How long does it take for the first symptoms of a tick bite to appear? What to do with a tick bite: symptoms of dangerous diseases in humans and how long they appear

Norwegian (crustous, crusting, keratotic) scabies is a severe form of common infectious-type dermatosis, which is characterized by the absence of pruritus, a long relapsing course and the appearance of thick, crusty scales on the skin throughout the body. Norwegian scabies is a rather rare disease, since no more than 160 cases of infection have been recorded in dermatology since its description (19th century).

Adults and children, regardless of gender, can become infected with this infectious disease. The spread of the disease is facilitated by promiscuity, poor personal hygiene and crowded living conditions. The infectious process usually lasts for years. In this case, the body and face of an infected person is gradually covered with a crust. Crustose scabies is highly contagious and can cause sporadic outbreaks even in a clinical setting. V Lately cases of the development of the Norwegian form of dermatosis have become more frequent. In order to prevent mass infection, preventive examinations are carried out in medical, educational and social institutions.

Exciter characteristic

Crusted scabies is caused by the same mite as normal scabies. Previously, experts assumed that the Norwegian form of the disease occurs due to human infection with itching, but this assumption turned out to be erroneous. What does a scabies mite look like? Male and female individuals have appearance resembling a turtle. Their sizes vary within 0.25-0.3 mm. Males are usually smaller than females.

Symptoms of infection occur as a result of the vital activity of females, since males live exclusively on the skin and die immediately after fertilization. The causative agent of Norwegian scabies (female) makes winding passages in the skin, laying eggs at the border with the Malpighian layer. After 3-5 days, larvae hatch from the eggs, which go outside through the ventilation passages made by the female. A sexually mature individual becomes in 3-7 days and remains alive for two weeks.

Symptoms of the disease

Typical symptoms of Norwegian scabies:

Scabies appear, as a rule, starting from the lateral surfaces of the fingers, in the space between them, in the area reverse side elbows and knees, mammary glands, lower abdomen and foreskin of the penis.

The skin thickens and coarsens, gradually forming a kind of shell covered with furrows. Changes are noticeable on the face, nails and even hair, which is not typical for a typical form of the disease.

A typical feature is the appearance of dirty yellow crusts (scabs), which can reach a thickness of 2-3 cm. They cover large areas of the skin. When removing the crusts, rather large weeping erosions occur.

The nail plates thicken and loosen, which leads to their increased fragility. Outwardly, this sign resembles.

The patient's hair becomes dull. A characteristic sour odor emanates from an infected person.

Signs of Norwegian scabies are quite pronounced, which is not typical for the usual form of the disease. This is due to the fact that there are about 1 million scabies mites on infected human skin, and in the usual form of the disease - no more than 15 individuals.

Ways of infection

Collective infection occurs mainly with contact sports, strong handshakes and fuss of children. Household contamination is considered unlikely, which was proven back in 1940 in the UK. 272 attempts were made to infect volunteers who went to bed immediately after a sick person got up from it, in whom the symptoms of Norwegian scabies were quite pronounced. A total of 4 people were infected.

The disease develops, as a rule, against the background of severe somatic and mental pathologies. Most cases of infection occur in patients of neuropsychiatric boarding schools and residents of nursing homes. Among the special contingent of patients, one can single out people with Down's disease, infantilism, asthenia, senile dementia and an immunodeficiency state.

Diagnostics

The diagnosis is made on the basis of clinical data (characteristic rashes), epidemiological information (examination of contact persons, information about staying in an epidemic focus), laboratory diagnostics (detection of a tick and its eggs on the skin). With the defeat, an increase in leukocytes in the blood, eosins and ROE is observed. Norwegian scabies is determined using the method of needle extraction of mites, thin sections, layered scrapings, alkaline preparation and lactic acid solution.

The differential diagnosis of the Norwegian form of the disease is carried out with, and hyperkeratotic psoriasis. With the development of serious complications in the absence of timely treatment, the prognosis of this disease is unfavorable. Drug therapy is effective only at the initial stages of the development of the disease. Fatal outcomes are often noted, which occurs due to severe intoxication of the patient's body or damage to cardiac activity.

