Crusted scabies. Norwegian scabies: symptoms and treatment. Treatment of Norwegian scabies with medications

Cause of the disease

As mentioned above, Norwegian scabies is caused by a common scabies mite, but despite this, immune mechanisms play a leading role in the pathogenesis of the disease. The disease develops against the background of a decrease in the body's defenses. For this reason, this type of scabies occurs in patients with immunodeficiency conditions (tuberculosis, AIDS, leukemia, autoimmune diseases, Bloom's syndrome, etc.)

Norwegian scabies occurs equally in women and men of all ages and races. The duration of the disease can vary from several months to almost 50 years. Duration incubation period ranges from 3 months to 16 years, when the first cortical layers appear.

The disease is provoked by a common scabies mite, which creates passages under the patient’s skin, causing scabies. The disease was first recorded at the end of the 19th century in Norway, hence its name.

The disease is spread only by the female tick. The male dies immediately after fertilization. The female makes winding passages under the human skin in which she lays eggs. After maturation, the larvae are selected out through the same passages. They reach maturity in 4-7 days.

Norwegian scabies is highly contagious. People with weakened immune systems are at risk and are more likely to become infected. For this reason, the disease is more often diagnosed in people suffering from HIV infection, tuberculosis, lymphoma, leprosy, and Down's disease.

Clinical picture and pathogenesis

The incubation period lasts about 2 – 6 weeks. Further, the disease can develop over years and even decades. The patient rarely experiences a fever, but the skin becomes very dry and hot to the touch - these are the first symptoms of scabies in adults.

Due to the formation of passages, the patient's skin gradually becomes thicker and rougher. Scabs of gray, yellow and even greenish color form on it. If left untreated, the upper layers of the skin take on the appearance of a shell covered with grooves. When the upper crusts are removed, reddish skin with areas of erosion can be seen.

Norwegian scabies causes scabs to appear all over the body, including the face. The patient's nails thicken, become loose and change color - the process resembles a fungal infection of the nail plate. A person's hair becomes dull, thin and brittle. The patient emits a characteristic sour odor, which is an important diagnostic criterion.

Types of scabies

Scabies is a highly contagious disease that requires immediate treatment. It is important to monitor the condition of the skin, respond to changes in a timely manner and not engage in self-diagnosis.

Scabies different persons may proceed in different ways.

2. Scabies without moves.

Its difference from typical scabies is that there are no scabies on the skin, but there are bubbles up to 2-3 mm in diameter. Scabies without burrows develops in people who have been in contact with someone with scabies, but they were infected not by adults, but by larvae, which take time to develop.

4. Norwegian scabies develops in people with weakened immune systems (for example, with AIDS, tuberculosis), drug addicts, and people with Down syndrome. Norwegian scabies is very severe, affects the entire body, including the head, and is highly contagious.

5. Pseudoscabies (pseudosarcoptosis) develops in people infected from animals. Animal scabies mites are not capable of causing typical human scabies and only manifest as severe itching. Healing occurs independently after stopping contact with the sick animal.

Clinical picture: what symptoms accompany the disease?

Scabies appear, as a rule, starting from the lateral surfaces of the fingers, in the space between them, in the area reverse side elbows and knees, breasts, lower abdomen and foreskin penis.

The skin thickens and coarsens, gradually forming a kind of shell covered with furrows. Changes are noticeable on the face, nails and even hair, which is not typical for typical shape diseases.

A typical feature is the appearance of dirty yellow crusts (scabs), which can reach a thickness of 2-3 cm. They cover large areas of the skin. When removing the crusts, fairly large weeping erosions occur.

The nail plates thicken and loosen, which leads to their increased fragility. Externally this sign resembles nail fungus.

The patient's hair becomes dull. An infected person emits a characteristic sour odor.

The signs of Norwegian scabies are quite pronounced, which is not typical for the usual form of the disease. This is due to the fact that there are about 1 million scabies mites on infected human skin, and in the normal form of the disease there are no more than 15 individuals.

A characteristic symptom of Norwegian scabies is the absence of intense itching. No itching is not a very favorable symptom, since scratching is a kind of protective reaction of the body. Infected lesions are most often localized on the skin of the upper and lower extremities, face, buttocks, palms and soles.

The affected areas are covered with massive crusts from 2 mm to 4 mm, gray or yellow-green in color, emitting an unpleasant specific odor. Sometimes the crusts may look like cutaneous horn, can spread over large areas of skin in the form of a horny shell. The surface of such areas is covered with cracks, from which bloody fluid is released, and in the area of the joints the skin is dotted with deep furrows, reminiscent of plowed soil.

These furrows are filled with a huge number of mites on different stages development. In addition to crusts, multiple rashes in the form of pustules, scales, papules and vesicles are noticed. Sometimes skin lesions are accompanied by a general malaise of the body: headaches, fever, joint pain, enlarged lymph nodes.

The disease is highly contagious and can lead to local epidemics.

Norwegian scabies is transmitted from person to person in the following ways:

Contact-household way. Use of general personal hygiene items: towels, bed linen, mattresses, pillows, blankets. Most often, infection occurs in shared housing in dormitories, on trains, in hotels, and in preschool institutions.
Contact method of infection. This method of infection is the most common. Most often you can become infected by shaking hands, general use household items.
Sexually. Sexual contact can provoke infection with Norwegian scabies.

There is evidence that Norwegian scabies is transmitted from domestic animals. In this case we are talking about pseudoscabies. It is known that pathogens that cause disease in animals are absolutely safe for humans.

This type of scabies lesion is different increased level contagiousness, but despite this, it is extremely rare. Main carriers of this disease are people who have an antisocial lifestyle. Further at risk are drug addicts, people with mental retardation, with weakened immunity or with a minimal level of it (in case of HIV infection), patients with tuberculosis and rheumatoid diseases.

