Data-Medicos 
Dermagic/Express No. 78 
14 Octubre 1.999. 14 October 1.999. 

~ Escabiosis y genetica, alguna relacion ? ~ 
~ Scabies and genetics, some relationship?~ 


EDITORIAL ESPANOL 
================= 
Hola Amigos de la red, el tema de hoy: LA ESCABIOSIS Y LA GENETICA, ALGUNA RELACION ???. Si yo les dijese que existe una relacion entre la vulgar y comun SARNA y la predisposicion a padecerla TENDRIA que convencerlos. Pues en algunas de estas referencias bibliograficas queda plasmado que se han hecho estudios donde se ha demostrado una susceptibilidad estadisticamente significativa entre los antigenos de histocompatibilidad (HLA) y la ESCABIOSIS, y en los dos estudios el antigeno asociado fue el MISMO. En otras el papel inmunologico del organismo es factor importante en el comportamiento de la enfermedad y sus manifestaciones clinicas. Al final un REPASO de las ya terapias conocidas lindano, permetrin y el ultimo grito de la MODA el popular IVERMECTIN. Quien iba a pensar que tenemos una predisposicion para que ese BICHITO se nos monte ??? 

En las 27 referencias, los hechos,,, 

Saludos a todos !!! 

Dr. Jose Lapenta R.,,, 

EDITORIAL ENGLISH 
================= 
Hello Friends of the net, today's topic: THE SCABIES AND THE GENETICS, SOME RELATIONSHIP ???. If I tell you that a relationship exists between the vulgar and common SCABIES and the susceptibility to suffer it I would HAVE to convince you. In some of these bibliographical references it is captured that studies have been made where a susceptibility has been demonstrated statistically significant among the Histocompatibility HLA) antigens and the SCABIES, and in the two studies the associate antigen was the SAME one. In others the immunologic paper of the organism is important factor in the behavior of the illness and its clinical manifestations. At the end a REVIEW of those already therapies well-known lindane, permethrin and the one FASHION and popular IVERMECTIN. Who we will think that we have a susceptibility to the BUG be mounted above us ??? 

In the 27 references, the facts,,, 

Greetings to ALL, !! 
Dr. Jose Lapenta R.,,, 
=================================================================== 
REFERENCIAS BIBLIOGRAFICAS / BIBLIOGRAPHICAL REFERENCES 
=================================================================== 
================================================================= 
1.) Histocompatibility (HLA) antigens in Egyptians with two parasitic skin diseases (scabies and leishmaniasis). 
2.) The immunology of scabies. 
3.) HLA antigens in patients with scabies. 
4.) Immunoglobulin and complement deposits in the skin and circulating immune complexes in scabies. 
5.) The immunology of scabies. 
6.) Serum IgE before and after treatment for scabies. 
7.) Cutaneous histiocytosis with Langerhans cell features induced by scabies: a case report. 
8.) Skin test and radioallergosorbent test characteristics of scabietic patients. 
9.) In vitro demonstration of specific immunological hypersensitivity to scabies mite. 
10.) A DNA fingerprinting system for the ectoparasite Sarcoptes scabiei. 
11.) The behaviour of Sarcoptes scabiei var. hominis in human skin: an ultrastructural study. 
12.) Immunohistopathological status of the skin in cases infested with three species of mites. 
13.) Scabietic nodules: a dermatopathologic and immunofluorescent study. 
14.) Immunologic cross-reactivity among various strains of Sarcoptes scabiei. 
15.) Can house dust mite-triggered atopic dermatitis be alleviated using acaricides? 
16.) Epiluminescence microscopy. A new approach to in vivo detection of Sarcoptes scabiei. 
17.)[Ivermectin and tropical dermatoses] 
18.) Success of a scabies control program in an Australian aboriginal community. 
19.) Equivalent therapeutic efficacy and safety of ivermectin and lindane in the treatment of human scabies. 
20.) The treatment of scabies with ivermectin. 
21.) Epidemiology and control of scabies in an Egyptian village. 
22.) Crusted scabies in two immunocompromised children: successful treatment with oral ivermectin. 
23.) Treatment of scabies with ivermectin. 
24.) Efficacy and tolerance of oral ivermectin in scabies. 
25.) Norwegian scabies in a patient with acquired immunodeficiency syndrome. 
26.) Ivermectin for Sarcoptes scabiei hyperinfestation. 
27.) Crusted scabies of the scalp in dermatomyositis patients: three cases treated with oral ivermectin. 
================================================================= 
1.) Histocompatibility (HLA) antigens in Egyptians with two parasitic skin 
diseases (scabies and leishmaniasis). 
================================================================= 
J Egypt Soc Parasitol 1990 Dec;20(2):565-72 

Morsy TA, Romia SA, al-Ganayni GA, Abu-Zakham AA, al-Shazly AM, Rezk RA 
Department of Parasitology, Faculty of Medicine, Ain Shams University, Egypt. 

The frequency of human leucocytic antigens (HLA) were studied in 62 
patients with scabies and 27 patients with cutaneous leishmaniasis to 
evaluate the role of HLA antigens as genetic markers in the pathogenesis of 
these parasitic skin diseases. A significant statistical association was 
proved between HLA-A11 antigen and scabies and between HLA-A11, -B5 and -B7 
antigens and diffuse cutaneous leishmaniasis. 