Medical measures

Drug therapy involves the use of drugs, which include benzyl benzoate, crotamiton, malathion and permethrin. In some cases, anti-scabies preparations are given orally, but it should be noted that with Norwegian scabies, local remedies give a more pronounced effect. As a preventive measure, it is recommended to boil clothes, bed linen and towels after taking a course of drug therapy. It is advisable to clean the room in which the patient is located. For this, it is recommended to use alkaline and chlorinated solutions.

Features of drug therapy

The main points of anti-scabies therapy for Norwegian scabies:

• repeated use of local medicines;
• applying ointment under short-cut nails;
• scraping off loose scales with a toothbrush;
• drugs are applied to without fail on the whole body daily for 4 days;
• bed linen and clothes are recommended to be changed every day.

For preventive purposes, a 10-day antibiotic therapy is prescribed, which eliminates the likelihood of developing a streptococcal or staphylococcal infection. Persons who come into contact with an infected person must pass preventive treatment, which is used in the classical form of the disease.

Norwegian scabies is a serious form of the disease, the treatment of which requires a qualified approach. Drug therapy should be started as early as possible.

The disease provokes a common scabies mite, which makes passages under the skin of the patient, causing scabies. The disease was first reported at the end of the 19th century in Norway, hence its name.

The disease is spread only by the female tick. The male dies immediately after fertilization. The female makes winding passages under the human skin, in which she lays her eggs. The larvae after maturation are selected along the same passages to the outside. They reach maturity in 4-7 days.

Norwegian scabies is highly contagious. People with weakened immune systems are at risk and are more likely to get infected. For this reason, the disease is more often diagnosed in people suffering from HIV infection, tuberculosis, lymphoma, leprosy, and Down's disease.

Varieties of scabies

Scabies is a highly contagious disease that requires immediate treatment. It is important to monitor the condition of the skin, respond to changes in time and not engage in self-diagnosis.

Scabies in different individuals can proceed in different ways.

1. Typical scabies, the most common. It is characterized by the presence of all of the above symptoms (itching, scabies, etc.)

2. Scabies without moves.

Its difference from typical scabies is that there are no scabies on the skin, but there are bubbles up to 2-3 mm in diameter. Scabies without moves develops in people who have been in contact with a patient with scabies, however, they were infected not by adults, but by larvae, which take time to develop.

3. Scabies "clean" is similar to typical scabies, but develops in people who often wash and remove most of the scabies mites from the body. Thus, their scabies is not as pronounced as typical.

4. Norwegian scabies develops in people with weakened immune systems (for example, with AIDS, tuberculosis), drug addicts, people with Down syndrome. Norwegian scabies is very severe, affects the whole body, including the head, and is highly contagious.

5. Pseudo-scab (pseudo-sarcoptic mange) develops in people infected from animals. The scabies mite of animals is not able to cause scabies typical for humans and is manifested only by severe itching. Healing occurs on its own after the termination of contact with a sick animal.

6. Complicated scabies develops with untreated typical scabies and is the result of infection. The lesions become red, sore, moist, and smell bad.

Symptoms of scabies

Itching of the skin, single rashes and the likely detection of small insects on it are the most likely primary signs of the disease. Increasing at night, they prevent a person from sleeping, irritate nervous system lead to exacerbation of existing chronic diseases.

In addition, numerous scratching leads to the addition of a purulent infection. In this case, the symptoms of Norwegian scabies can be complicated by body temperature, inflammatory septic processes, and general intoxication.

The lack of timely extermination measures leads to an abundant colonization of the skin by mites, a multi-layered lesion of the dermis. In this case, extensive fused foci are formed, which are covered with dead epithelial cells - crusts of gray, yellowish-brown or brown.

Such areas of necrosis can be seen in the photo of Norwegian scabies.

Symptoms of the disease appear only after the end of the incubation period, which can last from 2 to 6 weeks. How quickly the first manifestations of scabies appear depends on the number of mites that have fallen on the skin.