Itching of the skin, isolated rashes and the possible detection of small insects on it are the most likely primary signs diseases. Increasing at night, they interfere with a person’s sleep, irritate the nervous system, and lead to an exacerbation of existing chronic diseases.

In addition, numerous scratches lead to attachment purulent infection. In this case, the symptoms of Norwegian scabies may be complicated by body temperature, inflammatory septic processes, and symptoms of general intoxication.

The lack of timely exterminatory measures leads to an abundant colonization of the skin with mites and multi-layered damage to the dermis. In this case, extensive fused foci are formed, which are covered with dead epithelial cells - crusts of gray, yellowish-brown or brown color.

Symptoms of the disease appear only after the end of the incubation period, which can last from 2 to 6 weeks. How quickly the first manifestations of scabies appear depends on the number of mites on the skin.

The disease is characterized by the following symptoms:

The skin of an infected person becomes very dry and hot. The upper layers are covered with layers of green-gray crusts;
some areas of the skin are covered with dense, armor-like growths;
when tearing off the crusts, you can notice that underneath there is very thin and bleeding skin;
there is a huge number of itchy itches on the skin;
the color of the crusts can be different: green-gray, yellow-gray, gray-brown. The surface can be smooth or loose;
crusts can be located in several layers and have a thickness of 2-3 cm;
scabies itch primarily affects the skin in the abdomen, elbows, face, neck, and buttocks. There are cases where the disease affected the entire body;
the hair in the affected area becomes dull;
nails thicken and become deformed;
lymph nodes enlarge throughout the body;
A characteristic symptom of the disease is the specific smell of fermented dough.

The main symptoms of Norwegian scabies manifest themselves in the form of polymorphic rashes, erythroderma and massive layers of crusts. The thickness of such a layer can reach 2-3 centimeters, and a kind of shell is formed.

The surface is covered with deep cracks, and deep grooves can be seen at large joints. Upper layer It is particularly dense, and the lower one has a loose structure.

Sometimes the symptoms of the disease can manifest themselves in other ways. For example, the affected area may be the nails.

They take on a gray-yellow color, crumble and break. The patient has problems with his hair; it takes on an ash-gray tint, becomes brittle and dry.

Since this is one of the forms of scabies, it cannot be done without severe itching, unpleasant odor and increased body temperature.

A pathognomonic sign is the presence of scabies.

As soon as a female mite lands on human skin, she immediately begins to “dig” a passage in the stratum corneum of the skin at a speed of 0.5-5 mm per day. As a result, on the surface of the skin, upon careful examination, one can detect whitish-gray lines slightly rising above the surface of the skin, ranging in size from 1 mm to 1 cm.

Most often, scabies can be found in the interdigital spaces, on inside wrists and on the skin of the penis. Sometimes it is not possible to detect scabies burrows (scabies without burrows).

The primary rash is represented by small erythematous papules, which can be scattered or multiple, confluent. Over time, papules can transform into a vesicular (vesicles), rarely bullous (pemphigoid) rash.

The rash is distributed most often (in descending order) in the interdigital spaces of the hands, on the flexor side of the wrists; in men, it quickly moves from the hands to the penis and scrotum.

Then the elbows, feet, armpits, areas under the breasts in women, the umbilical area, the belt line, and buttocks are affected. As a result, the entire body can be involved, except for the face and scalp (although in children under 3 years of age, these areas are also affected).

The presence of itching, primary rash and scabies is the main clinical symptom complex of a typical form of scabies.

Papules and vesicles often develop into secondary scabies: excoriations (scratching), eczematous elements, secondary pustular rashes and crusts. Primary and secondary elements coexist in one patient.

Ardi's symptom - pustules and purulent crusts on the elbows and in their circumference; - Gorchakov's symptom - bloody crusts there; - Michaelis' symptom - bloody crusts and impetiginous rashes in the intergluteal fold with transition to the sacrum; - Sezari's symptom - detection of scabies in the form of a lung elevations upon palpation.

Diagnostic principles

The diagnosis is made on the basis of clinical data (characteristic rashes), epidemiological information (examination of contact persons, information about being in an epidemic focus), laboratory diagnostics(detection of a mite and its eggs on the skin). When affected, an increase in blood leukocytes, eosins and ROE is observed.

Differential diagnosis of the Norwegian form of the disease includes eczema, pyoderma and hyperkeratotic psoriasis. If serious complications develop in the absence of timely treatment, the prognosis of this disease is unfavorable. Drug therapy is effective only in the initial stages of the disease. Fatal outcomes are often observed, which occurs due to severe intoxication of the patient’s body or damage to cardiac activity.

When diagnosing Norwegian scabies, it is necessary to carry out a differential diagnosis with certain dermatoses. For example, congenital keratodermas, unlike Norwegian scabies, appear immediately after birth or in the first years of life. Or, for example, when differentially diagnosing Norwegian scabies from Devergie's disease, it is necessary to take into account the fact that this disease often appears in childhood or adolescence. Also characteristic of it are rashes in the form of horny cones on the superficial skin of the fingers.

Norwegian scabies can be confused with eczema, pyoderma, and also psoriasis. Psoriasis and Norwegian scabies have similar symptoms, which sometimes makes diagnosing the disease difficult.

To accurately diagnose the disease, a histological analysis of the biopsy specimen and a biochemical blood test are performed. There is a shift in the blood count towards an increase in leukocytes and eosinophils, and an accelerated erythrocyte sedimentation reaction (ERS) is also observed.

