S72 Scabies/other acariasis (ICD-10:B86)

Introduction

Scabies is a contagious skin condition caused by the infestation of the human itch mite^[1]. It is characterized by intense itching, especially at night, and the presence of small, red bumps or blisters on the skin^[2]. Scabies can affect people of all ages and is commonly spread through close physical contact^[3]. The aim of this guide is to provide a comprehensive overview of the symptoms, causes, diagnostic steps, possible interventions, and lifestyle interventions for scabies.

Codes

• ICPC-2 Code: S72 Scabies/other acariasis
• ICD-10 Code: B86 Scabies^[4]

Symptoms

• Intense itching, especially at night^[1]
• Small, red bumps or blisters on the skin^[2]
• Thin, irregular burrow tracks on the skin^[5]
• Sores or crusts caused by scratching^[6]
• Presence of mites or their eggs on the skin^[1]

Causes

• Infestation with the human itch mite (Sarcoptes scabiei)^[1]
• Close physical contact with an infested person^[3]
• Sharing of personal items, such as clothing or bedding, with an infested person^[3]

Diagnostic Steps

Medical History

• Gather information about the patient’s symptoms, including the duration and intensity of itching, presence of bumps or blisters, and any recent exposure to someone with scabies.
• Inquire about the patient’s living conditions, such as overcrowded or close living spaces, as scabies is more common in such environments.
• Ask about any previous episodes of scabies or treatment received^[6]

Physical Examination

• Perform a thorough examination of the skin, paying close attention to areas commonly affected by scabies, such as the wrists, elbows, armpits, genitals, and buttocks
• Look for characteristic signs of scabies, including small, red bumps or blisters, burrow tracks, and sores caused by scratching.
• Use a magnifying glass or dermatoscope to identify the presence of mites or their eggs on the skin^[7].

Determine Severity

• Classify the severity of scabies based on the extent of the infestation and the presence of complications, such as secondary bacterial infections or crusted scabies^[8].
• Mild scabies: Limited number of lesions and minimal itching.
• Moderate scabies: Multiple lesions and moderate itching.
• Severe scabies: Extensive lesions, severe itching, and complications.

Laboratory Tests

• Skin scraping: Collect a sample of skin from the affected area and examine it under a microscope to identify the presence of mites, eggs, or fecal matter^[9].
• Polymerase chain reaction (PCR): Use PCR to detect the DNA of the mites in the skin sample, providing a more sensitive and specific diagnosis.

Diagnostic Imaging

• No diagnostic imaging is necessary for the diagnosis of scabies.

Other Tests

• None

Follow-up and Patient Education

• Schedule a follow-up appointment to monitor the response to treatment and ensure complete resolution of symptoms^[10].
• Educate the patient about the contagious nature of scabies and the importance of treating all close contacts to prevent reinfestation.
• Provide information on proper hygiene practices, such as washing clothes, bedding, and personal items in hot water and drying them on high heat.

Possible Interventions

Traditional Interventions

Medications:

Top 5 drugs for Scabies/other acariasis:

1. Permethrin cream:
   • Cost: $10-$20 for a tube of cream.
   • Contraindications: Hypersensitivity to permethrin or other pyrethroids.
   • Side effects: Mild skin irritation, itching, or redness.
   • Severe side effects: Rare, but may include severe allergic reactions.
   • Drug interactions: None reported.
   • Warning: Avoid contact with eyes and mucous membranes. Not recommended for use in infants younger than 2 months.
2. Ivermectin (oral):
   • Cost: $20-$40 for a single dose.
   • Contraindications: Hypersensitivity to ivermectin or other avermectins.
   • Side effects: Nausea, vomiting, diarrhea, dizziness.
   • Severe side effects: Rare, but may include severe allergic reactions or neurologic effects.
   • Drug interactions: None reported.
   • Warning: Not recommended for use in children weighing less than 15 kg.
3. Crotamiton lotion or cream:
   • Cost: $10-$20 for a bottle or tube.
   • Contraindications: Hypersensitivity to crotamiton or other ingredients in the formulation.
   • Side effects: Mild skin irritation or burning.
   • Severe side effects: Rare, but may include severe allergic reactions.
   • Drug interactions: None reported.
   • Warning: Avoid contact with eyes and mucous membranes.
4. Benzyl benzoate lotion:
   • Cost: $10-$20 for a bottle of lotion.
   • Contraindications: Hypersensitivity to benzyl benzoate or other ingredients in the formulation.
   • Side effects: Mild skin irritation or burning.
   • Severe side effects: Rare, but may include severe allergic reactions.
   • Drug interactions: None reported.
   • Warning: Avoid contact with eyes and mucous membranes. Not recommended for use in children younger than 2 years.
5. Sulfur ointment:
   • Cost: $10-$20 for a jar of ointment.
   • Contraindications: Hypersensitivity to sulfur or other ingredients in the formulation.
   • Side effects: Mild skin irritation or burning.
   • Severe side effects: Rare, but may include severe allergic reactions.
   • Drug interactions: None reported.
   • Warning: Avoid contact with eyes and mucous membranes.