The disease is characterized by the following symptoms:

• the skin of an infected person becomes very dry and hot. The upper layers are covered with layers of green-gray crusts;
• some areas of the skin are covered with dense, armor-like growths;
• when tearing off the crusts, you can notice that under them there is very thin and bleeding skin;
• on the skin there is a huge number of scabies;
• the color of the crusts can be different: green-gray, yellow-gray, gray-brown. The surface may be smooth or loose;
• crusts can be arranged in several layers and have a thickness of 2-3 cm;
• scabies itch primarily affects the skin in the abdomen, elbows, face, neck, buttocks. Cases are known when the disease affected the whole body;
• hair in the affected area becomes dull;
• nails thicken and deform;
• lymph nodes are enlarged throughout the body;
• a characteristic symptom for the disease is the specific smell of fermented dough.

Norwegian scabies has a brighter course than usual.

The main symptoms of Norwegian scabies are manifested in the form of polymorphic rashes, erythroderma and massive layers of crusts. The thickness of such a layer can reach 2-3 centimeters, and a kind of shell is formed.

The surface is covered with deep cracks, and deep grooves can be seen in places of large joints. The top layer has a special density, and the bottom has a loose structure.

It is under the bottom layer that the ticks are located.

Sometimes the symptoms of the disease can manifest themselves in a different way. For example, the affected area may be nails.

They acquire a gray-yellow color, crumble and break. The patient has problems with the hair, they acquire an ash-gray tint, become brittle and dry.

Since this is one of the forms of scabies, it can not do without severe itching, an unpleasant odor and an increase in body temperature.

A characteristic, but not mandatory, clinical symptom of scabies is pruritus, aggravated in the evening. An erythematous papulovesicular rash forms on the skin, when combing, pustular elements join and crusts form with the formation of polymorphic rashes.

A pathognomonic sign is the presence of scabies.

As soon as the female tick gets on the skin of a person, she immediately begins to "dig" a passage in the stratum corneum of the skin at a rate of 0.5-5 mm per day. As a result, on the surface of the skin, upon closer examination, one can detect whitish-gray lines slightly rising above the surface of the skin, ranging in size from 1 mm to 1 cm.

The anterior blind end of the passage is distinguishable by the presence of a tick in it, which is visible through the epidermis as a dark dot. Scabies becomes visible after a few days during the formation of the peritoneal reaction of the host organism.

More often scabies can be found in the interdigital spaces, on inside wrists and on the skin of the penis. Sometimes scabies can not be detected (scabies without moves).

The primary rash is represented by small erythematous papules, which may be scattered or multiple, confluent. Over time, papules may develop into a vesicular (vesicles), rarely bullous (pemphigoid) rash.

The rash is distributed most often (in descending order) in the interdigital spaces of the hands, on the flexor side of the wrists, in men it quickly passes from the hands to the penis and scrotum.

Then the elbows, feet, armpits, areas under the breasts in women, the umbilical region, the belt line, and the buttocks are affected. As a result, the whole body can be involved, except for the face and scalp (although these areas are also affected in children under 3 years old).

The presence of itching, primary rash and scabies is the main clinical symptom complex of a typical form of scabies.

Papules and vesicles often develop into secondary itch elements: excoriations (scratches), eczematous elements, secondary pustular rashes and crusts. Primary and secondary elements at the same time coexist on one patient.

Ardi's symptom - pustules and purulent crusts on the elbows and in their circumference; - Gorchakov's symptom - bloody crusts in the same place; - Michaelis's symptom - bloody crusts and impetiginous rashes in the intergluteal fold with a transition to the sacrum; - Cesari's symptom - detection of scabies in the form of a lung elevations on palpation.

The reproduction period of the pathogen without pronounced symptomatic manifestations lasts up to 6 weeks, after which the immune system begins to respond in response to damage.

Diagnosis of scabies

The diagnosis is made after a full-time examination of the patient. An important role is played by the collection of clinical data, as well as epidemiological information. A laboratory test is required to confirm the diagnosis.

