Indian Journal of Dermatology
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ORIGINAL ARTICLE
Year : 2006  |  Volume : 51  |  Issue : 3  |  Page : 186-188
Evaluation of the commonest site, demographic profile and most effective therapy in scabies


Department of Dermatology & Venereology, B.S. Medical College, Bankura. West Bengal, India

Correspondence Address:
Sudip Das
P-103, Bosenagore, Madhyamgram, 24 Parganas (North), Kolkata - 700 129
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.27981

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   Abstract 

The study was planned to find out commonest sites of scabies in Indian patients. Attempt was made to study the demographic profile i.e., the common age groups, affection of family members, friends or sexual partners, type of skin lesions, history of previous affection of scabies, coassociation with STDs, and to find out the most effective treatment of scabies. Our study showed that genitalia and finger webs were the most common sites and papular lesions were by far the commonest lesion in scabies. Oral lvermectin remained the most effective drug closely followed by topical 5% permethrin cream.


Keywords: Scabies, commonest site, effective therapy


How to cite this article:
Das S, Chatterjee T, Banerji G, Biswas I. Evaluation of the commonest site, demographic profile and most effective therapy in scabies. Indian J Dermatol 2006;51:186-8

How to cite this URL:
Das S, Chatterjee T, Banerji G, Biswas I. Evaluation of the commonest site, demographic profile and most effective therapy in scabies. Indian J Dermatol [serial online] 2006 [cited 2020 Aug 11];51:186-8. Available from: http://www.e-ijd.org/text.asp?2006/51/3/186/27981



   Introduction Top


Scabies is the commonest parasitic infection of human beings in tropical climates. This occurs commonly in poor people who live in crowded conditions and cannot adopt proper hygienic measures. It occurs as itchy papules on finger webs, genitalia, wrist, buttock, umbilicus, lower abdomen, inner thighs, soles (particularly in children), and face (in children). Various types of lesion have been seen and reported in literature e.g., papular, papulovesicular, eczematous and nodular. Though rare, erythrodermic and crusted scabies (Norwegian variety) have also been seen. Scabies occurs in all ages and all groups of person of both sexes are susceptible.

The sources of infection in scabies can be an infected family member, sexual partner or friends (in school or otherwise) and is spread commonly by direct contact, fomites and sexual route. However, scabies can co-exist with other skin diseases-both infective and noninfective.

Various treatment modalities have been tried in scabies: 25% benzylbenzoate, 1% gamma benzene hexachloride (GBHC), 6% precipitated sulfur and 5% permethrin (which is regarded by most as the treatment of choice) though oral therapy with lvermectin 200 g/kg is fast emerging as another choice. One percent GBHC is still the cheapest and most prescribed treatment of scabies in various types of pharmacies, by general practitioners, pediatricians and probably also dermatologists. Precipitated sulfur (6-10%), though messy, is the treatment of choice in pregnant women and children less than 2 months. 25% benzyl benzoate is no longer used and is regarded as obsolete by most and 10% crotamiton oil per se is not a very good effective antiscabetic. We aimed to compare the treatment efficacy of 1% GBHC (Gr I) 5% permethrin (Gr II), oral Ivermectin 200 mg/kg (Gr III) and white soft petrolatum jelly (Gr IV, control group)


   Materials and Methods Top


Two hundred consecutive patients of scabies were enrolled in the study. Pregnant women and children (less than two years) were excluded from the study. They were randomly distributed into 4 groups of fifty patients each; microscopic and clinical confirmation was done in each case. A questionnaire was prepared to look into various age groups; sexual partners; whether family members, friends, sexual partners were affected and whether place of residence was hostel or home. Sites of affection in each patient after detailed clinical examination and the type of lesion/lesions were noted. We also recorded the number of patients living in same rooms and whether there was any history of similar affection previously. We also noted if there was any association with sexually transmitted disease and association with HIV infection was also found out in STD associated cases.

Of the four groups, (Gr. I - 50 patients) was treated with GBHC for 2 consecutive overnight application to all family members and results noted after 2 weeks for reduction of lesions and as well as itching and similarly again at 4 weeks. Gr - II was treated with 5% permethrin (overnight single application) from neck to toes in all family members and results noted similarly. Gr. - III was treated with 2 doses of oral Ivermectin 200 mg/kg body wt. 2 weeks apart and Gr. - IV was treated with white soft paraffin in a manner similar to group I [Table - 1].