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2.) The immunology of scabies. 
================================================================= 
Ann Allergy 1983 Dec;51(6):560-6 

Dahl MV 
Scabies is an inflammatory skin disease caused by the mite Sarcoptes 
scabiei. The mite itself provokes little dermatitis. The rash and itch 
associated with scabies is probably a manifestation of immune response. The 
immune response may help to limit the number of infesting organisms either 
directly by toxic products generated during the reaction or indirectly by 
evoking scratch. Critical studies using purified antigens from scabies 
mites in vivo and in vitro will be necessary in order to clarify the nature 
of the antigens involved and the role of different types of immune 
responses in producing clinical disease. 

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3.) HLA antigens in patients with scabies. 
================================================================= 
Br J Dermatol 1981 Mar;104(3):317-20 

Falk ES, Thorsby E 
Sixty patients with scabies were typed for thirty-three antigens of the 
HLA-A, -B and -C series. A significantly increased frequency was found for 
HLA-AII (28.3%), compared to healthy controls (10.4%). This deviation was 
only found in those of the patients without signs of atopic disease. 

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4.) Immunoglobulin and complement deposits in the skin and circulating 
immune complexes in scabies. 
================================================================= 
ARTICLE SOURCE: Acta Derm Venereol (Sweden), 1982, 62(1) p73-6 
AUTHOR(S): Salo OP; Reunala T; Kalimo K; Rantanen T 
PUBLICATION TYPE: JOURNAL ARTICLE 
ABSTRACT: Sixteen patients with papulovesicular, 6 with nodular and one 
with a Norwegian scabies were studied. Direct immunofluorescence (IF) 
examination revealed C3 deposits in the skin lesions of 13 of the 18 
patients. Among them were all 6 cases with nodular scabies. C3 was found 
mostly in dermal vessel walls and 3 of the patients also showed IgM and 2 
IgA deposits at the same site. No circulating immune complexes were found, 
with a solid-phase C1q radioimmunoassay (RIA), but HSV- and RSV-RIA methods 
detected IgM antibodies of rheumatoid factor type in 5 of the 15 sera 
examined. These results suggest that local complement activation and 
perhaps also immune complex deposition may by important in the pathogenesis 
of the papular and nodular skin lesions of human scabies. 

================================================================= 
5.) The immunology of scabies. 
================================================================= 
ARTICLE SOURCE: Semin Dermatol (United States), Mar 1993, 12(1) p15-21 
AUTHOR(S): Cabrera R; Agar A; Dahl MV 
AUTHOR'S ADDRESS: Department of Dermatology, University of Chile School of 
Medicine, Santiago. 
PUBLICATION TYPE: JOURNAL ARTICLE; REVIEW (52 references); REVIEW, TUTORIAL 
ABSTRACT: Individuals with scabies react to bites by generating a 
cell-mediated immune response at the bite site. This elicits a very itchy 
papule that is often excoriated. Sometimes ulcerated papules, vasculitis, 
and nodules develop as a result of other immunologic reactions in skin. 
Immunologic reactions mediated by antibodies of the immunoglobulin G (IgG), 
IgM, and especially, IgE classes may also be involved. None of these 
reactions have been shown to eliminate all mites from the skin surface, but 
locally these reactions may prevent the epidemic multiplication of scabies' 
organisms on the skin surface, as observed in some patients with crusted 
scabies. 

================================================================= 
6.) Serum IgE before and after treatment for scabies. 
================================================================= 
ARTICLE SOURCE: Allergy (Denmark), Apr 1981, 36(3) p167-74 
AUTHOR(S): Falk ES 
PUBLICATION TYPE: JOURNAL ARTICLE 
ABSTRACT: In 120 patients, treated for scabies infection, the serum IgE 
concentrations fell from high levels in 54 and normal levels in 66 to lower 
levels 12 months after treatment. The specific IgE antibodies to 
Dermatophagoides pteronyssinus (RAST) were also reduced 12 months after 
treatment. The decrease in both IgE concentrations and IgE antibodies was 
most conspicuous in non-atopic patients. These findings confirm previous 
observations of specific immunological hypersensitivity to scabies mite, 
and that scabies infection stimulates the production of IgE antibodies. 

================================================================= 
7.) Cutaneous histiocytosis with Langerhans cell features induced by 
scabies: a case report. 
================================================================= 
ARTICLE SOURCE: Pediatr Dermatol (United States), Dec 1994, 11(4) p327-30 
AUTHOR(S): Talanin NY; Smith SS; Shelley ED; Moores WB 
AUTHOR'S ADDRESS: Division of Dermatology, Medical College of Ohio, Toledo 
43699-0008. 
INDEXING CHECK TAG(S): Case Report; Human; Male 
PUBLICATION TYPE: JOURNAL ARTICLE 
ABSTRACT: An infant with biopsy-proven scabies developed nodular lesions. 
Histopathology revealed atypical histiocytes with Langerhans cell features. 
Within six months after treatment all skin lesions gradually disappeared. 
We suggest that the nodules in scabies can be due to Langerhans cell 
proliferation. 

