examined by medical workers of an enterprise or clinic during medical examinations and medical examinations.
  • Persons staying in institutions of the social security system are examined by the medical staff of the institution 2 times a month.
  • Patients admitted to inpatient treatment are examined by a nurse in the admission department, and in case of long-term treatment - by a nurse in the treatment department at least once every 7 days.
  • Persons living in dormitories are examined upon check-in, then quarterly. Inspection is carried out by medical workers with the involvement of educators, commandant, etc.
  • Medical workers of medical institutions examine patients for scabies when seeking medical help. Particular attention is paid to persons referred for inpatient treatment, to organized groups (sanatoriums, rest homes, children's institutions), living in hostels, lonely elderly, chronically ill, disabled people, people without a fixed place of residence, etc.

Anti-epidemic measures in the detection of scabies

  • Conducting a full treatment of each identified patient, taking into account the indications for hospitalization. Children of preschool and school age are suspended from attending organized groups for the duration of treatment. They can be allowed only after the completion of a complex of therapeutic and preventive measures with a confirming certificate from a doctor.
  • Determination of the circle of contact persons, including contacts in organized groups (sports sections, institutions of additional education, etc.).
  • Implementation of medical monitoring of contact persons: in organizations where preventive treatment of contact persons was not carried out, examination of the skin is carried out three times with an interval of 10 days.
  • Organization of disinfection in foci: when scabies is detected in children attending preschool educational and general educational organizations, in lonely, elderly, disabled persons, persons. living in dormitories, members of large families, migrants, persons without a fixed place of residence, the final disinfection (disinsection) is carried out by specialized organizations licensed in disinfectology, at the request of medical workers of healthcare facilities, organizations and individuals, including with chamber processing of underwear and bed linen, bedding.
  • An examination of the family focus and an organized invasive-contact team is carried out upon detection of the first patient and two weeks after the completion of therapy for the last identified patient with scabies, provided that all members of the focus were examined in a timely manner, and, in accordance with the indications, preventive treatment was carried out for contact persons. In organized groups, where preventive treatment was not carried out for contact persons, the examination is carried out three times with an interval of 10 days.


  • Carrying out the current disinsection in the outbreaks. The current disinsection is aimed at the destruction of ticks on bedding, clothes and personal hygiene items of the patient. The attending physician explains the current disinfection methodology, and it is carried out by the sick person or a family member caring for him. Each patient must have a separate bed, bedding and personal items (towel, washcloth, slippers, bathrobe).
  • Disinfection of bedding, underwear, towels is carried out by washing at a temperature of 70-90 o, or by soaking for an hour in chlorine-containing solutions. Outerwear is disinfected by ironing things on both sides with a hot iron, paying special attention to pockets. Permethrin and malathion-based preparations are used to disinfect textiles, shoes, and children's toys. Some things that are not subject to heat treatment can be hung out in the open air for 3 days. To disinfect a number of things (children's toys, shoes, clothes), you can use the method of temporary exclusion from use, for which they are placed for 3 days in hermetically tied plastic bags.
  • In case of mass outbreaks of scabies in organized groups, in the presence of several patients in family foci, when patients with scabies are admitted to a hospital in the admission department, the room is disinsection.
  • In hospitals and scabiozoria, mattresses, pillows, bed and underwear, clothes of incoming patients are processed in a disinfection chamber. In the same way, bedding used by patients with scabies is treated after discharge from the hospital.
  • Disinsection measures are of particular importance in identifying patients with scabious erythroderma and Norwegian scabies. Microepidemics often occur around such patients. In this regard, preventive treatment should be carried out by medical personnel, caregivers, roommates. Such patients are isolated in a separate ward, where they conduct daily current, and at discharge - chamber disinfestation.
  • In the "surveillance chambers" of psychiatric hospitals, when a patient with scabies is detected, prophylactic treatment is carried out for all patients who are in the same ward. In the presence of pruritic dermatosis in a patient admitted to a psychiatric hospital, a consultation with a dermatologist and prophylactic treatment with scabicide in the emergency department are necessary. In an unfavorable epidemic situation, in order to prevent the introduction and spread of scabies in large organized groups (army, navy, prisons), all newcomers to the quarantine zone are subject to prophylactic treatment with scabicides. For this purpose, preparations in liquid form (permethrin) are suitable.

IF YOU HAVE ANY QUESTIONS REGARDING THIS DISEASE, PLEASE CONTACT DERMATOVENEROLOGIST ADAEV KH.M:

WHATSAPP 8 989 933 87 34

Email: [email protected]

INSTAGRAM @DERMATOLOG_95

Norwegian scabies (crustal, bushy scabies or scabies norvegica) is a complicated form of the disease, which is characterized by the formation of dense gray crusts and scales, as well as the absence of itching. This course of the disease was first noted in 1847 in Norway (hence the name) in a person with leprosy. For all the time, about one and a half hundred cases have been registered.

Features of the disease

Symptoms and signs of an infectious process

Signs of Norwegian scabies

  • if the crust is separated, the skin under it is loose, red, bleeds easily;
  • absolute absence of itching;
  • scanty hairline;
  • thickening and dystrophy of the nail plates;
  • from a person comes the smell of fermented sour dough;
  • lymph nodes are enlarged;
  • infection affects any part of the skin.

Photo of Norwegian scabies

Principles of treatment

Therapy of this disease is carried out exclusively in a hospital setting. In this case, the patient must be isolated in a separate box due to the high risk of infection. Medical staff in the care of such a patient uses personal protective equipment.

