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CLINICAL PHARMACY
PRESENTATION
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PRESENTED TO RESPECTED TEACHERS
• Sir Khalid Tipu • Sir Amir Riaz
M.Ayub
Zeeshan
Jahanzaib
Nousher
Wahidullah
Waqas 3
Scabies is an infestation of the skin with the Sarcoptes Scabiei mite.
It is characterized by intense itching, usually at night.
SCABIES
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Background
Scabies Is An Intensely Pruritic, Highly Contagious Infestation Of The Skin .
Originally, Scabies Was A Term Used By The Romans To Denote Any Pruritic Skin Disease.
In The 17th Century, Giovanni Cosimo Bonomo Identified The Mite As One Cause Of Scabies.
SCABIES
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SARCOPTES SCABIEI
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BACK GROUNDTHE NAME SARCOPTES SCABIEI IS DERIVED FROM THE GREEK WORDS
Sarx (the flesh)
Koptein (to smite or cut)
LATIN SCABERE (TO SCRATCH). TODAY, THE TERM SCABIES REFERS TO THE SKIN LESIONS PRODUCED BY THIS mite.
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PATHOPHYSIOLOGY
The larvae leave the burrow to mature on the skin. Fewer than 10% of the eggs laid result in mature mites.
An affected host harbors approximately 11 adult female mites during a typical infestation. The eggs hatch in 3-4 days.
The female mite burrows into the epidermis of the host using her jaws and front legs, where she lays up to 3 eggs per day for
the duration of her 30-60 day lifetime.
After mating, the male mite dies.
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Pathophysiology
Individuals who already are sensitized from a prior infestation can develop symptoms within hours.
This reaction is responsible for the intense pruritis, which is the hallmark of the disease.
A delayed type IV hypersensitivity reaction to the mites, their eggs, or scybala (packets of feces) occurs approximately 30 days
after infestation.
PATHOPHYSIOLOGY
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Scabies usually is transmitted by direct contact with an affected individual.
Although it has been disputed, it is believed possible to become infested by indirect contact with the personal items or clothing of an affected person because the mite can survive away from the skin for 2-5 days.
MODES OF TRANSMISSION
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Diagnosis
Definitive diagnosis of scabies is made by direct visualization of the mite, eggs, or feces. Under Microscope(Dermoscopy)
DIAGNOSIS
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Primary and secondary lesions
The classic rash of scabies includes primary and secondary lesions.
The primary lesions include burrows, papules, vesicles, and pustules.
The secondary lesions occur from scratching and include excoriated papules and crusted areas.
Short
zigzag or
'S'-shaped
lines or
burrows is
another
symptom
PHYSICAL EXAMINATION
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TYPES OF SCABIES
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CLASSIC SCABIES NORWEGIAN
SCABIES(CRUSTED)
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NORWEGIAN SCABIES
In 1848, the Norwegians Danielssen and Boeck described a highly contagious variant of scabies that occurs in immunocompromised patients.
This rare form of scabies occurs in elderly or Because of an impaired antibody response, i.e HIV & AIDS these individuals can be infested with thousands to a couple million mites.
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NORWEGIAN SCABIES
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NORWEGIAN SCABIES
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TREATMENT
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SR. #
DRUG BRAND DOSE SIDE EFFECTS DRUG INTERACTION
1 PERMETHRIN bioscabli-caremalin
nedax pluspermite
skab
Apply 5% preparation over whole body and wash off after 8–12 hours
Pruritus erythema stinging Rarely rashes
N/A
2 CROTAMITON crotanScat
SCABION
APPLY 10 % PREPARATION 2–3
TIMES DAILY; CHILD BELOW 3 YEARS,
APPLY ONCE DAILY
PRURITUS, IRRITATION, CONTACT DERMATITIS, WARMTH FEELING.
N/A
3 LINDANE Scabene APPLY 1 % PREPARATION APPLY
8 HOURLY
DIZZINESSHEADACHE SKIN IRRITATION CONTACT DERMATITIS.
N/A
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SR. #
DRUG BRAND DOSE SIDE EFFECTS DRUG INTERACTION
4 IVERMECTIN Stromectol 200 micrograms/kg HEADACHE
DIZZINESS
MUSCLE PAIN
N/A
5 BENZYL BENZOATE
Benzyl Benzoate APPLY 25% PREPARATION OVER WHOLE BODY AND
WASH OFF AFTER 8–12 HOURS
SKIN IRRITATION
MUCOUS MEMBRANE IRRITATION
N/A
6 SULPHUR Scabion APPLY PREPARATION OVER WHOLE BODY
AND WASH OFF AFTER 8–12 HOURS
SKIN IRRITATION
MUCOUS MEMBRANE IRRITATION
N/A
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SR. #
DRUG BRAND DOSE SIDE EFFECTS DRUG INTERACTION
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CHLORPHINRAMINE MALEATE
PIRITON
4 mg 6 hourly
Or
10 mg per day
DrowsinessDry mouthSedationConstipation
Phenytoin
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HYDROXYZINE MARAX
25 mg ORALY per day
Dizziness, Headache, Drowsiness, Fatigue, Nervousness
Anxiolytics and hypnotics
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SR. #
DRUG BRAND DOSE SIDE EFFECTS DRUG INTERACTION
9 POTENT STEROID
BetamethasoneBETNOVATE
0.1% twice or thrice a day Apply to the affected area only
Skin thinningSweatingHypersensitivity reactions
Phenytoin↓Carbamazepine↓
10MILD STEROID
HYDROCORTISONEHYDROCORTISONE
1% twice or thrice a day Apply to
the affected area only
Irritation, Allergic reactions, Itching, Burning
Carbamazepine,↓
Barbiturates ↓
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“HOW TO APPLY THE TOPICAL MEDICAMENT?”
AND WASHED OFF AFTER 10 TO 12 HOURS, USUALLY OVERNIGHT, AS DIRECTED BY THE PHYSICIAN.
DO NOT APPLY ON FACIAL AND SCALP REGION.
THEN APPLY THE MEDICAMENT TO THE WHOLE BODY FROM THE NECK DOWNWARDS.
TAKE A HOT BATH AND THOROUGHLY DRY YOUR BODY.
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ReferencesCurrent medical diagnosis and treatment 2010
Clinical medicine by Parveen j.kumar 6th Edition
Harrison principal of internal medicine 16th Edition
Basic and clinical pharmacology by Bertram G.Katzung 10th Edition
Robbin’s basic pathology 7th Edition
British national formulary 56th edition
Diagram from
Diagram from www.GOOGLE.com/images
Diagram from www.wikipedia.org
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Thank You
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