With Norwegian scabies, leukocytes in the blood and ESR are increased. Several methods are used to diagnose the disease:

1. Needle extraction method.
2. Layered scraping.
3. Thin cuts.
4. With lactic acid solution or alkaline preparation.

It is important to exclude the following diseases:

• pyoderma;
• eczema;
• hyperkeratotic psoriasis.

Treatment can be effective only at the initial stage of the disease. It is not uncommon for Norwegian scabies to be fatal as a result of heart damage and severe intoxication.

1. Traditional extraction of a tick with a needle from the blind end of the scabies passage, followed by microscopy of the pathogen. This method is ineffective in the study of old dilapidated papules.

2. The method of thin sections of sections of the stratum corneum of the epidermis in the area of ​​​​the scabies during microscopy allows you to identify not only the tick, but also its eggs.

3. The method of layer-by-layer scraping from the area of ​​​​the blind end of the scabies passage until blood appears. followed by microscopy of the material.

4. The method of alkaline preparation of the skin, with the application of an alkaline solution to the skin, followed by aspiration of the macerated skin and microscopy.

Diagnostic measures are of a differential nature. The absence of itchy sensations often leads to an incorrect diagnosis. At an early stage, it should be differentiated from allergic reactions, dermatitis and infections transmitted by airborne droplets.

The diagnosis of scabies is due to the presence of the following criteria:

1. Abnormal thickening of the skin, the detection of a large number of scabies, which are arranged in tiers.
2. Symptoms of acanthosis are strong pigmentation in the groin and armpits.
3. Change in blood counts. In particular, the level of leukocytes, eosinophils increases, the erythrocyte sedimentation rate increases.

Treatment is carried out only in a hospital. The patient is isolated in the ward. Doctors during therapy use personal protective equipment. Treatment consists of two stages. At the first, the cortical layer is removed. On the second - the patient takes medications.

After removing the cortical formations, the patient should wash himself. During the subsequent treatment, washing is prohibited. Each hand wash requires the subsequent application of specialized products. Nails are trimmed at the root.

Treatment

When a person notices this ailment, he needs urgent and comprehensive treatment. The best remedy for the treatment of the Norwegian form of the disease is a water-soap emulsion of benzyl benzoate.

The affected areas are treated daily for 3-5 days. The patient must first take a bath, which will help soften crusts and other infectious inflammations. Ointments are rubbed with hands, as this is a kind of prevention.

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Treatment for Norwegian scabies consists of:

• extermination of ticks (by treatment with special insecticides);
• restoration of the integrity of the skin (treatment with anti-inflammatory, regenerating and antibacterial compounds);
• removal of symptoms of allergization (antistaminic and desensitizing drugs);

In case of contraindications for external skin treatment, a detrimental effect on mites can be achieved by internal administration of ivermectin tablets.

Personal prevention

You can protect yourself from such a disease by observing the necessary preventive measures:

• compliance with hygiene standards and rules;
• if symptoms appear, consult a doctor;
• maintaining a healthy lifestyle;
• strengthening immunity;
• avoidance of stress and conflict situations.

Treatment is stopped only after complete recovery, which is confirmed by laboratory tests. It is necessary to strictly follow all the recommendations of the doctor at all stages of therapy in order to avoid relapse.

The course of treatment includes drugs containing:

• crotomiton;
• benzyl benzoate;
• permethrin;
• malathion.

In some cases, these drugs are also prescribed orally, however, the greatest effect can be achieved by topical application.

Treatment of Norwegian scabies has its own characteristics:

• ointment is applied under short-cut nails;
• local preparations are applied to the whole body;
• medicines are used repeatedly;
• treatment lasts at least 4 days;
• exfoliated skin elements are recommended to be scraped off with a non-rigid brush;
• clothes and bed linen are changed every day.

Only with strict adherence to all the rules can a complete cure for the disease be achieved.

If the treatment of Norwegian scabies is unavoidable, then it is important that all family members of the infected person take this course at the same time. In this case, you must strictly follow all the recommendations of the doctor.

To date, there are many anti-scabies drugs containing melathion, permethrin, crotamiton and benzyl benzoate.