================================================================= 
8.) Skin test and radioallergosorbent test characteristics of scabietic 
patients. 
================================================================= 
Morgan MS; Arlian LG; Estes SA 
Department of Biological Sciences, Wright State University, Dayton, Ohio 
45435, 
USA. 
Am J Trop Med Hyg (UNITED STATES) Aug 1997 57 (2) p190-6 ISSN: 0002-9637 
Contract/Grant No.: AI-17252--AI--NIAID 
Language: ENGLISH 
Document Type: JOURNAL ARTICLE 
Journal Announcement: 9711 
Subfile: AIM; INDEX MEDICUS 
The scabies mite Sarcoptes scabiei and the Dermatophagoides house dust 
mites (HDM) 
are related phylogenetically and are the sources of several cross-reactive 
antigens. 
The purpose of this study was to investigate the immune response to S. 
scabiei and 
HDM in scabietic patients. Skin test sensitivity and serum IgE to both S. 
scabiei 
and HDM were determined for patients who had or previously had confirmed 
ordinary 
scabies. A retrospective group included nine subjects who had received 
successful 
treatment three weeks to one year prior to the study. A prospective group 
included 
16 subjects with active scabies. Allergic histories were obtained, serum was 
collected, and skin prick tests (SPTs) were performed at enrollment for all 
and 
periodically over the next 12 months for the prospective patients. None of 
the 
individuals in either group reported a known sensitivity to HDM. Six of 
the nine 
retrospective patients were SPT positive to both S. scabiei and HDM and two 
of these 
showed circulating IgE specific for these antigens. At diagnosis, 13 of 16 
patients 
with active scabies were SPT positive to S. scabiei and 12 of these were 
also SPT 
and/or radioallergosorbent test positive to HDM. Six patients had 
circulating IgE 
directed at both S. scabiei and HDM antigens while one subject had IgE to 
S. scabiei 
only and another had IgE directed at HDM only. Twelve of the 15 subjects 
tested also 
showed IgE and/or IgG binding to one or more bands on Western blots of an 
S. scabiei- 
specific protein fraction. This study indicated that approximately half of 
the 
patients with active scabies had S. scabiei- and HDM-specific circulating 
IgE while 
most patients cured of scabies lacked S. scabiei- and HDM-specific serum 
IgE. The 
data also suggested that antibodies to S. scabiei in scabietic patients also 
recognize HDM; however, some antibodies were directed at scabies-specific 
antigens. 

================================================================= 
9.) In vitro demonstration of specific immunological hypersensitivity to 
scabies mite. 
================================================================= 
ARTICLE SOURCE: Br J Dermatol (England), Oct 1980, 103(4) p367-73 
AUTHOR(S): Falk ES; Bolle R 
PUBLICATION TYPE: JOURNAL ARTICLE 
ABSTRACT: An extract prepared from 200 adult female scabies mites was used 
for prick and intracutaneous testing in twelve patients with previous 
scabies infestation, as well as in six healthy controls and three persons 
with skin sensitivity to Dermatophagoides pteronyssinus who had never had 
scabies before. Seven individuals who had had scabies less than a year 
prior to the testing had positive intracutaneous (immediate type) 
reactions, whereas all the five who had had scabies more than a year before 
had negative reactions. The prick tests were negative in all cases. No skin 
reactions could be evoked in the controls. The passive transfer, or 
Prausnitz-Kustner, test was positive with the scabies mite extract and 
serum from three of five patients tested on one healthy individual, and 
with both of two sera tested on a second healthy individual. These findings 
indicate that immediate type hypersensitivity reactions may occur with 
scabies infection. 

================================================================= 
10.) A DNA fingerprinting system for the ectoparasite Sarcoptes scabiei. 
================================================================= 
Walton SF; Currie BJ; Kemp DJ 
Menzies School of Health Research, Casuarina, Australia. 
[email protected] 
Mol Biochem Parasitol (NETHERLANDS) Apr 1997 85 (2) p187-96 ISSN: 
0166-6851 
Language: ENGLISH 
Document Type: JOURNAL ARTICLE 
Journal Announcement: 9709 
Subfile: INDEX MEDICUS 
We describe multiple hypervariable microsatellites that will provide a 
highly 
informative genetic marker system for the sarcoptid mite Sarcoptes scabiei. 
Eighteen 
positive clones containing the highly repetitive sequence (GA)n were 
isolated from a 
partial genomic library of S. scabiei. Ten of these clones were 
characterised by 
sequencing and primers were designed from the unique sequences flanking eight 
microsatellite loci. Genomic DNA was subsequently extracted from 
individual mites 
and the repeat blocks were amplified by way of [gamma 33P] ATP end-labelled 
polymerase chain reaction. Fragment length polymorphisms were revealed in 
three of 
the loci when resolved on polyacrylamide sequencing gels. The high levels 
of allelic 
variability demonstrated between individual mites enable these three loci 
to form a 
DNA fingerprinting system that will be suitable for epidemiological and 
taxonomic 
studies both within and between host species. 