With Norwegian scabies, leukocytes in the blood and ROE are elevated. Several methods are used to diagnose the disease:

Needle extraction method.
Layer-by-layer scraping.
Thin sections.
Using lactic acid solution or alkaline preparation.

It is important to exclude the following diseases:

pyoderma;
eczema;
hyperkeratotic psoriasis.

1. Traditional removal of the mite with a needle from the blind end of the scabies tract, followed by microscopy of the pathogen. This method is ineffective when examining old, dilapidated papules.

3. Method of layer-by-layer scraping from the area of the blind end of the scabies tract until blood appears. Followed by microscopy of the material.

4. Method of alkaline skin preparation, with application of an alkaline solution to the skin, followed by aspiration of macerated skin and microscopy.

Diagnostic measures are differential in nature. The absence of itching sensations often leads to an incorrect diagnosis. At an early stage it is necessary to differentiate from allergic reactions, dermatitis and infections transmitted through airborne droplets.

The diagnosis of scabies is determined by the presence of the following criteria:

Abnormal thickening of the skin, detection large quantity scabies burrows, which are arranged in tiers.
Symptoms of acanthosis are severe pigmentation in the groin and armpits.
Change quantitative indicators blood. In particular, the level of leukocytes and eosinophils increases, and the erythrocyte sedimentation rate increases.

After removing the cortical formations, the patient should wash himself. During subsequent treatment, washing is prohibited. Each hand washing requires the subsequent application of specialized products. Nails are cut to the root.

The diagnosis is made after an in-person examination of the patient. The collection of clinical data as well as epidemiological information plays an important role. A laboratory test is required to confirm the diagnosis.

Treatment can be effective only when initial stage diseases. There are frequent cases where Norwegian scabies led to fatal outcome as a result of heart damage and severe intoxication.

It is very important to correctly diagnose the disease. Medicine knows of a case where a patient was misdiagnosed and prescribed treatment for psoriasis. This led to the generalization of the process and the death of the patient.

Ways of infection by ticks

Collective infection occurs mainly through contact sports, strong handshakes, and the fussing of children. Household infection is considered unlikely, which was proven back in 1940 in the UK. 272 attempts were made to infect volunteers who went to bed immediately after a sick person got up from it and whose symptoms of Norwegian scabies were quite pronounced. A total of 4 people were infected.

The disease usually develops against the background of severe somatic and mental pathologies. Most cases of infection occur among patients in psychoneurological boarding schools and residents of nursing homes. Among the special contingent of patients we can distinguish people with Down's disease, infantilism, asthenia, senile dementia and immunodeficiency.

The process of transmission of the disease from person to person occurs in the following ways:

infection during sexual contact when bodies come into contact. This is also due to the fact that the scabies mite becomes most active in the evening;
infection through household items. Interacting with a patient’s personal belongings can trigger the transmission of the disease from person to person. You can become infected through towels, bed linen, mattresses, however, there are only 4 known cases of infection in this way;
infection through direct contact. The most common method of transmission of the disease. Infection occurs when shaking hands, or while sleeping with a sick person.

Despite the highly contagious nature of the disease, Norwegian scabies is quite rare. No more than 160 cases of infection are known in the world since its discovery.

A healthy person can become infected with a tick in three main ways:

Through cutaneous route occurs when the skin of a healthy person comes into direct contact with the affected skin of a sick person.
Contact- household way occurs through household items previously used by an infected person.
Sexual transmission occurs in persons who lead a promiscuous intimate lifestyle.

The contact and household transmission mechanism contributes to the development of the epidemic process.

A household route of transmission is also possible. For example, if you live in the same house with a sick person, you can catch an infection by using the same utensils, bed linen, towels, clothes, toys and other items.

Drug treatment

Treatment with Spregal aerosol shows a good therapeutic effect. When treating the affected areas with Spregal aerosol, persistent positive dynamics are observed. There is a total rejection of the crusts, regression of numerous papular elements and relief of other symptoms. It is worth mentioning that treatment is carried out only by a specialized specialist after confirmation of the diagnosis. Under no circumstances should you self-medicate, as this can worsen the patient’s condition.

When a person notices this illness, he needs urgent and complex treatment. The best remedy for the treatment of the Norwegian form of the disease is a water-soap emulsion of benzyl benzoate.

The affected areas are treated daily for 3-5 days. The patient must first take a bath, which will help soften the crusts and other infectious inflammation. Ointments are rubbed in with your hands, as this is a kind of prevention.

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Treatment for Norwegian scabies consists of:

extermination of ticks (by treatment with special insecticides);
restoring the integrity of the skin (treatment with anti-inflammatory, regenerating and antibacterial compounds);
relieving allergy symptoms (with antinistamines and desensitizing drugs);

Personal prevention

You can protect yourself from such a disease by following the necessary preventive actions:

compliance with hygiene standards and rules;
if symptoms appear, consult a doctor;
maintaining a healthy lifestyle;
strengthening immunity;
avoiding stress and conflict situations.

The course of treatment includes drugs containing:

krotomyton;
benzyl benzoate;
permethrin;
malathion.

In some cases, these drugs are also prescribed orally, however, the greatest effect can be achieved through topical application.

Treatment of Norwegian scabies has its own characteristics:

the ointment is applied under short-cropped nails;
local preparations are applied to the entire body;
medicines are used repeatedly;
treatment lasts at least 4 days;
It is recommended to scrape off exfoliated skin elements with a soft brush;
clothes and bed linen are changed every day.

If treatment for Norwegian scabies is unavoidable, it is important that all family members of the infected person undergo this course at the same time. In this case, you must strictly follow all the doctor’s recommendations.

Today, there are many anti-scabies medications containing melathion, permethrin, crotamiton and benzyl benzoate.