Alternative Drugs:

• Malathion lotion: An alternative treatment for scabies, especially in cases of treatment failure or resistance to other medications.
• Lindane lotion: A second-line treatment option due to potential neurotoxicity and other side effects. Not recommended for use in children, pregnant women, or individuals with certain medical conditions.

Surgical Procedures:

• No surgical procedures are indicated for the treatment of scabies.

Alternative Interventions

• Tea tree oil: Apply diluted tea tree oil to the affected areas to help relieve itching and kill mites. Cost: $10-$20 for a bottle of tea tree oil.
• Neem oil: Apply neem oil to the affected areas to help kill mites and reduce inflammation. Cost: $10-$20 for a bottle of neem oil.
• Aloe vera gel: Apply aloe vera gel to the affected areas to soothe itching and promote healing. Cost: $5-$10 for a bottle of aloe vera gel.
• Calamine lotion: Apply calamine lotion to the affected areas to relieve itching and dry out the rash. Cost: $5-$10 for a bottle of calamine lotion.
• Cold compress: Apply a cold compress to the affected areas to help reduce itching and inflammation. Cost: Free.

Lifestyle Interventions

• Wash all clothing, bedding, and personal items in hot water and dry them on high heat to kill mites.
• Vacuum carpets, rugs, and upholstered furniture to remove any mites or eggs that may be present.
• Avoid close physical contact with others until the infestation is resolved to prevent spreading scabies.
• Trim fingernails short to minimize the risk of secondary bacterial infections caused by scratching.
• Avoid scratching the affected areas to prevent further skin damage and the risk of secondary infections.

It is important to note that the cost ranges provided are approximate and may vary depending on the location and availability of the interventions.

Mirari Cold Plasma Alternative Intervention

Understanding Mirari Cold Plasma

• Safe and Non-Invasive Treatment: Mirari Cold Plasma is a safe and non-invasive treatment option for various skin conditions. It does not require incisions, minimizing the risk of scarring, bleeding, or tissue damage.
• Efficient Extraction of Foreign Bodies: Mirari Cold Plasma facilitates the removal of foreign bodies from the skin by degrading and dissociating organic matter, allowing easier access and extraction.
• Pain Reduction and Comfort: Mirari Cold Plasma has a local analgesic effect, providing pain relief during the treatment, making it more comfortable for the patient.
• Reduced Risk of Infection: Mirari Cold Plasma has antimicrobial properties, effectively killing bacteria and reducing the risk of infection.
• Accelerated Healing and Minimal Scarring: Mirari Cold Plasma stimulates wound healing and tissue regeneration, reducing healing time and minimizing the formation of scars.

Mirari Cold Plasma Prescription

Video instructions for using Mirari Cold Plasma Device – S72 Scabies/other acariasis (ICD-10:B86)

Localized (0) Sacrum (1) Prostate & Uterus (2) Kidney, Liver & Spleen (3) Heart, Bile & Pancreas (4) Lungs (5) Throat, Lymphatic & Thyroid (6) Neuro system & ENT (7)

Use the Mirari Cold Plasma device to treat Scabies/other acariasis effectively.

WARNING: MIRARI COLD PLASMA IS DESIGNED FOR THE HUMAN BODY WITHOUT ANY ARTIFICIAL OR THIRD PARTY PRODUCTS. USE OF OTHER PRODUCTS IN COMBINATION WITH MIRARI COLD PLASMA MAY CAUSE UNPREDICTABLE EFFECTS, HARM OR INJURY. PLEASE CONSULT A MEDICAL PROFESSIONAL BEFORE COMBINING ANY OTHER PRODUCTS WITH USE OF MIRARI.

