Skin diseases

Scabies (“Scabies”).

Symptoms:
This contagious skin disease is characterized by severe itching (especially at night under warm bed covers) and multilayered clinical manifestations (red, itchy “spots and whimpers,” some scaly-crusty) in typical locations (e.g., interfinger spaces, wrists, groin region, elbows, area around nipples, genital area, palms and soles of feet in young children).

Occurrence and transmission:
Scabies occurs worldwide and affects individuals of all ages. It is estimated that approximately 300 million people worldwide are infected with the scabies mite, but there are no frequency figures for individual countries. These vary according to climate, population density, living conditions and hygienic conditions. In German-speaking countries, a sharp increase in scabies cases has been registered in recent years.^1,2,3

Scabies is more likely to occur in populations living together in close quarters, where direct skin-to-skin contact for a minimum of several minutes is common (e.g., members of a family or shared apartment, sexual partners, nursery schools, care facilities for the disabled and elderly, hospitals, prisons, homeless asylums, etc.).⁴ Indirect transmission may occur via shared bedding or clothing.⁵ Typically, infection does not occur with brief contacts, such as handshakes or via inanimate objects.¹

Pathogen:
Scabies is a parasitic skin disease and is caused by the scabies mite Sarcoptes scabiei. Female scabies mites grow to 0.3-0.5 mm in size (just visible as a dot to the human eye), while male mites grow to 0.21-0.29 mm. Female scabies mites can penetrate the skin after fertilization. In the stratum corneum, the uppermost layer of the epidermis, female scabies mites dig tunnel-shaped tunnels in which they lay eggs and excrete fecal pads, moving forward about 0.5-5 mm per day.⁴ Larvae hatch from the eggs after 2-3 days and swarm out to the skin surface, where they develop into so-called nymphs that mature into sexually active mites after about 2-3 weeks.¹ This leads to the unpleasant symptoms of scabies already described.

Treatment:
Medicinal scabies therapy can be performed externally by means of topical drugs in the form of creams, or, in certain cases, systemically with tablets.  Combination therapy of topical and systemic medicines is also possible. Your doctor will select the therapy individually for you based on your symptoms according to the current therapy recommendations for your age group and will check the success of the therapy.^5,6

In addition, follow general hygiene measures for cleaning your body, clothing, bedding, towels, and other items with prolonged physical contact (e.g., stuffed animals, blood pressure cuff, etc.), and keep fingernails short and clean.^5,7

Tropical diseases

Strongyloidiasis (Anguillulosis)

Strongyloidiasis is an infection with Strongyloides stercoralis (threadworm infection). This disease is endemic in the tropics and subtropics, including rural areas of the United States, in locations where unprotected skin comes into contact with contaminated soil (e.g., by walking barefoot) or unsanitary conditions exist.

Acute symptoms of strongyloidiasis can affect the skin (itchy, erythematous rash), lungs (cough), and gastrointestinal tract (abdominal pain, diarrhea, anorexia), depending on where the larvae or adult worms are located in the body of the infected person. Due to autoinfection, a chronic course lasting for years is also possible. Both acute and chronic courses may be asymptomatic. However, a hyperinfection syndrome with severe to fatal symptoms may occur.

Therapy is with so-called anthelmintics (agents against worm infections).⁸

Filariasis

Lymphatic filariasis is a mosquito-borne tropical disease, is endemic to Southeast Asia, Pacific, tropical Africa, Caribbean and is 90% caused by Wuchereria bancrofti. The pathogens pass through their life cycles partly in mosquitoes and partly in the human host, where they localize in the lymphatic system. This leads to acute symptoms such as swelling of the lymph nodes and fever. Chronic progression may result in blockage of the lymphatic system and subsequent elephantiasis due to lymphedema.⁹

Preventive mosquito protection measures should be used. In endemic areas, chemoprophylaxis is given with antifilarial substances, which include ivermectin.¹⁰

¹ Das Land Steiermark. Jahresbericht zum Steirischen Seuchenplan 2018, 16. Ausgabe. Im Auftrag der Steiermärkischen Landesregierung Abteilung 8: Gesundheit, Pflege und Wissenschaft. Hrsg. Hofrat Dr. Odo Feenstra. Graz, March 2019. Franz F Reinthaler unter Mitarbeit von Gebhard Feierl und Marianne Wassermann-Neuhold.
² Kämmerer E. Medizinreport: Skabies. Erfahrungen aus der Praxis. Deutsches Ärzteblatt Jg 115, Heft 15, 13.04.2018.
³ Österreichische Gesellschaft für Sexually Transmitted Diseaseses und dermatologische Mikrobiologie. Skabies-Informationsblätter für Patienten. ©ÖGSTD http://www.oegstd.at/web/index.php/skabies-informationsblaetter (accessed: 10.01.2022)
⁴ Robert Koch Institut. RKI-Ratgeber Skabies (Krätze). https://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_Skabies.html (accessed: 10.01.2022)
⁵ Österreichische Gesellschaft für Sexually Transmitted Diseaseses und dermatologische Mikrobiologie. Skabies-Informationsblätter für Patienten. ©ÖGSTD http://www.oegstd.at/web/index.php/skabies-informationsblaetter (accessed: 10.01.2022)
⁶ Oberösterreich. Skabies – Ärzteinformationsblatt Beilage 4 – Status: March 2021
⁷ Package leaflet Ivergelan^®–Tablets.
⁸ Pearson RD. MSD Manual. Ausgabe für medizinische Fachkreise. Strongyloidiasis (Fadenwurminfektion). March 2019. https://www.msdmanuals.com/de/profi/infektionskrankheiten/nematoden-rundw%FCrmer/strongyloidiasis (accessed: 10.01.2022)
⁹ Centers for Disease Control and Prevention. Lymphatic Filariasis https://www.cdc.gov/dpdx/lymphaticfilariasis/index.html (accessed: 10.01.2022)
¹⁰ SmPC Ivergelan^®-Tablets