Experience shows that with scabies there are no relapses; the reasons for the resumption of the disease are reinvasion from untreated contact persons in the outbreak or outside it, undertreatment of the patient due to non-compliance with treatment regimens, partial treatment of the skin, and a reduction in the duration of the course of therapy.

Treatment should be carried out exclusively under the guidance of a physician;

Treatment of all patients living together should be carried out simultaneously;

It is necessary to strictly adhere to the treatment regimen described in the instructions for the drug or as prescribed by the doctor;

The drug is applied to the entire body, except for the face and scalp, and in children under 3 years of age these areas must also be treated;

It is important to cut your nails short and apply the preparation thickly under them (when scratching, itchy eggs accumulate under the nails);

Rubbing in any drug is done with your hands, which is due to the high number of scabies on the hands. If the perineum and groin are densely covered with hair, it is better to rub the drug in with a brush;

Treatment must be carried out in the evening, which is associated with the nocturnal activity of the pathogen;

It is recommended to wash the patient before and after the course of treatment; if necessary, the patient can wash off the drug every morning, while its exposure on the skin should be at least 12 hours, including the entire night period;

Change of underwear and bed linen is carried out at the end of the course of therapy;

One teaspoon of turpentine is thoroughly mixed with two tablespoons butter and the resulting mixture is treated with the affected areas of the skin;

One tablespoon of celandine juice is mixed with 4 tablespoons of Vaseline and the resulting mixture is treated with the skin;

Birch tar is applied evenly to the affected areas of the skin. After three hours, wash off the tar with warm water;

For scabies, you need to grind freshly picked yellow tansy “buttons” and lubricate the skin affected by the scabies mite with this grated mass. Sometimes two or three such procedures are enough to get rid of the sore;

In the evening, pour 0.5 liters of water into an enamel bowl with 1 tbsp. l

Put on clean, ironed linen, iron the bed and go to bed. Repeat the procedure every night until recovery;

Mix 1 tsp. pharmaceutical turpentine with 1-2 tbsp. pork lard or boiled drying oil and regularly lubricate the rash with this ointment until it completely disappears;

Dilute soap in a bowl with warm water so that you get a large head of soap foam, moisten a sponge in this solution and rub the patient’s body with it so that a layer of soap remains on the surface of the skin.

Stir all components until a homogeneous mass is obtained. If after a few hours the body begins to itch very much, then you need to wash off the ointment from the patient’s body with warm water and put clean underwear on him;

If there are traces of scratching on the body, then you need to apply sulfur ointment made from 1 part by weight of sulfur in powder and 4 parts of lard. It is necessary to treat the body with this ointment 2 times a day after a bath;

Brew (really brew!) 6-8 kg of salt in an enamel pan and pour the broth into a bath of water at a temperature of 37-38°C. Lie in the solution for at least an hour and, after leaving the bath, do not wipe off, but dry. Carry out the procedure daily until cure;

A mixture of chicken manure and tar treats scabies. The ingredients should be thoroughly ground and the prepared ointment should be applied to the affected areas overnight. It is advisable not to wear underwear. In the morning, wash your body thoroughly;

For scabies, grate the chalk, sift it through a thick sieve and lubricate the rash areas well with this “flour”. The scabies will go away;

For skin diseases, especially scabies, you need to wash yourself with a strong decoction of elecampane root until the body is cleansed. Do not expect instant healing, but be patiently treated, and recovery will soon come;

Rub laundry soap grate and soften by adding water. Stir and place on low heat. Stir constantly. Once the mixture is smooth, remove it and add a medium grated onion and a head of garlic. Cool, roll into balls and wash with this soap daily;

It is often possible to treat scabies at home, but only after prior consultation with your doctor.

The drug benzyl benzoate is available in the form of ointment and emulsion. It is one of the most common medicines for scabies; Treatment in this case takes up to four days.
Permethrin is available in the form of gels, ointments, sprays and lotions. The cost of the drug is slightly higher than benzyl benzoate, however, in two days of therapy you can completely get rid of the disease.
Spregal is one of the most expensive drugs produced in France. This aerosol is very simple and easy to use: it leaves no marks on clothes and is practically odorless. Most often, dermatologists recommend double treatment with the drug with an interval of 3 days.

Basic principles of therapy

Treatment of Norwegian scabies is carried out using special ointments:

Benzyl benzoate is a drug used for skin lesions. Available in 20% form medicinal solution or ointments.

The pyrethrin group is medicinal product, containing in its chemical composition insecticides, they have an active anti-scab effect and have a less toxic effect.

Yakutin is applied to damaged areas immediately after a shower, and washed off after 6 hours. The drug is used extremely rarely because it can affect the human nervous system with the development of its damage. It is strictly forbidden to use the drug during pregnancy and childhood.

Polysulfide liniment – anti-scabies medicine, which comes in the form of a 10% ointment or solution. 3-4 days after the initial application, skin hygiene can be carried out.

Treatment of scabies requires a huge amount of time and regular application of drugs. If the necessary rules are not followed, treatment will be ineffective.

Preparations for Norwegian scabies: brief characteristics and instructions

Important: all persons in contact with the patient undergo preventive treatment.

IN medical practice medications are used:

Sulfur ointment: simple instructions for use

The drug is used to treat scabies, acne, psoriasis, demodicosis, lice, dandruff. Before applying the ointment to the skin, you need to take a shower. The remaining ointment should not be washed off during the day. The procedure is repeated three days in a row. Sulfuric ointment- cheap and effective remedy treatment. But today the drug is rarely used. The fact is that the product has a sharp, unpleasant odor, and on clothes and bed linen stains remain.

The drug "Benzyl benzoate": instructions for use, price

As mentioned, this drug is most often used to treat Norwegian scabies. What is benzyl benzoate? Instructions for use, price, properties - these are the questions that interest every patient.