================================================================= 
11.) The behaviour of Sarcoptes scabiei var. hominis in human skin: an 
ultrastructural study. 
================================================================= 
Fimiani M; Mazzatenta C; Alessandrini C; Paccagnini E; Andreassi L 
Department of Dermatology, University of Siena, Italy. 
J Submicrosc Cytol Pathol (ITALY) Jan 1997 29 (1) p105-13 ISSN: 
0022-4782 
Language: ENGLISH 
Document Type: JOURNAL ARTICLE 
Journal Announcement: 9706 
Subfile: INDEX MEDICUS 
The biology of Sarcoptes scabiei var. hominis is poorly understood 
because of the 
lack of an in vivo or in vitro propagation system. To obtain more 
information on the 
mite behaviour in its natural habitat we conducted an ultrastructural study 
of 
burrows in a number of patients with common scabies. Scanning electron 
microscopy 
furnished attractive images of the tunnel, parasite body and eggs 
architecture and 
demonstrated the presence of holes in the tunnel roof probably representing 
aeration 
structures. Transmission electron microscopy showed a marked keratinocyte 
damage 
around burrowing mites, well evident ahead of the mite capitulum also. 
Faecal 
pellets containing keratinocyte micro-organelles (melanosomes and 
mitochondria) were 
documented in posterior midgut. For the first time we disclosed the adhesion 
mechanism of eggs to the burrow floor. We showed that the typical 
finger-like 
projections of the outer layer of the egg shell gradually disappear where 
the eggs 
are in contact with the tunnel floor. This allows the inner layer of the 
egg shell 
to fuse and stick with the damaged keratinocytes lining the tunnel floor. 
Our 
observation substantiates that Sarcoptes scabiei produces a proteolytic 
substance 
(salivary secretions?) that has a key role in its life cycle allowing 
burrowing, 
feeding and eggs-burrow adhesion. 

================================================================= 
12.) Immunohistopathological status of the skin in cases infested with 
three species of mites. 
================================================================= 
Yassien NA; Ghoraba HM; Doghaim NN; Afify EM 
Department of Parasitology, Faculty of Medicine, Tanta University, Egypt. 
J Egypt Soc Parasitol (EGYPT) Dec 1996 26 (3) p567-73 ISSN: 0253-5890 
Language: ENGLISH 
Document Type: JOURNAL ARTICLE 
Journal Announcement: 9704 
Subfile: INDEX MEDICUS 
This study was performed on eighty patients with clinical manifestations 
of scabies. 
Sarcoptes scabiei adult or larva was isolated from 39 patients (48.8%). 
Dermanyssus 
gallinae (red poultry mite) and Dermatophagoides sp. were isolated from 6 
and 5 
patients respectively. Punch biopsies were taken from the patients, 
stained with 
haematoxylin and eosin and direct immunofluorescence stain to study the 
immunopathological status of the skin infested with three species of mites. 
The 
results declared that the pathological changes and the immunoglobulin 
deposition in 
the skin were nearly similar regardless of the type of the causative mite 
with the 
except of the presence of burrows in Sarcoptes scabiei. 

================================================================= 
13.) Scabietic nodules: a dermatopathologic and immunofluorescent study. 
================================================================= 
ARTICLE SOURCE: J Cutan Pathol (Denmark), Apr 1992, 19(2) p124-7 
AUTHOR(S): Liu HN; Sheu WJ; Chu TL 
AUTHOR'S ADDRESS: Department of Dermatology, Veterans General 
Hospital-Taipei, Taiwan, R.O.C. 
PUBLICATION TYPE: JOURNAL ARTICLE 
ABSTRACT: Mites and their eggs were thought to be rarely found in nodular 
lesions of scabies. However, serial sections from 27 scabietic scrotal 
papules or nodules revealed mite parts in 22% (6/27). This supports the 
contention that scabietic nodules may result from persisting antigens of 
mite parts. In contrast to previous studies, vasculitis with fibrinoid 
degeneration was uncommon (3/27) in our series. This discrepancy may be due 
to the timing of the biopsies: 2 of 3 cases with vasculitis were associated 
with diffuse dense infiltration, and vasculitis may be a late event in the 
development of scabietic nodules. The specificity of immunoreactant 
deposits along the epidermodermal junction (EDJ) in scabies is 
controversial. In our study, direct immunofluorescence (DIF) was performed 
on 13 scabietic nodules. Four (31%) showed immunoreactants at the EDJ and 
two on blood vessels. Because of the relatively low positive rate, the low 
intensity of fluorescence, and 3 of 4 cases with positive immunoreactants 
having only a single class of immunoglobulin, the deposition may only be 
secondary to inflammation instead of a specific type II immunologic 
reaction to scabies. 

