PRESENTER DR. MD. ABDAL MIAH ASSISTANT PROFESSOR DERMATOLOGY & VENEREOLOGY MYMENSINGH MEDICAL...
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Transcript of PRESENTER DR. MD. ABDAL MIAH ASSISTANT PROFESSOR DERMATOLOGY & VENEREOLOGY MYMENSINGH MEDICAL...
PRESENTER
DR. MD. ABDAL MIAHASSISTANT PROFESSOR
DERMATOLOGY & VENEREOLOGYMYMENSINGH MEDICAL COLLEGE,
MYMENSINGH
CHAIRED BY
DR. MD. SHAHAB UDDIN AHMED CHOWDHURYAssociate Professor & Head
Department of Dermatology & VenereologyMymensingh Medical College, Mymensingh.
TODY’S TOPIC IS
IVERMECTIN
USE IN SCABIES
Source: American Family Physician (Review Journal)Sept 15, 2003, V-68, P-1089-92
Scabies is a skin disease caused by infestation with the mite female gravid sarcoptes scabiei var hominis. Scabies has been a problem for humans since before the first millennium and was reported by the earliest writers who described mankinad’s health problems. It is estimated that there may be 300106 cases of scabies worldwide each year. Mostly, scabies is treated with topical scabicides, which needs to be used over whole or nearly whole skin surface, which is a difficult process.
INTRODUCTION
So, non compliance or improper use of
topical scabicides can result in scabies
as a public health problem. So, the time
honored demand was for systemic
alternative. Now, oral ivermectin has
appeared as an effective and cost-
comparable alternative to topical agents
in the treatment of scabies infection.
DIAGNOSIS OF SCABIES
The diagnosis of scabies usually is
clinical but may be confirmed by
microscopic identification of female
mite, eggs and scybala in skin
scrapings.
Key points for the diagnosis of scabies
are the following:
1. Morphology of skin lesions (i.e. type of eruptions)–
Pathognomonic lesion– Linear burrows.
Nonspecific- Papular or papulovesicular or vesiculo-pustular lesions.
Excoriations and ulcerations.
Urticarial lesions- rarely.
2. Typical distribution–
Common sites (irrespective of age and sex).
Finger-webs, flexor surfaces of wrists, flexor surfaces of elbows, axillae, umbilicus, waistband, gluteal crease.
Male- genitalia
Female- breasts (Areola and Nipple)
Infants and young children-
Scalp, face, palms and soles
3. Pruritus– Usually intense, disproportionate to the amount of eruptions, worse at night and pleasant in quality.
4. Positive history in skin contacts.
5. Definitive diagnosis rests on identification of the mites or its products.
Useful diagnostic methods:a) Direct examination of skin scrapings
under low power objective.
b) Dermoscopy.
c) PCR.
TREATMENT
A. Treatment of patients: It includes
i) Treatment of complications
ii) Symptomatic treatment and
iii) Specific treatment with scabicides.
Topical and systemic scabicides:a. Topical scabicides include
– Precipitated sulfur 6% or 7% in petroleum jelly– Benzyl benzoate emulsion 25%– Monosulfiram- a 25% solution– 1% Gamma benzene hexachloride (lindane)– Malathion 0.5%– Crotamiton 10%
b. Systemic scabicide- oral ivermectin 200 gm/kg- Single dose, may have to be repeated.
B. Treatment of contacts.C. Trcatment of house-hold utensils.
IVERMECTIN First it was developed in the 1970s as a
veterinary treatment for animal parasites. It is a member of a family of macrolytic
lactones, the avermectins. It has broad spectrum activity against
parasites such asFDA approved- Strongyloidiasis
Onchocerciasis.Not FDA approved-Filariasis
Cutaneous larva migrans.Scabies.Pediculosis etc.
An estimated 6 million people world-wide have taken ivermectin for various parasitic infestations.
Since 1993, it has been successfully used in different countries to treat human scabies that is resistant to treatment.
Some of the study results are shown below:
Study No. of patients Cured (%) Not Cured (%)
1 26 96.15 3.85
2 11 100 00
3 100 83 17
4 11 (with AIDS) 70*
>90**
30*
<10**
Many other studies done by different
groups such as Glaziou P et al, Dunne
CL et al, Kar SK et al, Shouela EN et
al, Madan V et al, Usha V et al also
confirmed the efficiency of ivermectin
as a treatment of scabies infection.
SAFETY OF IVERMECTIN:
Adverse effects such as anorexia, nausea,
vomiting, rash, headache, dizziness,
arthralgia, itching, eosinophilia,
abdominal pain, fever, tachycardia etc
may occur but occur very infrequently. No
serious drug-related adverse events or
significant drug interactions have been
reported.
But its safety in young children and
pregnant women– not established.
A comparison of ivermectin with 5% permethrin is shown below:
Drug Efficacy Adverse effects
Cost Use in children
In pregnancy
Nursing women
Ivermectin 83-100% anorexia, nausea,
vomiting, rash,
headache, dizziness, arthralgia,
itching, eosinophilia, abdominal pain, fever, tachycardia
etc
Tk. 40*
Tk. 80**
Safety not proved in children
<15 kg or <5 years
C Not recommended
Permethrin 91-98% Pruritus, burning, stinging
Tk. 40*
Tk. 80**
Safe in children
2 months
B Not recommended
Superiority of ivermectin over others:
1. Easy route of administration– oral.
2. Dose convenience– only single dose.
3. Efficacy– very high- 98-100%.
4. Safe– very infrequent side effects and not a single major adverse event over 6 million users.
5. Cost effective.
So, many authors and publications
consider it to be the treatment of choice.
CONCLUSION
Oral ivermectin, because of its single oral
dosing, very high efficacy and safety, and low
cost, may replace the other topical agents in
the treatment of scabies. It may be particularly
useful in the treatment of severely crusted
scabies lesions in immunocompromised
patients or when topical therapy has failed or
application of topical agents is logistically
difficult (e.g. large institutional outbreaks or
mentally impaired patients).
MESSAGE
We know the cause
We know the mode of transmission
We have multiple weapons to fight against this mite.
But this mite is winning the battle affecting 300 million peoples each year around the globe.
So, IVERMECTIN may be the best weapon
to win this battle.