The ointment (or emulsion) cannot be used if there are ulcers on the skin. The price of the drug is not too high - a 50 g jar of cream will cost about 60 - 100 rubles.

Are there risk factors?

Norwegian crusted scabies develops against the background of weakening immune system, as this allows ticks to actively reproduce. Scientists identify several risk factors:

presence of HIV infection in the body;
systemic autoimmune diseases, including lupus erythematosus;
oncological diseases;
general candidiasis;
tuberculosis, leprosy and some other diseases;
exhaustion of the body that occurs against the background nervous overstrain, severe stress, alcoholism;
neurological and mental disorders, including infantilism, dementia, dementia;
long-term therapy with cytostatics and hormonal steroid drugs;
paralysis, impaired sensitivity of peripheral nerves.

Basic preventive measures

The prognosis may be unfavorable. Errors in diagnosing the disease, untimely treatment and worsening symptoms can lead to a terminal condition - death. Prevention of the disease lies in compliance with sanitary and hygienic standards:

careful adherence to personal hygiene;
daily change of underwear;
regular change of bed linen;
early diagnosis of patients with scabies;
Regular visits to the doctor and identification of contact persons.

After completing the main course of therapy and eliminating symptoms, preventive measures begin to avoid re-infection.

Norwegian scabies is a serious and dangerous disease, the treatment of which should not be carried out without medical supervision.

Persons from the same outbreak are treated together to prevent re-infection. All persons in contact with the affected persons carry out a one-time preventive treatment of the skin with anti-tick drugs.

After treating the patient, many guidelines recommend treating all things and linen with which the patient has been in contact (special sprays, washing in hot water).

Important! Contrary to popular belief, scabies is not associated with low level hygiene. The scabies mite is not susceptible to water or soap. At daily intake shower/bath, the number of ticks and the likelihood of infection are not reduced.

As a rule, in case of scabies, prevention should be carried out several times a day.

You should wipe all surfaces with a damp cloth, and then treat the furniture with a 1% soda solution.

It is worth remembering that often medical examination adults and children, as well as constant personal hygiene can significantly reduce the risk of developing this type of disease.

Etiological factors

decreased functioning of the nervous system;
chronic bacterial diseases;
excessive use of alcoholic substances;
organic pathologies of the central nervous system;
oncological diseases of the circulatory system;
long-term therapy with hormonal and cytostatic drugs.

Symptomatic manifestations

The period of reproduction of the pathogen without pronounced symptomatic manifestations lasts up to 6 weeks, after which the immune system begins to react in response to damage.

With Norwegian scabies, the symptoms have their own individual characteristics:

Scabies from the advancement of the mite can be localized in various areas of the skin.
Their most intense accumulation is located at the site of initial penetration of the insect.
Over time, the skin becomes rough and thickened with covering grooves.
A typical symptom is a dirty yellow color of the crusts covering the elements of the skin rash.
When removing the crusts, erosions and ulcers are formed that have an extensive appearance.
A thickening of the nail plate is formed, and the disease should be differentiated from fungal infection of the nails.

Diagnostic measures

In order to make a final diagnosis, basic laboratory tests should be carried out:

clinical blood test;
histological examination.

In the results of the general laboratory research peripheral blood reveals signs of an inflammatory reaction in the body.

A histological biopsy reveals the presence of scabies and mite larvae.

A biochemical blood test is carried out to determine the severity of intoxication symptoms.

Differential diagnosis is carried out with eczema, psoriasis and hyperkeratosis. All mentioned diagnostic signs indicate that Norwegian scabies is developing in the body.

Therapeutic measures

Treatment of Norwegian scabies should only be carried out under conditions infectious diseases hospital with complete isolation from other patients.

Treatment should be carried out using two main methods:

using mechanical removal of cortical formations;
drug therapy.

After the patient has had the crusts removed, he should take a shower. On clean skin etiotropic drugs are applied that cannot be washed off with running water. In case of development purulent complications drug stimulation of the immune system is carried out.

Etiotropic treatment aimed at getting rid of ticks is carried out mainly at night or in the evening, since ticks are most active during this period.

Drug treatment

The most effective and widely applicable drugs include:

Benzyl benzoate;
Pyrethrins;
Yakutin;
Polysulfide liniment.

Benzyl benzoate is a drug used for skin lesions. Available in the form of a 20% medicinal solution or.

The group of pyrethrins is a medicinal product containing insecticides in its chemical composition; they have an active anti-scab effect and have a less toxic effect.

Yakutin should not be taken during pregnancy

Polysulfide liniment is an anti-scabies drug that is available in the form of a 10% ointment or solution. 3-4 days after the initial application, skin hygiene can be carried out.

Requires a huge amount of time and regular application of drugs. If the necessary rules are not followed, treatment will be ineffective.

Basic preventive measures

It has been proven that tick infection does not depend on social level and adherence to basic hygiene rules. The insect is not susceptible to soapy substances; regular hygiene procedures are not able to protect humans from tick-borne infections.

Prognosis for recovery

Norwegian scabies was first discovered in 1847 in Norway, where it got its name. This is very rare disease Since then, only 150 cases of the disease have been described.

Norwegian scabies is a type of ordinary scabies, but accompanied by complicated symptoms. The disease is caused by the same mite as other types of scabies, but a distinctive feature of Norwegian scabies is that it appears only in people with immunodeficiency.

Causes of Norwegian scabies

Some experts believe that Norwegian scabies is caused by a different type of scabies mite than the one that causes regular scabies. But these data have not been confirmed and there is still agreement that it is caused by a common scabies mite.