================================================================= 
14.) Immunologic cross-reactivity among various strains of Sarcoptes scabiei. 
================================================================= 
AU: Arlian-LG; Morgan-MS; Arends-JJ 
AD: Department of Biological Sciences, Wright State University, Dayton, 
Ohio 45435, USA. 
SO: J-Parasitol. 1996 Feb; 82(1): 66-72 
ISSN: 0022-3395 
PY: 1996 
LA: ENGLISH 
CP: UNITED-STATES 
AB: Varieties of Sarcoptes scabiei from different hosts are highly host 
specific but they are morphologically indistinguishable. The purpose of 
this study was to investigate the immunologic cross-reactivity among 
several varieties of scabies mites using serum from a human scabies patient 
and from several other species of infested hosts. Homologous and 
heterologous crossed-immunoelectrophoretic (CIE) analysis of extracts 
prepared from var. canis (dog) and var. suis (pig) mites yielded very 
similar antigen profiles. Serum from a human patient infested with var. 
hominis had circulating IgE that bound to antigens present in extracts 
prepared from each animal mite variety. Antigen homology was further 
confirmed by fused peaks on tandem CIE. Additionally, sodium dodecyl 
sulfate polyacrylamide gel electrophoresis/immunoblot analysis showed that 
the 2 extracts contained proteins that bound antibody in serum from a var. 
suis-infested pig, a var. canis-infested dog, var. canis-infested rabbits, 
and a var. hominis-infested human. The results of this study clearly 
indicate that different varieties of scabies mites, though host specific, 
introduce some immunologically cross-reactive molecules into the host. 
However, each serum from the 4 scabies-infested hosts also contained 
antibody that was specific for proteins in extract from only 1 variety of 
mite. These data indicated that each variety of scabies introduced some 
unique molecules into the host, each strain produced some similar 
molecules, or both, but different hosts responded immunologically to 
different sets of these. 

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15.) Can house dust mite-triggered atopic dermatitis be alleviated using 
acaricides? 
================================================================= 
Cameron MM 
Department of Medical Parasitology, London School of Hygiene & Tropical 
Medicine, 
U.K. 
Br J Dermatol (ENGLAND) Jul 1997 137 (1) p1-8 ISSN: 0007-0963 
Language: ENGLISH 
Document Type: JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL 
Journal Announcement: 9711 
Subfile: INDEX MEDICUS 
House dust mite (HDM) allergens are the most important triggers for atopic 
dermatitis. Reducing exposure to these allergens may alleviate clinical 
symptoms. 
Chemicals with acaricidal activity have been used to treat upholstered 
furniture, 
carpets and bedding with the aim to reduce HDM allergen exposure. These 
chemicals, 
by reducing HDM, can decrease the concentration of mite allergens in dust but 
improvements in clinical symptoms are not always apparent. Clinical 
improvement is 
more likely to occur if bedding has been treated rather than carpets and 
upholstery. 
Future control strategies should be aimed at treating bedding. Permethrin 
is a very 
efficient killer of mites. It is used topically to treat scabies and head 
lice and 
is impregnated in bed nets to prevent mosquito bites. Even when applied to 
the skin 
in high concentrations, it has a very low toxicity in humans and other 
mammals. 
Permethrin-impregnated bedding may prove to be the best control method in the 
treatment of HDM allergen-triggered atopic conditions. (93 References) 

================================================================= 
16.) Epiluminescence microscopy. A new approach to in vivo detection of 
Sarcoptes 
scabiei. 
================================================================= 
Argenziano G; Fabbrocini G; Delfino M 
Clinic of Dermatology, Federico II University of Naples, Italy. 
Arch Dermatol (UNITED STATES) Jun 1997 133 (6) p751-3 ISSN: 0003-987X 
Language: ENGLISH 
Document Type: CLINICAL TRIAL; JOURNAL ARTICLE 
Journal Announcement: 9709 
Subfile: AIM; INDEX MEDICUS 
BACKGROUND: The usual methods of scabies diagnosis include microscopic 
identification of the mites and their eggs and feces in skin scrapings. In 
many 
cases, the results of microscopic examination can be negative owing to the 
low number 
of parasites present in the cornified layer. Epiluminescence microscopy 
(ELM) is an 
in vivo technique that allows a detailed inspection of the skin, from the 
surface to 
the superficial papillary dermis. This is where the scabies mite lives. 
In this 
study, we evaluate the applicability and the usefulness of ELM for in vivo 
diagnosis 
of scabies. OBSERVATIONS: Sixty-five (93%) of 70 cases of scabies showed 
small, 
dark, triangular structures at the sites examined with ELM. A subtle 
linear segment 
seen below the base of the triangle was made visible by the presence of 
small air 
bubbles. Together, both structures resembled a jet with contrail. On 
traditional 
microscopic examination of the scrapings, we verified that the triangular 
structure 
corresponded to the pigmented anterior section of the mite in all cases. 
The linear 
segment observed on ELM was thought to be the burrow of the mite along with 
its eggs 
and fecal pellets. The cases in which the results of a first ELM 
examination were 
negative demonstrated positive results on a second ELM examination carried 
out 20 
days later. CONCLUSION: Epiluminescence microscopy is a very useful tool 
for in vivo 
diagnosis of scabies because it permits Sarcoptes scabiei detection in only 
a few 
minutes, with no discomfort to the patient and with a very low number of 
false- 
negative results. 

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17.)[Ivermectin and tropical dermatoses] 
Ivermectine et dermatoses tropicales. 
================================================================= 
Caumes E 
Service de maladies infectieuses et tropicales, Groupe hospitalier Pitie- 
Salp.ANG.etriere, Paris. 
Bull Soc Pathol Exot (FRANCE) 1997 90 (1) p37-8 
Language: FRENCH Summary Language: ENGLISH 
Document Type: 
JOURNAL ARTICLE; REVIEW; REVIEW, TUTORIAL English Abstract 
Journal Announcement: 9710 
Subfile: INDEX MEDICUS 
Among tropical dermatoses, the main indications of ivermectine are tropical 
parasitoses such as filariasis and cosmopolitan diseases due to 
ectoparasites such as 
scabies. The efficacy and tolerance of ivermectine in filariasis 
(onchocerciasis, 
lymphatic filariasis, loiasis) have been the topic of numerous articles and 
reviews. 
More recent studies showed that ivermectin was also efficient in the 
therapy of 
scabies, cutaneous larva migrans and larva currens. (17 References) 

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18.) Success of a scabies control program in an Australian aboriginal 
community. 
================================================================= 
Carapetis JR; Connors C; Yarmirr D; Krause V; Currie BJ 
Menzies School of Health Research, Darwin, Northern Territory, Australia. 
[email protected] 
Pediatr Infect Dis J (UNITED STATES) May 1997 16 (5) p494-9 ISSN: 
0891-3668 
Language: ENGLISH 
Document Type: JOURNAL ARTICLE 
Journal Announcement: 9710 
Subfile: INDEX MEDICUS 
OBJECTIVE: To adapt, implement and evaluate a model of scabies control in 
an 
Australian Aboriginal community. METHODS: After initially examining the 
population, 
we offered all residents treatment with 5% permethrin cream. Visits were 
made during 
the ensuing 25 months to rescreen and to treat new-cases of scabies and 
contacts. 
RESULTS: The prevalence of scabies was reduced from 28.8% before the 
program to < 10% 
during the entire period (from 32.3% to < 10% in children) (P < 0.01 for 
each visit). 
The initial prevalence of pyoderma in children was 69.4%, which was reduced 
and 
maintained at approximately one-half that rate during the last 16 months (P 
< 0.004 
for the last 4 visits). Residual pyoderma in children was significantly 
less severe 
and no longer scabies-related. CONCLUSIONS: This simplified model of 
scabies control 
had a substantial effect on scabies prevalence and on pyoderma prevalence and 
severity which was sustained for > 2 years. It could prove useful for other 
communities with high rates of scabies and pyoderma. 

================================================================= 
19.) Equivalent therapeutic efficacy and safety of ivermectin and lindane 
in the treatment of human scabies. 
================================================================= 
Arch Dermatol 1999 Jun;135(6):651-5 

Chouela EN, Abeldano AM, Pellerano G, La Forgia M, Papale RM, Garsd A, 
Balian MC, Battista V, Poggio N 
Department of Dermatology, the Hospital General de Agudos Dr Cosme 
Argerich, Buenos Aires, Argentina. [email protected] 

OBJECTIVE: To compare the therapeutic efficacy and safety of ivermectin and 
lindane for the treatment of human scabies. DESIGN: Randomized, 
prospective, controlled, double-blind, "double-dummy," and parallel 
clinical study. SETTING: A single department of dermatology at a hospital 
in Buenos Aires, Argentina. PATIENTS: Patients were outpatients, 
hospitalized patients, and those referred to our hospital from nursing 
homes and asylums. Fifty-three patients had clinical signs and symptoms 
compatible with scabies. INTERVENTION: Patients received either a single 
oral dose of ivermectin (150-200 microg/kg of body weight) or a topical 
application of 1% lindane solution. Treatment was repeated after 15 days if 
clinical cure had not occurred. MAIN OUTCOME MEASURES: Clinical healing and 
adverse effects. RESULTS: Of 53 patients, 43 (81%) completed the study, 19 
in the group treated with ivermectin and 24 in the group treated with 
lindane. At day 15, 14 patients (74%; 95% confidence interval, 48.8%-90.8%) 
in the group receiving ivermectin showed healing of their scabies and 13 
patients (54%; 95% confidence interval, 32.8%-74.4%) in the group treated 
with lindane were healed. At 29 days, both treatments resulted in 
statistically equivalent therapeutic efficacy: 18 patients (95%; 95% 
confidence interval, 74.0%-99.9%) were healed with ivermectin and 23 
patients (96%; 95% confidence interval, 78.9%, 99.9%) were healed with 
lindane (P<.02). Adverse effects from the treatments were few, mild, and 
transient. Results from laboratory tests showed no major abnormalities and 
no difference between treatments. CONCLUSIONS: Ivermectin is as effective 
as lindane for the treatment of scabies. Ivermectin is simpler to use and, 
therefore, is a promising tool to improve compliance and to control 
infestations. 