Treatment of patients with scabies is aimed at the destruction of the pathogen with the help of acaricidal preparations (scabicides).

Experience shows that there are no relapses in scabies, the causes of the recurrence of the disease are reinvasion from untreated contact persons in the focus or outside it, undertreatment of the patient due to non-compliance with treatment regimens, partial treatment of the skin, reduction in the duration of therapy.

Treatment should be carried out exclusively under the guidance of a doctor;

Treatment of all patients living together should be carried out simultaneously;

It is necessary to strictly adhere to the treatment scheme described in the instructions for the drug or as prescribed by the doctor;

The drug is applied to the whole body, except for the face and scalp, and in children under 3 years old, these areas must also be treated;

It is important to cut the nails short and apply the drug thickly under them (when combing under the nails, itching eggs accumulate);

Rubbing of any drug is carried out by hand, due to the high number of scabies on the hands. If the perineum and groin are densely covered with hair, it is better to rub the drug with a brush;

Treatment should be carried out in the evening, which is associated with the nocturnal activity of the pathogen;

It is recommended to wash the patient before and after the course of treatment, if necessary, the patient can wash off the drug every morning, while its exposure on the skin should be at least 12 hours, including the entire night period;

Change of underwear and bed linen is carried out at the end of the course of therapy;

One teaspoon of turpentine is thoroughly mixed with two tablespoons of butter and the affected skin is treated with the resulting mixture;

One tablespoon of celandine juice is mixed with 4 tablespoons of petroleum jelly and the resulting mixture is treated with the skin;

Birch tar is applied evenly on the affected areas of the skin. After three hours, wash off the tar with warm water;

With scabies, it is necessary to grind the freshly picked yellow "buttons" of tansy and lubricate the skin affected by the scabies mite with this grated mass. Sometimes two or three such procedures are enough to get rid of the sore;

Pour in the evening in an enamel bowl 0.5 liters of water 1 tbsp. l

crushed rue leaves, bring to a boil and immediately remove from heat. After 30-40 minutes, strain, and then grease the whole body with the decoction.

Put on clean ironed linen, iron the bed and go to bed. Repeat the procedure every night until recovery;

Mix 1 tsp. pharmacy turpentine with 1-2 tbsp. pork lard or boiled drying oil and regularly lubricate the rash with this ointment until it disappears completely;

Dilute soap in a bowl with warm water so that a large cap of soap suds is obtained, moisten a sponge in this solution and rub the patient's body with it so that a layer of soap remains on the surface of the skin.

After 30 minutes, wash everything off with warm water and treat the problem areas well with an ointment made from 1 part by weight of potassium carbonate (potash), 2 parts of pharmaceutical sulfur powder and 1/8 part of rendered internal pork fat.

Mix all components until a homogeneous mass is obtained. If after a few hours the body begins to itch strongly, then it is necessary to wash off the ointment from the patient's body with warm water and put on clean underwear;

If there are traces of scratching on the body, then it is necessary to apply sulfuric ointment, made from 1 part by weight of sulfur in powder and 4 parts of lard. Treat the body with this ointment 2 times a day after a bath;

Brew (precisely brew!) 6-8 kg of salt in an enamel saucepan and pour the broth into a bath of water at a temperature of 37-38°C. Lie down in the solution for at least an hour and, after leaving the bath, do not dry yourself, but dry. Carry out the procedure daily until cured;

A mixture of chicken manure and tar treats scabies. The components should be rubbed well and smeared with the prepared ointment overnight on the affected areas. It is advisable not to wear underwear. Wash the body thoroughly in the morning;

For scabies, rub the chalk, sift it through a thick sieve and lubricate the rashes well with this “flour”. The scabies will pass;

In case of skin diseases, especially scabies, it is necessary to wash with a strong decoction of elecampane root until the body is cleansed. Do not expect instant healing, but patiently heal, and recovery will soon come;

Grate laundry soap grated and soften by adding water. Stir and put on a slow fire. Stir constantly. As soon as the mass becomes homogeneous, remove it and add a medium grated onion and a head of garlic. Cool, roll into balls and wash daily with this soap;

How to treat scabies? Scabies in humans is a fairly common disease that can be treated with the use of special drugs. All of them differ in cost and duration of therapy.