These factors influence the development of common scabies. But if a person suffers from serious diseases associated with immunodeficiency or other factors in which it develops into a severe stage - into Norwegian scabies. Factors include:

Tuberculosis
Alcoholism and smoking
Addiction
Leprosy
Down syndrome, dementia, other diseases of the nervous system
Long-term use of hormonal drugs

These points affect the deterioration of immunity, which leads to the disease of ordinary scabies and its complex form.

Symptoms of Norwegian scabies

The symptoms of Norwegian scabies are always pronounced, which makes it easier for the attending physician to diagnose.

There have been cases where, without proper and timely treatment, Norwegian scabies resulted in death due to damage to the cardiovascular system or intoxication. Therefore, it is important to diagnose on time. If you experience symptoms characteristic of normal, typical scabies, immediately consult a doctor to diagnose and treat Norwegian scabies.

The symptoms of Norwegian scabies at the initial stage are similar to the symptoms of other skin diseases: psoriasis, eczema, pyoderma. The attending physician must conduct not only an examination, but also collect tests from the patient. These include a blood test and a biopsy of any crusts that have formed (taking a sample and examining it under a microscope).

A doctor diagnoses Norwegian scabies in the following cases:

After diagnosis, treatment of Norwegian scabies should be carried out under the strict supervision of an experienced specialist, since the disease is rare and therapy must be carried out very carefully.

Use home medicine and folk recipes It is highly discouraged as it may complicate symptoms if the consequences of such treatment are not known. Only medications can cope with such a serious disease. Without proper treatment under medical supervision and use special means Possible death.

Ointments and aerosols should be applied to clean skin. For the full effect, they are left overnight, since the action time should be at least 12 hours. Immediately after therapy, all rooms are disinfected, bed linen, underwear, and clothes are washed at 60 degrees.

If after use you notice the appearance or intensification of itching, this means that the medicine copes with mites perfectly, and an allergy to their waste products appears. Therefore, the doctor additionally prescribes antihistamines that will cope with allergies.

Remember that using products that do not kill the mite, but only reduce the symptoms of scabies, will not cure the disease, but will only shorten the time until a severe form of the disease develops, which often ends badly.

The doctor also prescribes medications that strengthen the immune system, vitamins, and recommends the use of creams and oils that soften the skin.

Treatment of Norwegian scabies with medications

As mentioned above, in medicine they use different kinds preparations for the destruction of mites for Norwegian scabies.

Anti-tick agents in the form of ointments must contain sulfur, salicylic acid or other substances that can cope with skin diseases. The most commonly used remedy is sulfur ointment, but with frequent use it can lead to contact dermatitis, so it is advised to give preference to other means.

In addition to well-known ointments, there are products aimed specifically at combating scabies mites. You should check with your doctor, as medications may have their own special side effects, the patient has a personal intolerance to their components.

Instead of ointments, emulsions are often used, which have a less pronounced odor. They also do not leave marks on clothes, but are absorbed into the skin. Before using them, the linen is thoroughly cleaned, changed and washed.

Treatment of scabies with folk remedies

Application of recipes home medicine often turns out to be not only useless, but also dangerous. Without timely contact with a specialist and the use of medications, it can become severe. stage of the disease.

For Norwegian scabies, folk remedies are ineffective, but after a course of therapy, you can take baths with herbal decoctions that are safe for the body and help cope with the consequences of the disease.

Among the many diseases that can occur in weakened human body, Norwegian scabies occupies a special place. Developing long time without external manifestations, it eventually flares up with violent symptoms, each of which is extremely unpleasant both for the suffering person and for those around him. The patient finds himself cut off from society and exposed to painful treatment- and this despite the fact that it was quite easy to prevent such an outcome.

Description of the disease

Norwegian scabies - rare skin disease, caused by scabies (Sarcoptes scabiei). Despite the fact that this pathogen is widespread in human populations, the form under discussion is one of the most severe types of acariasis (tick-borne disease). The “Norwegian” disease got its name because of the place where it was discovered. Other names - cortical, crustose, keratotic - appeared due to a characteristic symptom: the affected areas, in rare cases covering almost the entire body, are covered with a thick, up to 2-3 centimeters, layer of dead skin.

Cases of crustose scabies were first described in 1847 by dermatologists Daniel Danielsen and Carl Beck, who studied the spread of leprosy in Norwegian leper colonies. One of the patients showed symptoms of a hitherto unknown skin disease, which turned out to be a severe form of scabs.

The disease is quite rare, since from the time of its discovery until the early 90s of the twentieth century, no more than 150 cases were clinically described. People with weakened immune systems are most likely to be vulnerable to Norwegian scabies. The combination of the extreme rarity of the disease with its extremely severe symptoms for a long time made the question of origin and causative agent very problematic.

Classification problems

Throughout the 19th century, it was believed that the causative agent of crustose scabies was some aggressive form of mite - if not a new unknown species, then certainly a special subspecies of scabies. This was indicated by the sluggish, long course of the pathology, and by special symptoms, and by the circle of vulnerable people. If ordinary scabs spread among the population without making class distinctions, then the disease discovered by Norwegian dermatologists affected only certain categories: patients in leper colonies, psychiatric hospitals, and prisoners in prisons. Subsequently it was shown that healthy people are easily infected from sick people, but they do not suffer from Norwegian scabies, but from other, milder forms: typical, childhood or so-called “clean scabies” (in the event that the infected person has previously weakened the integrity and protective properties washing the skin too thoroughly).

Notable is the case of a patient with Down syndrome who suffered from a strange disorder for two decades. skin pathology, presumably chronic eczema or pyoderma. Until the histological examination was carried out, 8 clinic nurses and 11 patients were infected from it. All patients showed characteristic symptoms ordinary scabies in a mild form.

