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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_141_библиотеки_им_акад_М_И_Перельмана
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70 Scabies, Scabies Mites, Scabies Mite Burrows
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Fig. 70.21–70.89 (continued)
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70 Scabies, Scabies Mites, Scabies Mite Burrows
Fig. 70.21–70.89 (continued)
70 Scabies, Scabies Mites, Scabies Mite Burrows
https://t.me/med1917
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Fig. 70.21–70.89 (continued)
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70 Scabies, Scabies Mites, Scabies Mite Burrows
Fig. 70.21–70.89 (continued)
70 Scabies, Scabies Mites, Scabies Mite Burrows
https://t.me/med1917
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Fig. 70.21–70.89 (continued)
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70 Scabies, Scabies Mites, Scabies Mite Burrows
Fig. 70.21–70.89 (continued)
cal and epidemiological studies, and the development and
practical application of a commercialized mite diagnostic kit
that can diagnose mites simply and quickly is desperately
needed. Scabies was additionally designated as a “neglected
tropical disease” by WHO in 2017, and more understanding
of its disease burden is currently needed. However, there
were limitations in interpreting research and epidemiological
survey results because standardized test methods or screen-
ing procedures for diagnosis have not been established, but
in 2018, The International Alliance for the Control of Scabies
(IACS) developed agreed mite diagnostic criteria.
I recently read an article by a blogger. He said, “in Korea,
when things aren’t going well, people sometimes say,
‘Scabies stick to my luck.’ Actually, I didn’t know what
‘scabies‘was, but after suffering from itching for several
months and being diagnosed with scabies, I realized what a
70 Scabies, Scabies Mites, Scabies Mite Burrows
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Figs. 70.90–70.92 Scabies mites and burrows—500 times magnied image
Figs. 70.93 and 70.94 Classical scabies
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Figs. 70.95 and 70.96 Crusted scabies (Norwegian scabies)
70 Scabies, Scabies Mites, Scabies Mite Burrows
Figs. 70.97 and 70.98 Canine scabies
Figs. 70.99 and 70.100 Vesicular scabies
70 Scabies, Scabies Mites, Scabies Mite Burrows
https://t.me/med1917
Figs. 70.101 and 70.102 Nodular scabies
301
Figs. 70.103 and 70.104 Scabies incognito
Fig. 70.105 In women, scabies infestation tend to occur at older ages
Fig. 70.106 Scabies in the elderly
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70 Scabies, Scabies Mites, Scabies Mite Burrows
terrible expression.” Even if all the mites are exterminated, it
can take about 6weeks for hypersensitivity symptoms and
signs to be resolved, so it is suggested that treatment failure
should not be determined until at least 6weeks after treatment is completed. Most cases of treatment failure are due to
inappropriate treatment or poor compliance with treatment,
but sometimes differential diagnosis should be considered.
In developing countries, differential diagnosis should include
pruritic skin diseases such as psoriasis, atopic dermatitis, and
lichen planus, and if there are blisters, bullous pemphigoid
and dermatitis herpetiformis should be considered. In infants
and young children, differential diagnoses such as
Langerhans cell histiocytosis, papular urticaria, and infantile
acropustulosis should be made. In tropical environments, it
is important to differentiate from pyoderma that occurs without scabies. Norwegian scabies need to be differentially
diagnosed from diseases that show hyperkeratosis such as
psoriasis, seborrheic dermatitis, Darier’s disease, and palmoplantar keratoderma. Additionally, it should be remembered
that double infections such as scabies and pediculosis, or
scabies and syphilis, may occasionally occur. In sexually
active patients, tests for sexually transmitted diseases, including AIDS, must be added. With the recent increase in atypical clinical manifestations of scabies and the resulting delay
in diagnosis and misdiagnosis, it is always necessary to keep
in mind the possibility of scabies in patients with persistent
and severe itching that is resistant to treatment.
Scabies improves within a few weeks with early diagnosis
and appropriate treatment. Nodular scabies heals in about
3 months in 80% of patients, but sometimes lasts up to a
year. If left untreated for several weeks or months, it not only
spreads to those around but also suffers from complications.
The complications of scabies and its secondary effects can
be a huge burden on public health, but they are not yet generally well recognized. In private clinics, if scabies medication
is administered without an accurate diagnosis, it can be
unclear how long to use scabies medication for ongoing itching, so it is essential to make an effort to directly conrm the
scabies mite or scabies mite burrow. The two drugs most
commonly used worldwide for the treatment of scabies are
topical permethrin (a synthetic pyrethroid insecticide) and
oral ivermectin (an anti-parasitic macrocyclic lactone antibiotic), both of which are similarly effective and usually well
tolerated. In Korea, since oral scabies medication, ivermectin, is not yet produced/distributed, it is important to choose
an appropriate topical application that can eradicate scabies
mites and all people who have had physical contact, including family members, should be treated together. Along with
the topical application of anti-scabies agents, oral antihistamines and mild topical steroids are needed to treat dermatitis
caused by allergic reactions to scabies mite excrement. If the
skin rash is severe and does not improve with topical treatment alone, oral steroids can be administered for 1–2weeks,
and if there is a secondary bacterial infection, appropriate
antibiotics should be administered concurrently.
The family who came today had been receiving treatment
for itching for quite some time, and their skin symptoms had
repeatedly improved and worsened without knowing the
cause. When I looked at the palms and soles of my 8-monthold baby, I found a lot of scabies mite burrows. I showed the
scabies mite burrows and the scabies mites hiding at the end
of the burrows and showed the mite burrows and mites
between the ngers of the mother and father, and they were
surprised and said, “Everyone said it was atopy and prescribed medicine, but it’s refreshing to conrm the scabies
mites like this!” Today, my heart is really refreshing.
For reference, the most interesting part in the history of
human scabies mite discovery is that Simon François
Renucci saw scabies mites without a magnifying glass and
specied their location on the skin. He extracted the mites
directly from the patient’s skin and xed them at the end of
the needle and raised them high in the sky. His success was
because he knew the previous report that scabies mites are
not found in vesicles, but at the end of the scabies mite burrow, which others overlooked. Thus, the existence of human
scabies mites was proven, and the question was nally
answered. This fact was announced in the 1834 Gazette des
hôpitaux, and Renucci’s 1835 paper included extensive
information on scabies symptoms, the shape of scabies mite
burrows, and how to accurately extract scabies mites. Also,
the articial transmission of scabies mites was experimented
by himself (Fig.70.107).
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