It is often possible to treat scabies at home, but only after prior consultation with the attending physician.

1. The drug benzyl benzoate - is available in the form of an ointment and emulsion. It is one of the most common scabies medicines; treatment in this case takes up to four days.
2. Permethrin - available in the form of gels, ointments, sprays and lotions. The cost of the drug is slightly higher than that of benzyl benzoate, however, in two days of therapy, you can completely get rid of the disease.
3. Spregal is one of the most expensive drugs produced in France. This aerosol is very simple and easy to use: it does not leave marks on clothes and has almost no smell. Most often, dermatologists recommend double treatment with the drug with an interval of 3 days.

The most effective and widely used drugs include:

• benzyl benzoate;
• pyrethrins;
• Yakutin;
• Polysulfide liniment.

Benzyl benzoate is a drug used for skin lesions. Available in the form of a 20% medicinal solution or ointment.

A group of pyrethrins is a drug containing in its chemical composition insecticides, they have an active anti-scabies effect and have a less toxic effect.

Yakutin is applied to damaged areas immediately after a shower, and washed off after 6 hours. The drug is used extremely rarely because it is able to affect the human nervous system with the development of its damage.

Polysulfide liniment - anti-scabies medicine, which is available in the form of a 10% ointment or solution. 3-4 days after the initial application, skin hygiene can be carried out.

Treatment of scabies requires a huge amount of time and regular application of drugs. In case of failure necessary rules treatment will be ineffective.

Preparations for Norwegian scabies: a brief description and instructions

Important: all persons who have been in contact with the patient undergo preventive treatment.

Self-treatment of Norwegian scabies is strictly prohibited. Application folk ways will not give the desired therapeutic effect. Significantly increases the risk of irreversible consequences, lethal outcome is not excluded when the form is running.

After the end of the main course of therapy and the elimination of symptoms, preventive measures begin to avoid re-infection.

Norwegian scabies is a serious and dangerous disease, the treatment of which should not be carried out without medical supervision.

The volume of preventive measures is determined depending on the epidemiological situation. When scabies is detected, an emergency notification form is filled out and the SES authorities at the patient's place of residence are notified.

Individuals from the same focus are treated together to prevent re-infection. All persons in contact with the affected carry out a single prophylactic treatment of the skin with anti-tick preparations.

After treating the patient, many guidelines recommend the treatment of all things and linen with which the patient has come into contact (special sprays, washing in hot water).

In accordance with the data on the survival of scabies mites in external environment, and also due to the extremely low probability of scabies transmission through household items (indirect contact route of transmission), these recommendations are discussed on a case-by-case basis.

Important! Contrary to popular belief, scabies is not associated with low level hygiene. The scabies mite is not susceptible to water or soap. Daily showering/bathing does not reduce the number of mites and the likelihood of infection.

Prevention of scabies is necessary if the patient is in the same room healthy people. It consists in a constant change of bed linen on which an infected person sleeps (linen should be boiled in a soda solution); frequent change of clothes and constant wet cleaning of all rooms.

As a rule, with scabies, prophylaxis should be carried out several times a day.

Wipe all surfaces with a damp cloth, and then treat the furniture with a 1% soda solution.

Prevention of scabies also consists in a complete examination of all family members. They should be treated if necessary.

It is worth remembering that frequent medical examinations of adults and children, as well as constant personal hygiene, can significantly reduce the risk of developing this kind of disease.

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Specific prophylaxis infectious disease is carried out when a critical epidemiological situation develops in a certain region. All those in contact with an infected person must undergo mandatory skin treatment with anti-scabies preparations.

After a person has completely got rid of the disease, his things and household items must be carefully processed in order to avoid a recurrence of the disease.

It has been proven that tick infestation does not depend on the social level and the observance of basic hygiene rules in the steam room. The insect does not differ in susceptibility to soapy substances; regular hygiene procedures are not able to protect a person from a tick infection.