Note! It is important that all people who have been in contact with the patient undergo preventive treatment.

After removing the crusts, the person is advised to wash himself completely, because during the entire healing process it is forbidden to take a shower. And also after each washing of the hands, the patient needs to re-apply anti-scabies agents to the skin. Nails should be trimmed short and carefully trimmed.

With the complication of Norwegian scabies with dermatitis and pyoderma, these diseases are also treated at the same time. It is also important to influence the cause of immunodeficiency. Without this, the positive effect will not last long.

The main drugs in the treatment of scabies

Forecast

To see new comments, press Ctrl+F5

All information is presented for educational purposes. Do not self-medicate, it is dangerous! An accurate diagnosis can only be made by a doctor.

Norwegian scabies has several other names - crusty, crustose, keratotic scabies, and Latin – scabies norwegica. This disease is a severe form of typical scabies with a long relapsing course, no pruritus, thick crusty scales all over the body.

Prevalence

For the first time this type of scabies was described by scientists Beck and Danielsonn in the 19th century in Norway, so it was called Norwegian.

The disease is quite rare. – in dermatology, a little more than 150 clinical cases of the disease have been described.
The infection affects children and adults of both sexes and all races. Contribute to the spread of infection loose sexual behavior, crowded living conditions, non-compliance with the rules of personal hygiene. The infectious process can last for years and even throughout life, gradually covering the entire body with a crust. Patients are highly contagious and can cause sporadic outbreaks of crusty scabies in hospitals.

The most susceptible to infection are persons with weak immunity (patients with HIV infection, leprosy, tuberculosis, dementia, Down's disease, leukemia, lymphoma, syphilis, skin sensitivity disorders, discoid lupus, candidiasis, as well as people taking corticosteroid hormones for a long time).

Transmission routes

Cortical disease is transmitted from person to person in the following ways:

  • Contact, or "skin to skin". The most common route of transmission of the disease. Infection occurs when shaking hands, during children's games, in cases where children sleep with sick parents in the same bed;
  • Contact household. The use of linen, toys, clothes of a sick person can contribute to infection. For example, you can get scabies through bed linen, towels, mattresses, pillows, blankets in trains, hostels, kindergartens, hotels;
  • Sexual. Contact of bodies during sexual intercourse can provoke an infection with scabies. This method is due to the increased activity of scabies in the evening and at night.

There is evidence that scabies can be transmitted from domestic animals (cats, dogs, rabbits, horses, small cattle).
In this case, they speak of pseudoscabies, because the mites that cause scabies in animals are harmless to humans. Pseudo-scabies cannot be passed from person to person.

Diagnostics

In patients with scabies in the general blood test, eosinophilia, leukocytosis, and accelerated ESR are noted. Microscopically, a high number of itch moves arranged in layers, as well as the phenomena of acanthosis and parakeratosis, are determined. Making an accurate diagnosis is complicated by the absence of unbearable itching, characteristic of the symptoms of typical scabies. The disease can be confused with pyoderma, eczema complicated by pyoderma, and also with the hyperkeratotic form of psoriasis. Norwegian scabies is confused with psoriasis most often because of similar symptoms: widespread reddening of the skin, powerful horny crusts, peeling of the skin, deformation of the nails in the absence of itching.

Clinical picture and pathogenesis

With scabies, the amount of pathogen on the body is very large and is measured in thousands and millions. The skin of patients is dry, hot, covered with a thick layer of gray-green crusts. In some places, keratinization resembles a thick, continuous shell, tightly covering the skin. When tearing off the crust, reddened, thin and bleeding skin is visible.
The affected areas are densely populated with clusters of scabies. The crusts are yellow-gray, gray-brown, thick with a smooth or uneven surface. They are usually located one above the other, in several layers, 2-3 centimeters thick, resembling a shell. Between the layers there is such a large number of mites that in one square centimeter of the skin you can see up to two hundred itchs with numerous passages.
The lesions are located on the elbows, abdomen, buttocks, interdigital spaces, face, neck, head, but it happens that the pathological process covers the entire body. Hair in areas of keratinization is dull and dry, nails are deformed and thickened. Lymph nodes enlarge and become inflamed throughout the body. One of the typical symptoms – the skin has a specific smell of fermented dough.

Forecast

If the treatment was not started or chosen incorrectly, then the pathological process can spread throughout the body and cause death. Errors in the diagnosis entail incorrect treatment, so the disease can become neglected and generalized.

Treatment

Preparations

The benzyl benzoate emulsion is prepared in a concentration of a 10% solution for children or a 20% solution for adults. The emulsion is sold in a pharmacy, it looks like milk. Unlike sulfur ointments, it does not have a specific unpleasant odor and dries quickly on the skin. For a single treatment, 100 ml of emulsion is required. The treatment is carried out on the first and fourth days of treatment. In addition, the patient needs to change bed and underwear on the first and sixth days of treatment.

Spregal is available as an aerosol. Aerosol treatment is carried out once. The bottle is kept at a distance of 20 cm from the skin and the entire body is treated. You can swim after 12 hours. Bedding and underwear are changed.

Permethrin is available as a spray. Processing is carried out once within three days. Then on the 4th day the patient should bathe with soap and change bed and underwear. Permethrin should not be used to treat children, pregnant or lactating women. Itching and other symptoms reduce their severity already on the second day.