Decreases in scabies and lice cases among the pediatric and adult populations during COVID ‐19
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The influence of the nationwide lockdown orders during the COVID-19 pandemic on the transmission of scabies and lice remains unknown. We conducted a cross-sectional study utilizing UNC patient registry i2b2 to investigate monthly cases and prescriptions for scabies and lice in adult and pediatric patients in North Carolina. There were significant decreases in the cases and prescriptions for scabies and lice in the pediatric and adult populations. These results provide early insights on how COVID-19 pandemic lockdown orders affected the prevalence of these two conditions and suggest that physical distancing measures reduce transmission of these parasitic conditions.Keywords:
Pandemic
2019-20 coronavirus outbreak
A 4-year-old boy is brought to a health center with sores on his arms and legs. He and several siblings receive a diagnosis of scabies. Crusted scabies is diagnosed in an elderly aunt in the same household. The family members are treated with topical permethrin, which disrupts the function of voltage-gated sodium channels in arthropods. The aunt is treated with oral ivermectin, which disrupts the function of chloride ion channels.
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Scabies is one of the commonest diseases among all age groups. Topical permethrin is a widely used treatment option for scabies. Ivermectin is a newer oral agent for the treatment of scabies. This study was done to compare the efficacy of permithrin and oral Ivermectin in the treatment of Scabies in patient suffering from Diabetes mellitus. This comparative clinical trial was carried out in the outpatient department of Dermatology & Venereology, Diabetic Association Medical College Hospital (DAMCH), Faridpur from January 2012 to December 2012. A total 60 cases were enrolled purposively and divided into 2 groups. Group I received 2 doses oral Ivermectin and group II treated with 5% permethirn cream. Patients were followed up at the 3rd and 4th week. Total 86.6% patients of Ivermectin group and 90% of permethrin group were cured. Though permethrin showed somewhat more effective, the difference was not statistically significant. The study found that both ivermectin and permethrin were similarly effective in the treatment of scabies in patients suffering from Diabetes Mellitus.Faridpur Med. Coll. J. 2014;9(2): 70-72
Venereology
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Thirty-eight patients with scabies (21 males and 17 females) received oral ivermectin in two doses of 200 microg/kg at 7 days interval. Excellent results were achieved in 29 cases (76.34%), improvement in 6 (15.78%) and poor responses in 3 (7.88%). Tolerance was satisfactory-excellent in 32 patients (84.2%). The effectiveness and safety of the drug described in previous studies are confirmed by the present results.
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The efficacy of a pour-on formulation of ivermectin at 500 micrograms/kg body weight applied on the dorsum on days 1 and 15 was evaluated in 90 dogs from a shelter, naturally infested with Sarcoptes scabiei. This very practical form of treatment was successful in eradicating scabies from this shelter.
Sarcoptes scabiei
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The standard treatment for scabies has long been based on topical scabicides. Ivermectin, a broad-spectrum anti-parasitic agent, was first used in veterinary medicine. This drug, active against nematodes and arthropods, is used in humans for the treatment of filariasis. For the past few years worldwide reports on the use of ivermectin in human scabies have suggested that this drug could be an alternative oral therapy.
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Currently available topical medications for scabies are messy and need prolonged application. This leads to poor patient adherence. Emerging drug resistance to topical scabicides has made eradication of scabies difficult.Availability of an effective oral scabicidal agent, ivermectin (Ivm), opens a new era in the management of scabies. This review summarizes the published literature on the use of ivermectin in the treatment of scabies.A single oral dose of ivermectin of 200 mg/kg body weight is very effective in the treatment of human scabies. A second dose 7-10 days later substantially improves the cure rate. This suggests that ivermectin may not be effective against all the stages in the life cycle of the parasite. Endemic and epidemic scabies in institutions are better treated with Ivm. Crusted scabies ideally should be treated with a combination of Ivm and topical scabicides. Other standard measures and precautions should be taken. Additional controlled studies using a higher single oral dose or using parenteral or topical forms of Ivm are needed. The safety of Ivm in children less than 5 years old and in pregnant women has to be established. The U.S. FDA has not yet approved the drug for the treatment of human scabies.
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Ivermectin, an anti-parasitic agent widely used for onchocerciasis in humans, is emerging as an oral antiscabietic that is as safe and effective as the topical antiscabietics. In the recent reports, all groups of population responded to ivermectin in the treatment of scabies, including immunocompetent, immunocompromised, and other high-risk populations such as individuals with Down's syndrome. This report reviews the efficacy, the mechanism of action, and the safety profile of ivermectin in the treatment of scabies, particularly its utility in crusted scabies and outbreaks of scabies in institutional settings.
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Since the mid-1980s, worldwide reports confirm that scabies in individuals infected with the human immunodeficiency virus (HIV) result in a wide range of-clinical manifestations which differ from those seen in immunocompetent patients. There is also general agreement that HIV-related scabies is more difficult to treat. Oral ivermectin has been shown in several countries to be a safe and effective therapy. In otherwise healthy persons, one dose of 200 microg/kg is usually curative. In HIV-related scabies, one treatment may be curative but repeated doses may be required. Crusted scabies in these individual requires a combination of oral ivermectin, total body treatments with 5% permethrin cream, and keratolytic agents to hasten removal of crusts.
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