Nowadays, the generally accepted point of view is that scabies provokes the development of pathology in both the typical and crustose variants. The possibility of moving from one to another depends rather on the characteristics human body than from abnormal behavior of the pathogen.

Causes and development factors

The most important role in the development of the disease is played by female scabies, since males, engaged exclusively in fertilization, die on the surface of the skin, without penetrating deeper. Fertilized females make deep branched passages in the host's integument, reaching the Malpighian layer, where they lay eggs. The larvae appear after 3–5 days, and after another 3–7 days they become sexually mature.

The routes of transmission of pathogens are quite simple, their diversity is limited to three options.

Comparative table of transmission routes for crustose scabies

Vulnerable to Norwegian scabies are people with weakened or suppressed immune systems, as well as those unable to perform basic self-care. Conditions that are threatening in this regard include:

long-term exposure to corticosteroids, glucocorticoids, cytostatics;
exhaustion;
alcoholism;
taking drugs;
impaired sensitivity and blood supply to the extremities;
paralysis;
lupus;
heavy fungal infections ();
senile dementia (senile dementia);
Down syndrome;
syringomyelia (structural damage to the spinal cord);
Bloom's syndrome;
leukemia;
lymphoma;
tuberculosis;
leprosy;
AIDS.

In people with a functional immune system, the disease occurs in the form of typical scabies.

Symptoms of the disease

Illusory absence of irritation if the patient is unable to comb the affected area independently (with degradation of muscle tissue, paralysis);
Virtual absence of pain upon injury nerve fibers and endings (syringomyelia);
Immune system weakened serious illness, does not perceive itching toxins as an allergen.

After the incubation period, characteristic scabies burrows appear in the skin, and over time their number and density continue to grow. At first they are localized between the fingers, on the bends of the elbows and knees, in the area of the mammary glands, and occasionally on the stomach, buttocks, ears, near the genitals. Itching sensations may occur at this stage, but only in 50% of cases. The affected areas begin to expand, and a rash appears on them in many forms - nodules, blisters, blisters, ulcers. The condition of the skin deteriorates sharply, the integument becomes coarser, turning into a thick (up to 3 cm) shell of several layers of brown or grayish scales. These dead elements are tightly welded together; separating them without preliminary treatment is very painful. The feet can become covered with such a thick layer of crusts that it becomes impossible for the patient to move independently.

The body temperature rises, the lymph nodes become inflamed, the skin becomes dry and red. Nails and hair become dull, flake, and in particularly advanced cases, their complete degradation is possible. The patient begins to emit a sour odor, the intensity of which increases as the disease progresses. Other symptoms also intensify as the scabies itch multiplies.

Symptoms of various forms of Norwegian scabies in the photo

Severe skin lesions in bedridden patient
Classic picture of scabies symptoms Children can become infected with scabies through contact with sick people.
Nail plates with Norwegian scabies can be completely destroyed

Diagnostic features

Making the correct diagnosis is decisive in the treatment of Norwegian scabies. Given the complex symptoms that are not always identified on early stages, the disease is often mistaken for less dangerous pathologies:

eczema;
pyoderma is a purulent skin lesion.

For accurate diagnosis It is necessary to perform a biopsy of the affected tissues followed by microscopic examination. On the resulting preparations, the characteristic passages of scabies are clearly visible in huge numbers, filled with mites on various stages life cycle.

A blood test showing an increased number of eosinophils and an increased erythrocyte sedimentation rate is also informative.

Treatment of Norwegian scabies

Considering the severity of the symptoms accompanying the disease, in order to cure it, you should follow several rules:

Processing must be systematic. The drugs are applied not only to the lesions, but also to the entire surface of the body: hair, skin, under the nails;
The effect should be carried out on clean, scale-free areas of the skin. Keratinized scabs are pre-soaked in warm baths with a weak solution potassium permanganate, after which they are scraped off;
The effect of the drugs must be long-lasting, more than 12 hours, and regular - daily throughout the course of treatment.
Secondary infection should not be allowed. The patient's clothes and underwear should be changed daily, followed by their subsequent treatment.

Drug therapy

The use of Wilkinson's ointment, containing 30% sulfur and 30% tar, demonstrates high effectiveness in the treatment of crustose scabies. The active components quickly suppress the activity of itching, but given the frequent side effects of the drug in the form of dermatitis and allergies, it is recommended to periodically alternate it with other medications.

An effective remedy is Demyanovich's liquid, consisting of 60% sodium thiosulfate and 6% hydrochloric acid successively rubbed into the skin. The products of the interaction of these substances - sulfur compounds - cause the death of mites in the affected areas.

A more patient-friendly method of treatment is the use of a 25% water-soap emulsion of benzyl benzoate. When treating children, the drug is used in low concentration - 10%. The emulsion is easily absorbed into the skin, there is a risk of side effects lower than when using Wilkinson ointment.

The drug Lindane is considered one of the most effective anti-scabies. The use of its 1% ointment (0.3% for children) leads to remission of the disease in as soon as possible. It should be remembered, however, that the active substance of Lindane - hexachlorane - is a strong poison, as a result of which it must be taken in a strict dosage, and only as prescribed by a doctor. The use of Lindane for the treatment of pregnant women is prohibited.

Treatment of Norwegian scabies involves taking immunomodulators, tonics, vitamin complexes. These measures help improve the general condition and well-being of the patient, partially restore the body's resistance, and increase tissue regeneration.

Video about scabies

Folk remedies

Folk remedies that are effective against typical scabies are not effective in treating the crustose form. Soft impact herbal ingredients unable to overcome severe symptoms of the disease. The rate of reproduction of itches far exceeds their losses, which is negated positive results treatment. On the contrary, in combination with drug therapy, folk remedies show a clear supportive effect that can become a significant aid in the rehabilitation of the patient.

