Indian J Sex Transm Dis Indian J Sex Transm Dis
Official Publication of the Indian Association for the Study of Sexually Transmitted Diseases
Indian J Sex Transm Dis
The Journal | Search | Ahead Of Print | Current Issue | Archives | Instructions | Subscribe | Login    Users online: 346   Home Email this page Print this page Bookmark this page Decrease font size Default font size Increase font size


 
  Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 41  |  Issue : 1  |  Page : 10-16
 

Genital scabies: Haven of an unwelcome guest


1 Department of Dermatology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
2 Department of Dermatology, Venereology and Leprosy, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India

Date of Submission20-Jan-2018
Date of Acceptance30-Dec-2019
Date of Web Publication18-Jun-2020

Correspondence Address:
Dr. Hima Gopinath
All India Institute of Medical Sciences, Mangalagiri, Guntur - 522 503, Andhra Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijstd.IJSTD_69_17

Rights and Permissions

 

   Abstract 

The itch mite Sarcoptes scabiei var. hominis has been a menace to humanity for ages. Diagnosing scabies can be a challenge in view of the varied presentations of the disease. The male genitalia are an important area of predilection of the mite. Examination of this often overlooked area is essential as it may reveal both characteristic and atypical manifestations of scabies. Genital involvement also attains special relevance in view of the possible sexual transmission of the mite. In addition to the morbidity caused by itching, patients may have to deal with myths, stigma, and embarrassment.


Keywords: Genital infection, scabies, sexually transmitted diseases


How to cite this article:
Gopinath H, Karthikeyan K. Genital scabies: Haven of an unwelcome guest. Indian J Sex Transm Dis 2020;41:10-6

How to cite this URL:
Gopinath H, Karthikeyan K. Genital scabies: Haven of an unwelcome guest. Indian J Sex Transm Dis [serial online] 2020 [cited 2020 Sep 18];41:10-6. Available from: http://www.ijstd.org/text.asp?2020/41/1/10/287013



   Introduction Top


Scabies caused by Sarcoptes scabiei var. hominis is a common health problem with a worldwide prevalence of around 300 million/year.[1] The link between the mite and the disease was described in 1687 by Giovani Cosimo Bonomo.[2] Scabies affects humanity irrespective of sex, age, socioeconomic class, or ethnicity and can cause debilitating and depressing itch. It can present with typical or atypical presentations and mimic a wide range of diseases. The male genitalia are a classical site of infestation.[3],[4] Scabies can be sexually transmitted and lesions limited to the genitalia or genital itch may be among the presenting features of the disease causing diagnostic dilemmas.[2],[5],[6]


   Etiology Top


The causative agent of scabies is the burrowing obligate ectoparasite, S. scabiei var. hominis.[7] The life cycle involves eggs, larvae, protonymphs, and tritonymphs prior to emergence of the adult mite.[8],[9]


   Genital Involvement in Scabies Top


Genital lesions are commonly reported (16.8%–60%) in clinical studies on human scabies.[10],[11],[12],[13] However, the genitalia are usually spared in animal scabies.[14] In a case series of 886 men with scabies, Mellenby isolated 8.4% of the total mites from the penis and scrotum and 4% from the buttocks.[15] The different structures, varying epithelium, moisture, higher temperature, and mechanical friction in the genital area may modify the presentation of dermatoses.[16]

The exact mechanisms of host seeking and reasons for localization in specific sites are not known. Scabies mites respond to thermal, chemical, light, and odor stimuli.[17] The mites are lesser in areas with increased density of pilosebaceous glands.[18] Soft folded skin may be preferred by the mite.[19] The mites, especially adult females, are attracted to 17 lipids present in or on the epidermis. These included both saturated (pentanoic, hexanoic, octanoic, lauric, pentadecanoic, and stearic acid) and unsaturated fatty acids (oleic, linoleic, and arachidonic), fatty acid methyl esters, cholesterol, squalene, and tripalmitin.[20] Mites are also attracted to nitrogenous waste and phenolic compounds that may act like pheromones and cause aggregation of mites.[21] Scabies mite proteases assist digestion of host proteins and enable penetration and migration through skin. Ease of availability of nutrients and chemical, physical, and immunological attributes of skin in different areas may be responsible for distribution of the mite in specific areas.[20],[22]


   Clinical Features Top


Classical scabies usually presents with pruritus that is worse at night. Symptoms usually begin 3–4 weeks after infestation. However, pruritus may manifest immediately in previously sensitized individuals.[23],[24]

The pruritus is of two types: a generalized type and the localized type. The localized pruritus is of a burning type caused by activity of the mite. Rarely, patients may not have itch.[25] Pruritus of the penis may be an early clue of scabies infestation.[26] Pruritus occurring exclusively on the scrotum has also been reported.[6]