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 long time corticosteroid hormones).

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 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.

Crusty Norwegian scabies is a rare form of the disease of infectious origin. Over the past three centuries, only 160 cases have been recorded and described. Both adults and children are affected with the same frequency. Pathology has no race or gender. Recently, outbreaks of infection have been recorded, the number of infected people is increasing, so it is so important to know how crusty scabies begins, how symptoms develop and treatment is carried out.

This skin pathology is a complication of common scabies. It develops with a massive lesion, accompanied by the appearance of thick crust-like formations. It is characterized by a long course, constant relapses and the absence of itching.

Causes of the disease

Various factors contribute to the spread of the described form of infection. Among them, the most common: a disorderly intimate life, ignoring the rules of personal hygiene, living in a small room for a large number of people. The most active process of the development of the disease occurs against the background of somatic and mental abnormalities. Therefore, scabies of the Norwegian form is most often diagnosed:

• people living in nursing homes;
• among patients of neuropsychiatric clinics;
• children with Down syndrome;
• infantile persons;
• patients with tuberculosis, AIDS, leprosy;
• suffering from leukemia, leukemia, lupus erythematosus and Bloom's syndrome.

Stages of the disease

The infection process can take years. Some patients develop clinical manifestations within five to six months, others within fifty years. They go through three stages:

1. incubation period. Its duration also varies - from two months to 15 years. The more mites that initially get on the skin of a person, the shorter the time interval between infection and the manifestation of the first symptoms.
2. The beginning of the layering of crusts.
3. The occurrence of associated complications.

The pathology is recurrent. It can become aggravated and progress, it can fade, stopping in its development. At any time, patients are contagious to others. They are capable of causing sporadic outbreaks within hospitals, so during the treatment of a patient diagnosed with scabies, quarantine rules are introduced.

Characteristic symptoms and signs

In addition, inflammation of all lymph nodes is noted.

Reasons for not itching

Only half of the patients have an allergic skin reaction. Infectionists explain the lack of itching for several reasons:

1. High weakness of the immune system, it is simply unable to respond to the introduction of foreign agents.
2. When scabs form, the transmission of nerve impulses is disrupted.
3. Degradation of muscle tissue and myopathy leads to the fact that the patient simply does not have the opportunity to scratch the itchy place, this is fixed in the brain.
4. Low skin sensitivity.

The absence of itching makes the diagnosis difficult. To confirm it, three components are needed: the presence of the above clinical manifestations, epidemiological data (confirming possible contact with an infected person), the results of some laboratory tests.

To accurately determine the Norwegian type of scabies, it is necessary to perform a detailed biochemical blood test. The course of infection is indicated by an increase in the number of leukocytes, eosinophils and ESR.

Next, the doctor necessarily produces a biopsy of the affected areas, followed by microscopy. They manage to detect a huge number of characteristic tunnels, the presence of tick eggs and their larvae. Layered scraping of horny tissues helps to differentiate Norwegian scabies from eczema, psoriasis, complicated pyoderma.

When the diagnosis is confirmed, the patient is hospitalized.

Therapeutic treatment of scabies

Treatment is considered effective only at the initial stages of the disease; advanced forms often lead to complications from the cardiovascular system and death.

There are general recommendations for getting rid of the disease. Anyone who lives under the same roof with a sick person needs to be treated for Norwegian scabies, this must be done at the same time. It is better to rub solutions and ointments into the affected areas of the skin with bare hands. Most often, it is the hands that are affected first, so they need to be treated first.

It is important for the patient to cut their nails very shortly. In the process of treatment, at certain periods, it is necessary to change the bed and linen of a hospitalized person, boil all things for fifteen minutes in a powder solution, and then, after washing, linen and clothes must be ironed with a hot iron. All tissues that come into contact with the patient's skin are subject to treatment. If disinfection is carried out poorly, it becomes possible to re-infect.

The listed activities are carried out exclusively by medical personnel in a medical hospital.