Traditional compositions of sulfur and tar ointments based on melted fat are known, vegetable oils, resins. These include the “Greek” balm. In composition and effect produced, these compositions are close to Wilkinson’s ointment. The content of active components in them ranges from 10 to 40%.

To quickly exfoliate scabs and heal the skin, use warm baths with herbal infusions. Elecampane root, calendula, chamomile, and sage flowers can be used as a plant base. To prepare the bath, 250 grams of dry herb should be brewed, strained, and diluted to the required volume. The resulting infusion is suitable for compresses and bathing.

Painful symptoms are relieved by baths from oatmeal. A few tablespoons of pure, unadulterated oatmeal should be poured into a linen rag, tied tightly, and placed in about 10 liters of freshly boiled water. As soon as the temperature of the liquid drops to a tolerable level, the extraction can be considered complete. The oatmeal bag can also be placed directly into the hot bath.

Forecast and consequences

A sluggish disease can develop over decades. The patient not only suffers himself, but also serves as a constant source of infection for others. With a timely diagnosis and correctly prescribed treatment, the prognosis is completely favorable, remission is achieved in the shortest possible time. The only reminder of the suffering endured are darkening and scars on the surface of the body.

A completely different result is observed if the therapy was not carried out on time. Large-scale skin damage serves as an excellent breeding ground for pathogens, and a weakened immune system is unable to resist infection. Concomitant infections can lead to the following diseases:

infectious;
streptococcal pyoderma;
microbial eczema;
sepsis.

A streptococcal infection that develops in the skin can affect the filtration system of the kidneys, causing infectious glomerulonephritis. When streptococci enter connective tissue, they initiate acute rheumatic fever, which can cause myocardial pathology.

Prevention

A set of preventive instructions to prevent infection with various forms of scabies includes:

compliance with personal hygiene rules;
regular replacement, cleaning and temperature treatment of linen;
constant monitoring of your health.

If cases of the disease are discovered in the social environment, these measures should be tightened by limiting social and household contacts, preventive examinations, timely isolation of infected people.

Norwegian scabies is a dangerous and serious disease with a chronic course. It is worth saying that this disease is rare. About 150 cases of the disease have been recorded in medical practice. The disease is accompanied by deep skin lesions and, in the absence of proper therapy can lead to dangerous complications, including the death of the patient.

Characteristics of the pathogen

It was believed that the pathogen of this disease is Sarcoptes scabiei var hominis, which is transmitted through contact with a sick person. But with further research, scientists were able to find out that the disease also develops against the background of infestation by the usual scabies mite. By the way, Norwegian scabies was first officially registered in Norway at the end of the 19th century, which, in fact, explains the name.

Are there risk factors?

Norwegian crusted scabies develops against a background of a weakened immune system, as this allows mites to actively reproduce. Scientists identify several risk factors:

presence of HIV infection in the body;
systemic autoimmune diseases, including lupus erythematosus;
oncological diseases;
general candidiasis;
tuberculosis, leprosy and some other diseases;
exhaustion of the body that occurs against the background of nervous overstrain, severe stress, alcoholism;
neurological and mental disorders, including infantilism, dementia, dementia;
long-term therapy with cytostatics and hormonal steroid drugs;
paralysis, impaired sensitivity of peripheral nerves.

Routes of transmission

A household route of transmission is also possible. For example, when living in the same house with a sick person, the infection can be picked up by using the same dishes, bed linen, towels, clothes, toys and other items.

Clinical picture: what symptoms accompany the disease?

The incubation period lasts about 2 - 6 weeks. Further, the disease can develop over years and even decades. The patient rarely experiences a fever, but the skin becomes very dry and hot to the touch - these are the first symptoms of scabies in adults.

Norwegian scabies causes scabs to appear all over the body, including the face. The patient's nails thicken, become loose and change color - the process resembles a fungal infection of the nail plate. A person's hair becomes dull, thin and brittle. The patient emits a characteristic sour odor, which is an important diagnostic criterion.

Diagnosis of the disease

Of course, taking an anamnesis and examining the skin tissue should prompt the specialist to think about scabies. The epithelium is covered with crusts, and the skin on the folds of the neck, groin and armpits acquires more pronounced pigmentation. Next, the patient donates blood for analysis - in the samples, the specialist can detect an increase in the number of eosinophils and leukocytes. There is a more accurate method to diagnose the disease. Tissue samples from the thickened stratum corneum of the skin are taken for analysis. Norwegian scabies is characterized by the presence of scabies in the biopsy specimen. Eggs and larvae of mites, as well as adults, may also be seen in skin samples.

Basic principles of therapy

As mentioned, this drug is most often used to treat Norwegian scabies. What is benzyl benzoate? Instructions for use, price, properties - these are the questions that interest every patient.

The ointment (or emulsion) cannot be used if there are ulcers on the skin. The price of the drug is not too high - a 50 g jar of cream will cost about 60 - 100 rubles.

Sulfur ointment: simple instructions for use

The drug is used to treat scabies, acne, psoriasis, demodicosis, lice, dandruff. Before applying the ointment to the skin, you need to take a shower. The remaining ointment should not be washed off during the day. The procedure is repeated three days in a row. Sulfur ointment is a cheap and effective treatment. But today the drug is rarely used. The fact is that the product has a sharp, unpleasant odor, and stains remain on clothes and bedding.

Preventive actions

Norwegian scabies is an extremely dangerous and contagious disease. Therefore, you should adhere to some safety rules:

This is a serious disease and should not be ignored or attempted to be treated on your own. Traditional methods and home remedies can only be used with the permission of the attending physician and only along with drug therapy.