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11.20 Scabies


Patients may rush to the emergency department shortly after having gone to bed, unable to sleep because of severe itching. Papules and vesicles (marking deposition of eggs) along thread-like tracks (mite burrows) are chiefly found in the interdigital web spaces as well as on the volar aspects of the wrists, antecubital fossa, olecranon area, nipples, umbilicus, lower abdomen, genitalia and gluteal cleft. Secondary bacterial infection is often present.

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Scabies is caused by infestation with the mite Sarcoptes scabiei. The female mite, which is just visible to the human eye, excavates a burrow in the stratum corneum and travels about 2mm a day for about 1-2 months before dying. During this time she lays eggs which reach maturity in about 3 weeks. Scabies is transmitted principally through close personal contact, but may be transmitted through clothing, linens, or towels. Severe pruritis is probably caused by an acquired sensitivity to the organism and is first noted 2-4 weeks after primary infestation. Sometimes nonspecific, pruritic, generalized maculopapular excoriated rash, turns out, after a therapeutic trial of Kwell, to have heen an atypical case of scabies.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD