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Mange is an infectious disease of skin which developing is provoked by a microscopic parasite who is called an itch mite or scabby zuden. The severe itch, and also emergence of papulovezikulezny rash is considered the main signs of development of itch in the person. Very often the secondary pustulous elements arising because the patient too strongly combs the skin affected with an illness can join rash.
For the first time this disease it was mentioned more than 2500 flyings ago. The illness with similar symptoms is described in the Old Testament and in Aristotle's works. And in 1687 the Italian doctors the first described interrelation between symptoms of a disease and itch mites.
Today there are data that aggression of an itch mite increases cyclically. Significant increase in quantity of cases increased during wars, hunger, and also other social phenomena in the course of which, life, food, hygiene of people considerably worsened.
Mange arises with a certain seasonality. So, in our country the greatest number of cases of itch is fixed in the winter and in the fall. This results from the fact that the greatest fertility of itch mites is fixed in September-December. At the same time in external environment ticks survive in cool conditions better.
In civilized countries mainly sporadic disease outbreaks are fixed. As a rule, they arise in organized collectives. There are data that at the end of the twentieth century in the world there were about 300 million people sick with a mange.
To thicket itch children at younger preschool age have. A mange at children is shown in view of lack of immunity to an itch mite
Causative agent of itch
As a rule, it is possible to catch this illness during direct contact of skin with skin. Often the illness is transmitted sexually. Infection of children occurs when those sleep with parents in the general bed. Ways of infection with an itch mite directly depend on his biological features. So, the insect inactively during the light period of days and to get into skin of the person, is required to a tick about half an hour. They very quickly perish in external environment, and, the death accelerates at low humidity and high temperature.
Ticks copulate on a surface of skin of the person. After pairing the male perishes, and the female in created by her scabby to the course in a corneous layer of skin postpones at night on
2-4 eggs. The female of an itch mite lives 4-6 weeks. Larvae vyluplivatsya in 2-4 days, and approximately in two weeks the adult tick forms. In most cases a mange is transmitted with the adult impregnated females.
In the afternoon ticks do not show activity, and in the evening of a female lay the courses. Then at the person the itch increases.
Initially at infection of the person with this illness the following symptoms of itch are shown: a skin itch which becomes stronger evening, erythematic papulovezikulezny rash on skin, the subsequent formation of pustules and crusts with forming of polymorphic rashes.
At a mange the human body shows immune and allergic reaction to waste products of an itch mite. So after infection of the person with mites symptoms of itch are shown only approximately in four weeks. The itch arises owing to allergic reaction of the IV type to eggs, excrement, saliva of mites. Owing to strong having combed there is an accession of bacterial flora (it is about stafilokokka and streptococci), pustules are formed.
At survey the doctor reveals the scabby courses. On an integument of the person at survey the skin which are a little towering over a surface white-gray lines which size can vary from 1 mm to 1 cm are noticeable. Most often the scabby courses find in interdigital intervals, on a penis and on the interior of wrists. In certain cases at a mange can not be the scabby courses.
Rash which is shown consists of small erythematic papules. They can be as disseminated through skin, and drain. After a while papules can be transformed to vesicular rash, is more rare – in violent rash. Expressiveness of rash at a mange first of all is influenced by allergic reaction.
Except the most frequent places of localization of rash (in intervals between fingers, on flexion side of wrists, on a penis) rash affects elbows, armpits, feet, a zone under a breast at women, area of a navel, a belt, a buttock. In especially hard cases a mange can extend to all body. Rash does not affect in that case only on the person and the part of the head covered with hair. Thus, the following symptoms of itch in a complex are important for definition of typical itch: presence of an itch, scabby courses and primary rash.
Mange at children is shown by vezikulourtikarny rash, the moknutiya, paronychias and onychias develop later. In the first six months of life a mange at children is shown by the symptoms reminding the small tortoiseshell. At the same time at the child symptoms of itch are shown also by emergence on skin of many combed blisters which generally appear on face skin, spins, buttocks.
Less often a mange at children is shown by acute eczema with very severe itch. Therefore the sick child can sleep badly.
Complications of itch
Owing to strong having combed sometimes there is a bacterial infection of primary elements then the pyoderma is shown. In some exceptional cases this state leads to a post-streptococcal glomerulonephritis or to rheumatic damage of heart. At a pyoderma quite often there are furuncles, an ecthyma and abscesses which are followed by lymphadenitis and a lymphangitis. Also at patients with a mange allergic dermatitis or microbic eczema can develop. Approximately complications in the form of a pyoderma and dermatitis are diagnosed for a half of patients with a mange.
Besides, in more exceptional cases there can be other complications: piogenic pneumonia, felon, erysipelatous inflammation, septicaemia, regional lymphadenitis, internal abscesses. At babies sepsis can develop as complication of itch.
At some patients nodulyarny itch which symptoms is emergence of cyanotic-crimson or brownish round consolidations of skin is shown. Such educations can not disappear several weeks even on condition of lack of parasites.
Besides, manifestation of atypical forms of itch — the Norwegian mange, psevdosarkoptoz, a mange "clean" is possible.
Diagnosis of itch
The diagnosis "mange" can be established, being guided by clinical manifestations, studying of epidemiological data, and also using laboratory methods of inspection. Today some methods of laboratory confirmation of itch are actively used. So, extraction of a parasite from the blind end of the scabby course with use of a needle and the subsequent its studying under a microscope is applied. Also layer-by-layer stripping in the blind end of the scabby course is used. Stripping continues before emergence of blood. One more diagnostic method – by means of alkaline preparation of skin.
In the presence at the patient of complaints to a skin itch first of all it is necessary to take all measures to exclude existence of itch.
The diagnosis is confirmed also in case of detection of the scabby courses. Finally to confirm the diagnosis, the scabby course is opened with a scalpel then are studied under a microscope.
To simplify process of detection of the scabby courses by means of coloring of skin iodine tincture. After that on a light brown background brown furrows on site of the courses are allocated.
It is important to carry out the differential diagnosis of a disease which is shown on generative organs, with syphilis. Differentiation of itch with other illnesses which are transmitted sexually and of which manifestation of rashes of erosive and ulcer and papular character is characteristic is also important
Treatment of itch
Main goal to which achievement treatment of itch, this elimination of the activator is directed. Acaricidal drugs are for this purpose used. These are drugs benzyl benzoate, spregal, Unguentum sulfuratum and others. Today there is a wide choice of the means which are let out in the form of ointments, solutions, creams, shampoos, aerosols.
It is important to apply all measures of therapy under the leadership of the specialist. All patients with a mange who live together have to be treated for this illness in at one time. It is important to monitor accurate implementation of recommendations about processing of places of defeat by drug carefully. It is necessary to apply means on all body parts except for the person and pilar part of the head. But children who were not three years old yet should process also these places. It is important to watch that drug surely got under the patient's nails under which owing to combing eggs of mites can accumulate. It is better to rub drug hands, however to places, densely, covered with hair, means can be rubbed by means of a brush. Drug uses more reasonablly in the evening in view of activity of mites at night. It is important that on skin drug remained not less than twelve hours. After the termination of a course of treatment of itch without fail it is necessary to replace all bed and underwear. Two weeks later after the end of treatment of the patient the attending physician has to examine surely to draw conclusions on need to conduct a repeated course of therapy.
Important also carrying out preventive treatment of all who live together with the patient with a mange.
Today for treatment of itch benzyl benzoate is most often used. After the only careful processing of a body of the patient with this drug all active stages of a parasite perish. But at the same time its eggs survive. So there is specially picked up scheme of use of this medicine.
After owing to treatment of itch ticks are completely brought, the skin itch, and also some elements of rash can take place some more weeks. Most longer rash in the form of small knots remains. To facilitate these manifestations, sometimes reception antipruritic, corticosteroid and antihistamines is appointed sick.
At treatment it is necessary to consider whether infections which in development of itch joined the main illness take place. In such cases the separate course of therapy with the purpose to eliminate the inflammatory process which arose in an organism is applied.
At timely and correct treatment a mange completely is eliminated.
Prevention of itch
Preventive actions are defined, being guided by weight of an epidemiological situation. People who contacted to the patient with a mange without fail pass processing of skin drugs against mites. Very important after the termination of a course of treatment to carry out very careful processing of linen and other things of the patient. It becomes by means of washing and processing by special means.
It is necessary to consider that everyday hygienic procedures with use of soap do not protect from infection with a mange.
Section: Dermatology (Skin diseases)