SCABIES

• Scabies is a parasitic skin infestation caused by the Sarcoptes scabiei var. hominis (S. scabiei) mite, which is primarily transmitted via close personal contact, but may be transmitted through clothing or towels
• The female scabies mite burrows into the stratum corneum, causing severe pruritus, particularly at night. Primary lesions commonly include erythematous papules, vesicles, or burrows

• Causative agent: Sarcoptes scabiei var. hominis 
• Highly contagious, typically via direct physical (skin-to-skin or sexual) contact and rarely indirect transmission (e.g., sharing textiles such as bedding, towels, or clothes)

• The classic symptom is intense pruritis especially at night
• The sites of predilection are the interdigital spaces, wrists, points of elbow, antecubital fossae, anterior axillary folds , umbilicus and the genitalia especially the gluteal cleft
• The most diagnostic or pathognomic finding is an intact S shaped or linear burrow with a papule or vesicle at its end housing the mite. Most common sites are web spaces of the hands, wrists, and lateral aspects of palms
• Generalized urticarial papules , excoriations and eczematous changes are secondary lesions caused by sensitization to the mite
• Tiny scaly papules on the nipple and male genitalia (glans, shaft, and scrotum) are pathognomonic of scabies

Nodular scabies: Itching nodules 5-20 mm diameter, red, pink, tan or brown in colour persist for several months. Commonly found in the scrotum

Scabies incognito : modifies clinical picture of classical scabies which mimic other dermatoses due to inappropriate use of topical steroids

• Typical history and skin lesions on clinical examination
• Detection of mites, larvae, ova, or mite faeces
• Dermoscopy : mite in burrow resembles jet with contrail
• Microscopic examination of the skin 
• Skin scraping and histology 

Internal medicines

• Nirgundyadi kashaya
• Aragwadhadi kashaya
• Krimighna vati
• Vilwadi gutika
• Amrutarishtam + Punarnavasavam

Procedures

• Sulphur containing ointments
• Pamantaka taila – ext application
• Gandhaka taila – ext application
• Guggulu marichadi taila – ext application
• Ayyapala taila – ext application
• Neeli taila – ext application
• Nimba twak + triphala kshalana