   Results Top


Two hundred patients were enrolled in the study. We divided them into 4 groups; of these, 9% were in the 0-5 yrs age group, 22% were in the 6-15 yrs age group, 22% were in the 16-30 yrs age group, 9% were in the 30-50 yrs age group and only 7% in the 51 years and above age group. The youngest patient in our study was 3 yrs and the eldest 71 years old. Males (70%) outnumbered females (30%) in our study. Fifty four percent had some or all family members affected; twenty six percent had some sexual partners affected and friends were co-affected in twenty percent of cases. 70% of our patients lived in own residence, 20% lived in hostels and remaining 10% in jhuggis or slums.

A large number of our patients had more than one type of skin lesions, though papular lesions were the commonest (76%), papulovesicular and eczemetous lesions were seen in 23 and 24% of our cases respectively. Burrows, the most characteristic lesion, was seen in 17% of cases. Only one case each of bullous lesions and erythroderma with scabies were recorded. Previous affection with scabies were seen in 25% of our cases and association with STDs were noted in seven cases (3.5%). No HIV positive cases were found. Some of the patients also had other infective disease like tinea infections, pyoderma, viral wart, and pityriasis versicolor. Noninfective skin diseases like vitiligo, acne, psoriasis etc. were also associated with it.

Multiple sites were affected in almost all patients. Genitalia (60%) remained the commonest site in our study, followed by finger webs (57%). Other important sites in our study were lower abdomen (48%), umbilicus (42%), inner thighs (38%), wrist (41%) and buttocks (40%), papular lesions on breast was found in a third of female cases of our study. the other rare sites noted to be affected included palms and soles (9%), lower leg (2%), back (2%), scalp (1%) and face (1%).

Ivermectin (200 mg/kg of body weight) given in 2 doses at 2 weeks interval showed the best results with 96% improvement clinically and 100% reduction in itching at 4 weeks. However, permethrin 5% also showed good results with 90% improvement clinically as well as in itching.


   Discussion Top


Scabies has been found to occur in both sexes and at any age group.[1] Lesions of scabies are bilateral and have been described on finger webs, side of fingers, flexor surface of wrist, elbow, anterior axillary fold, genitalia, buttocks, umbilicus and areola of female breast.[2] Involvement of multiple sites is the rule, but no study has attempted to find out the commonest sites of scabies.[3] Our study confirms that the above mentioned sites are the commonest but also emphasizes the rule that genital lesions and finger webs remains the two most common sites affected. Papular lesions are the commonest lesions of scabies and this is amply confirmed by our study. Eczematous lesions, though understated, is also very common in our country. Though scabies occurs in all age groups and in all sexes, our study had cases ranging in age from 3 years to 71 years and males out-numbered females. This was probably because of the fact that in a predominantly rural setup, males report more frequently than the conservative female population at OPDs. Though there are many anti scabetics, permethrin (5%) cream, a synthetic pyrethoid, is an excellent scabicidal with low mammalian toxicity and low potential for toxicity from misuse. It is regarded as antiscabetic of first choice.[3] Permethrin however is contraindicated in children younger than two months of age and in pregnant and nursing women. The most common adverse reactions are mild and transient burning and stinging, exacerbation and recurrence of pruritus. GBHC 1% is applied easily and left for 8-10 hrs. and then washed off. 10% of lindane applied is absorbed from skin and neurotoxicity has occurred primarily with abuse or overuse.[4] The other topical scabicidal, 6-10% precipitated sulfur remains the treatment of choice for pregnant, nursing mothers and children below 2 months of age. Crotamiton cream is not an effective scabicidal agent. Ivermectin, an anti parasitic agent, is a very highly effective antiscabetic.


   Conclusion Top


Our study proves that oral Ivermectin had the best results, both in terms of efficacy and patient compliance, followed by permethrin 5% cream. We however did not experience any adverse effect in all four groups. We therefore suggest that oral lvermectin be regarded now as a drug of choice in scabies.

 
   References Top

1.Orkin M, Maibach HI, Editors. Ectoparasitic infections in: Atlas of Infections of Scabies. Saunders: Philadelphia; 1998.   Back to cited text no. 1      
2.Pallen AS. Scabies in infants and small children. Semin Dermatol 1993;12:3-6.  Back to cited text no. 2      
3.Orkin M, Maibach HI. Scabies therapy. Semin Dermatol 1993;12:22-5.   Back to cited text no. 3  [PUBMED]    
4.Orkin M, Maibach HI. Scabies and Pediculosis in Freedberg IM, Arthur ZE, Wolff K, Austen FK et al . editors Fitzpatrick Dermatology in General medicine. 5th ed. McGraw Hill: New York; 2001. p. 2677-84.  Back to cited text no. 4      



 
 
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    Abstract
    Introduction
    Materials and Me...
    Results
    Discussion
    Conclusion
    References
    Article Tables

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