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20.) The treatment of scabies with ivermectin. 
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ARTICLE SOURCE: N Engl J Med (United States), Jul 6 1995, 333(1) p26-30 
AUTHOR(S): Meinking TL; Taplin D; Hermida JL; Pardo R; Kerdel FA 
PUBLICATION TYPE: CLINICAL TRIAL; JOURNAL ARTICLE 
ABSTRACT: BACKGROUND. Ivermectin is an anthelmintic agent that has been a 
safe, effective treatment for onchocerciasis (river blindness) when given 
in a single oral dose of 150 to 200 micrograms per kilogram of body weight. 
Anecdotal reports of improvement in patients who suffered from infestation 
with the mite Sarcoptes scabiei suggest that the ectoparasitic disease 
scabies might be treated with ivermectin. METHODS. We conducted an 
open-label study in which ivermectin was administered in a single oral dose 
of 200 micrograms per kilogram to 11 otherwise healthy patients with 
scabies and to 11 patients with scabies who were also infected with the 
human immunodeficiency virus (HIV), 7 of whom had the acquired 
immunodeficiency syndrome. All patients received a full physical and 
dermatologic examination; scrapings from the skin of all patients tested 
positive for scabies. Patients were reexamined two and four weeks after 
treatment, when the scrapings for scabies were repeated. The patients used 
no other scabicides during the 30 days before ivermectin treatment or 
during the 4-week study period. RESULTS. None of the 11 otherwise healthy 
patients had evidence of scabies four weeks after a single dose of 
ivermectin. Of the 11 HIV-infected patients, 2 had or = 10 scabies lesions 
before treatment, 3 had 11 to 49 lesions, 4 had or = 50 lesions, and 2 had 
heavily crusted skin lesions. In eight of the patients the scabies was 
cured after a single dose of ivermectin. Two patients received a second 
dose two weeks after the first. Ten of the 11 patients with HIV infection 
(91 percent) had no evidence of scabies four weeks after their first 
treatment with ivermectin. CONCLUSIONS. The anthelmintic agent ivermectin, 
given in a single oral dose, is an effective treatment for scabies in 
otherwise healthy patients and in many patients with HIV infection. 

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21.) Epidemiology and control of scabies in an Egyptian village. 
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Hegazy AA, Darwish NM, Abdel-Hamid IA, Hammad SM 
Department of Dermatology, Faculty of Medicine, Mansoura University, Egypt. 

BACKGROUND: Some studies have addressed the epidemiology of scabies among 
rural populations in developing countries; however, the epidemiology of 
scabies among the rural population in Egypt is unknown. We sought to 
determine the magnitude of scabies infestation in an Egyptian village and 
to evaluate the control measures after 1 year. METHODS: This study was 
carried out on 3147 residents of Mit-Moaned village in Dakahlia govemorate, 
Egypt. It was a cross-sectional follow-up study where the same individuals 
examined in round I were re-examined in round III. The two rounds were 
separated by a period of 1 year, during which infested patients were 
followed up and new cases were discovered (round II). Patients and their 
household contacts received treatment with topical permethrin. Patients 
showing resistance to permethrin received a single oral dose of ivermectin. 
RESULTS: In round III, the overall prevalence rate of scabies was reduced 
from 5.4% in round I to 1.1%. The incidence of new cases among susceptible 
persons during round II was 1.1%. Scabies was significantly (P < 0.05) more 
prevalent among families of large size, high crowding index at night, low 
socioeconomic standards, and those receiving their water supply from a hand 
pump. Children younger than 10 years showed the highest prevalence. 
CONCLUSIONS: Our data provide the first complete picture of the 
epidemiology of scabies in rural Egypt. The epidemiologic characteristics 
of the disease should be considered in the design of disease control 
programs for other villages with scabies epidemics. Our findings revealed 
that good control was achieved with the following: increased awareness and 
better case finding, education of the staff at the rural health unit, 
improved hygiene measures, and massive treatment campaigns using effective 
drugs such as topical permethrin and oral ivermectin. 

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22.) Crusted scabies in two immunocompromised children: successful treatment 
with oral ivermectin. 
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Australas J Dermatol 1999 Feb;40(1):37-40 

Patel A, Hogan P, Walder B 
Department of Dermatology, Sydney Children's Hospital, Randwick, Australia. 

Two immunodeficient children, aged 4 and 12 years, with crusted scabies 
were successfully treated with a single oral dose of ivermectin (200 
micrograms/kg). One child had been diagnosed in infancy with an undefined 
congenital T cell immunodeficiency and the other with chronic mucocutaneous 
candidiasis. Both had failed to respond to conventional topical therapy. In 
view of the excellent therapeutic response and absence of side-effects, 
ivermectin should be considered in the treatment of recalcitrant crusted 
scabies in children. 

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23.) Treatment of scabies with ivermectin. 
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Eur J Dermatol 1999 Mar;9(2):100-1 

Offidani A, Cellini A, Simonetti O, Fumelli C 
Clinica Dermatologica, Ospedale Umberto I, Piazza Cappelli 1, 60100 Ancona, 
Italy. 

The authors report six new cases of patients suffering from severe 
infestation with the mite sarcoptes scabiei, treated with ivermectin, 
currently the only oral therapy available for this disease. Each patient 
received 200 mug/kg of ivermectin, taken as single dose. No topical therapy 
was undertaken, except for topical treatment with emollient, as needed. The 
drug was very effective in all cases, easy to use, safe, and particularly 
useful in those patients with secondary eczematisation and escoriations, 
for whom the topical treatments are irritant and less well tolerated. 