Review of modern preparations for scabies

Treatment begins with the treatment of affected areas of the skin with ointments based on sulfur and salicylic acid. They help to soften the hard shell and remove all crusts. After that, acaricidal (anti-mite) emulsions or aerosols are used.

Products based on benzyl benzoate are sold as a 10% emulsion (for children) and a 20% solution for adults. They are similar in texture and appearance to milk. Such preparations are odorless, after application they are quickly absorbed into the affected areas. Skin treatment is carried out on the first day of the patient's hospitalization, and then on the fourth day of treatment. For a single procedure, it is necessary to use 100 milliliters of emulsion. The medicine is applied to the skin and left for twelve hours. After this, the patient is washed with soap and all his linen is changed. Body washing and change of underwear, bed linen is carried out before the use of anti-tick drugs.

All surfaces of the body (both healthy and affected areas) are treated with ointments. In some patients, after the use of agents based on benzyl benzoate, itching increases. This symptom does not mean the appearance side effects. Thus, the body responds to an increase in toxins that are formed at the time mass death more itchy. Therefore, treatment must be continued. To alleviate the patient's condition, second and third generation antihistamines, as well as steroid drugs, can be prescribed to quickly stop inflammatory processes.

If such treatment does not help to improve the dynamics of the disease, 60% sodium hyposulfite or 6% hydrochloric acid solution is used for rubbing into the skin. Treatment of the skin with these drugs can provoke the development of contact dermatitis.

Recently, dermatologists in the treatment of Norwegian scabies prefer to use the Spregal aerosol. This is a new generation drug, its use allows you to get stable positive dynamics. The instructions attached to it say that to achieve the desired effect, it is enough to perform a single treatment of the body, but in Russia a scheme is practiced that involves the use of an aerosol twice: on the first and on the fourth day of treatment.

Spray "Permethrin" has a similar effect. Starting from the second day after the first treatment of the body, positive results become visible. The therapeutic effect is very high, but this medicine should not be used to treat infants, pregnant and breastfeeding women. For this category of persons, Lindan ointment is considered an effective acaricidal agent. The course of application is three days.

In parallel with the main course, therapy is necessarily carried out, aimed at increasing the body's defenses. The patient is prescribed immunomodulators, vitamin complexes, mineral supplements. Folk remedies give a good result only in the process of implementing rehabilitation measures. From this point of view, doctors consider baths with decoctions of chamomile, sage and calendula to be completely safe and useful.

Ways of personal prevention

Prevention of Norwegian scabies can be prevented by personal and community prevention. Each of us must learn a number of simple rules to prevent the spread of infection within the same family. Important:

If infection could not be avoided, when the first symptoms appear, you should immediately seek advice from a dermatologist.

Public prevention

Outbreaks of Norwegian scabies are recorded in crowded places of people who are unable to fully serve themselves (hospitals, boarding schools for the disabled, nursing homes, kindergartens). There are known cases of infection of athletes involved in contact sports. To prevent the spread of infection, public prevention of the disease is carried out.

1. Infected people are identified, all their contacts are established, and sanitary supervision authorities are immediately notified of cases of infection.
2. Preventive examinations of persons at risk are carried out.
3. It is considered mandatory to isolate the patient and immediately start treatment.
4. It is supposed to limit the contact of a sick person with the outside world until a complete cure.
5. All personal belongings are disinfected.
6. For those who communicated with patients with Norwegian scabies, constant monitoring is organized.

Compliance with such preventive measures helps to prevent the spread of infection.

Possible complications of the disease

Prognosis for diseases directly depends on how early adequate treatment was undertaken. If intensive therapy is not started on time, unwanted complications may occur. Among them:

• bacterial infection;
• microbial eczema;
• glomerulonephritis caused by staphylococci;
• infectious dermatitis.

Acute rheumatic fever and the addition of a purulent infection can cause death. If the treatment is chosen incorrectly, the whole body will be covered with crusts, pyogenic bacteria almost always begin to multiply under them. Their penetration into the general circulation ends with the death of the patient.

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 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 functional immune system, the disease proceeds 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 directed 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 constant source 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.