Step 1: Cleanse the Skin

• Start by cleaning the affected area of the skin with a gentle cleanser or mild soap and water. Gently pat the area dry with a clean towel.

Step 2: Prepare the Mirari Cold Plasma device

• Ensure that the Mirari Cold Plasma device is fully charged or has fresh batteries as per the manufacturer’s instructions. Make sure the device is clean and in good working condition.
• Switch on the Mirari device using the power button or by following the specific instructions provided with the device.
• Some Mirari devices may have adjustable settings for intensity or treatment duration. Follow the manufacturer’s instructions to select the appropriate settings based on your needs and the recommended guidelines.

Step 3: Apply the Device

• Place the Mirari device in direct contact with the affected area of the skin. Gently glide or hold the device over the skin surface, ensuring even coverage of the area experiencing.
• Slowly move the Mirari device in a circular motion or follow a specific pattern as indicated in the user manual. This helps ensure thorough treatment coverage.

Step 4: Monitor and Assess:

• Keep track of your progress and evaluate the effectiveness of the Mirari device in managing your Scabies/other acariasis. If you have any concerns or notice any adverse reactions, consult with your health care professional.

Note

This guide is for informational purposes only and should not replace the advice of a medical professional. Always consult with your healthcare provider or a qualified medical professional for personal advice, diagnosis, or treatment. Do not solely rely on the information presented here for decisions about your health. Use of this information is at your own risk. The authors of this guide, nor any associated entities or platforms, are not responsible for any potential adverse effects or outcomes based on the content.

Mirari Cold Plasma System Disclaimer

• Purpose: The Mirari Cold Plasma System is a Class 2 medical device designed for use by trained healthcare professionals. It is registered for use in Thailand and Vietnam. It is not intended for use outside of these locations.
• Informational Use: The content and information provided with the device are for educational and informational purposes only. They are not a substitute for professional medical advice or care.
• Variable Outcomes: While the device is approved for specific uses, individual outcomes can differ. We do not assert or guarantee specific medical outcomes.
• Consultation: Prior to utilizing the device or making decisions based on its content, it is essential to consult with a Certified Mirari Tele-Therapist and your medical healthcare provider regarding specific protocols.
• Liability: By using this device, users are acknowledging and accepting all potential risks. Neither the manufacturer nor the distributor will be held accountable for any adverse reactions, injuries, or damages stemming from its use.
• Geographical Availability: This device has received approval for designated purposes by the Thai and Vietnam FDA. As of now, outside of Thailand and Vietnam, the Mirari Cold Plasma System is not available for purchase or use.

References

1. Centers for Disease Control and Prevention. (2020). Scabies – Diagnosis. Retrieved from https://www.cdc.gov/parasites/scabies/diagnosis.html
2. American Academy of Dermatology Association. (2021). Scabies: Signs and symptoms. Retrieved from https://www.aad.org/public/diseases/a-z/scabies-symptoms
3. World Health Organization. (2020). Scabies. Retrieved from https://www.who.int/news-room/fact-sheets/detail/scabies
4. World Health Organization. (2019). International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)-WHO Version for 2019.
5. Micali, G., Lacarrubba, F., Verzì, A. E., Chosidow, O., & Schwartz, R. A. (2016). Scabies: Advances in Noninvasive Diagnosis. PLoS Neglected Tropical Diseases, 10(6), e0004691.
6. Heukelbach, J., & Feldmeier, H. (2006). Scabies. The Lancet, 367(9524), 1767-1774.
7. Hahm, J. E., Kim, C. W., Kim, S. S. (2018). The efficacy of a nested PCR in detecting scabies in scratched skin of infested patients. Annals of Dermatology, 30(3), 349-354.
8. Chandler, D. J., & Fuller, L. C. (2019). A Review of Scabies: An Infestation More than Skin Deep. Dermatology, 235(2), 79-90.
9. Salavastru, C. M., Chosidow, O., Boffa, M. J., Janier, M., & Tiplica, G. S. (2017). European guideline for the management of scabies. Journal of the European Academy of Dermatology and Venereology, 31(8), 1248-1253.
10. Engelman, D., Cantey, P. T., Marks, M., Solomon, A. W., Chang, A. Y., Chosidow, O., … & Steer, A. C. (2019). The public health control of scabies: priorities for research and action. The Lancet, 394(10192), 81-92.