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24.) Efficacy and tolerance of oral ivermectin in scabies. 
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J Eur Acad Dermatol Venereol 1998 Nov;11(3):247-51 

Dourmishev A, Serafimova D, Dourmishev L 
Department of Dermatology and Venereology, Medical University, Sofia, 
Bulgaria. [email protected] 

OBJECTIVE: The aim of this open-label study was to investigate the 
therapeutic effect and adverse reactions of oral ivermectin in scabies 
patients. BACKGROUND: There is much confusion over reports of efficacy, 
adverse reactions and relapses after oral treatment of scabies with 
ivermectin. METHODS: Nineteen patients, ten otherwise healthy outpatients 
with scabies, and nine inpatients with scabies and another skin disease 
(dermatomyositis, 3; pemphigus, 2; bullous pemphigoid, 1; pyoderma, 1; HIV, 
1; Behcet's disease, 1) were treated with an oral dose of 0.2 mg/kg 
ivermectin (1% water solution) on days 1 and 8. The presence of live mites 
and ova in the patient's skin was investigated before, during and after the 
treatment. RESULTS: None of the 19 patients with scabies had evidence of 
scabies after the second dose of ivermectin. In seven patients we noted the 
enhancement of pruritus 24-72 h after the first administration of 
ivermectin. In three patients the skin manifestation, vesicle-pustular rash 
increased between the second and the fourth day. CONCLUSION: The advantages 
of oral ivermectin treatment in scabies patients are: high therapeutic 
efficacy against Sarcoptes scabiei, good tolerance and influence of the 
drug on the whole skin surface and on clinical symptoms. The administration 
of the drug is easy and quick. 

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25.) Norwegian scabies in a patient with acquired immunodeficiency syndrome. 
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Dermatology 1998;197(3):306-8 

Guggisberg D, de Viragh PA, Constantin C, Panizzon RG 
Service de Dermatologie, Centre Hospitalier Universitaire Vaudois, 
Lausanne, et Departement Hospitalo-Universitaire Romand de Dermatologie et 
Venereologie (DHURDV), Lausanne/Geneve, Suisse. 

We report the case of a 42-year-old man with symptomatic HIV infection (C3 
CDC stage) who presented widespread hyperkeratotic skin lesions diagnosed 
as Norwegian scabies. The CD4 count was 87 cells/mm3. The patient has been 
the source of a nosocomial outbreak (20 individuals affected). He was 
treated successfully with combined topical treatment (permethrin 5% cream 
plus keratolytic agents) and oral ivermectin. 

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26.) Ivermectin for Sarcoptes scabiei hyperinfestation. 
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Int J Infect Dis 1998 Jan-Mar;2(3):152-4 

Huffam SE, Currie BJ 
Royal Darwin Hospital, Menzies School of Health Research, Darwin, Northern 
Territory, Australia. 

OBJECTIVES: Crusted (Norwegian) scabies is an unusual variant of scabies 
caused by hyperinfestation with Sarcoptes scabiei. It has high morbidity, 
and secondary bacterial skin sepsis may result in life-threatening 
bacteremia. An open label study of oral ivermectin was carried out in 
patients with crusted scabies refractory to topical therapy. METHODS: 
Patients with refractory crusted scabies were prescribed oral ivermectin, 
one to three doses of 200 mg/kg at 14-day intervals, combined with topical 
scabicide and keratolytic therapy. RESULTS: Of the 20 patients who received 
ivermectin, 8 had a complete initial clinical response, a partial response 
was achieved in 9, and minimal improvement occurred in 3. Three doses of 
ivermectin were curative for 8 of 10 cases, but recurrence of scabies from 
presumed reinfestation occurred in at least half of these. CONCLUSION: The 
authors conclude that ivermectin is effective for crusted scabies; however, 
multiple doses may be required to achieve a cure, and recurrence 6 or more 
weeks after completing treatment is common. 

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27.) Crusted scabies of the scalp in dermatomyositis patients: three cases 
treated with oral ivermectin. 
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Int J Dermatol 1998 Mar;37(3):231-4 

Dourmishev AL, Serafimova DK, Dourmishev LA, Mualla MA, Papaharalambous V, 
Malchevsky T 
Department of Dermatology and Venereology, University of Medicine, Sofia, 
Bulgaria. 

BACKGROUND: Cutaneous features in the scalp area among adult patients are 
rarely considered as a manifestation of scabies. METHODS: Three patients 
with clinical and laboratory data of dermatomyositis with scalp involvement 
(fulfill three or four of Bohan and Peter's criteria), of 4 years, 8 
months, and 3 years duration, were seen at our department between 1995 and 
1996. For relapses of ordinary scabies, they were treated repeatedly with 
local scabicide with temporary effect. After a symptom-free period during 
the treatment of dermatomyositis with corticosteroids and azathioprine, 
they developed diffuse redness with scales and crusts on the scalp areas. 
Light microscopy examination of material taken from these crusts showed an 
abundance of live mites. RESULTS: All patients were successfully cured of 
scabies with a twice oral dose of 200 microg/kg ivermectin within 8 days. 
CONCLUSIONS: Our patients with crusted scabies of the scalp and 
dermatomyositis prompted us to change our standard diagnostic and 
therapeutic regimens. Fascinating features included mimicry of scabies in 
patients with dermatomyositis, location of parasites on the scalp, 
suppressed cell-mediated immunity and successful cure of mange by ivermectin. 
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DATA-MEDICOS/DERMAGIC-EXPRESS No (78) 14/10/99 DR. JOSE LAPENTA R. 
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