Two main types of cutaneous lesions are seen: a generalized pruritic papular eruption and papules and vesicles associated with burrows. The latter is associated with the presence of the mite. The tiny papules (”larval papules”) and vesicles associated with the burrows may be single or grouped and are due to reaction to larvae or immature stages of the mite. Papular lesions on the penis and scrotum are of diagnostic value in scabies. The generalized eruption is profuse, severely itchy, and is mainly seen in the axilla, periareolar region, abdomen, buttocks, and thighs.[9],[23],[25]

A burrow is classical sign of the disease. They are grayish, reddish, or brownish, 2–15 mm long serpiginous tunnels, wherein copulation, ovulation, and birth of larvae occur.[2],[27] Burrows are common in areas where there are no or few hair follicles and where the stratum corneum is thin and soft making the genital area an ideal site for infestation. The color of the burrow may vary with the site affected, color of skin, and cleanliness. Burrows on the penis, buttocks, elbows, and knees appear pale [Figure 1].[25],[26] Burrows can be obliterated by bathing, scratching, crust formation, or secondary infection.[28] Many typical burrows and papules may be seen on the glans penis, penile shaft, and scrotum.[29] The crease in the lower part of the buttocks where it joins the upper thigh is affected in scabies. Natal cleft involvement and extension onto the buttocks may occur [Figure 2].[30] Pustules may develop on the buttocks in those who are seated for long time.[25] Knowles reported marked involvement of the penis with many burrows and pustules in military personnel during World War I.[31] Burrows limited to the penis have also been reported in Japanese prisoner of war camps.[25]
Figure 1: Burrow on the shaft of the penis

Click here to view
Figure 2: Excoriated gluteal papules

Click here to view


Scabies usually affects thighs and buttocks and spares vulva in females.[32] However, scabies may cause pruritus vulvae, and vulvar nodules have been reported.[33],[34]

Secondary lesions such as excoriations, crusts, eczematization, and secondary infections may be seen [Figure 3]a and [Figure 3]b.[35] Chronic scratching and irritation may cause hyperpigmentation.[26]
Figure 3: (a) Eczematous crusted plaque on the penis. (b) Excoriated papules over the scrotum

Click here to view



   Atypical Scabies Top


Nodular scabies

Nodular or granulomatous scabies presents with firm, dull-red, brownish-red, or violaceous pruritic nodules measuring up to 2 cm that persist for months despite treatment. Nodules are seen on covered areas or soft skin such as may be seen over the elbows, axilla, thighs, penis, and scrotum [Figure 4]a, [Figure 4]b, [Figure 4]c. Secondary infection or eczematization may alter the clinical appearance. The nodules do not indicate the presence of the mite. It represents a hypersensitivity response to the mite antigens.[35],[36],[37],[38] It has been proposed that antigenic components of the mite enter the dermis and produce nodular lesions.[39] The histopathology of nodular scabies is similar to persistent bite reactions with dense superficial and deep infiltrate of lymphocytes, macrophages, plasma cells, eosinophils, Langerhans cells, and atypical mononuclear cells. Lymphoid follicles may be present.[40]
Figure 4: (a and b) Ulcerated nodules on the penis. (c) Erythematous plaques and nodules over the penis and scrotum

Click here to view


Nonpersistent nodules may be seen in infants. Nonpersistent hemorrhagic nodules that ulcerated and mimicked chancres have been reported on the penis.[25]

Vesiculobullous scabies

Vesiculobullous scabies is a rare subtype predominantly affecting elderly individuals.[36] It may mimic bullous pemphigoid or can present with true bullous pemphigoid triggered by scabies. Bullous scabies may also be seen in very young children due to thin stratum corneum and loosely attached epithelial layers.[38] Bullous lesions may involve the genitalia. Penile bullae that showed poor response to topical steroids but responded to topical sulfur have been reported.[41]

Crusted scabies

Crusted scabies or Norwegian scabies presents with massive infestation of mites in immunocompromised patients and those with reduced sensations or inability to scratch. It presents with thick crusts and warty hyperkeratotic lesions. Lesions are usually extensive, atypical, and can involve atypical sites.[38] Burrows, vesicles, and papules may be masked by the keratotic plaques. Margins of the plaques or non-keratotic areas such a penis may reveal burrows.[25] Crusted scabies may have generalized or localized presentations. Lesions may be limited to the genitalia in both males and females. Crusted scabies presenting as a single, asymptomatic, thick crusted plaque on the shaft of the penis has been reported in an AIDS patient.[5] Crusted scabies of the vulva presenting with an ill-defined yellowish and beige psoriasiform plaque on the labia majora and clitoris has been reported in an HIV patient. It was proposed the weight loss, thinning, and protrusion of labia minora, and increased keratinization due to loss of moisture might have led to the unusual involvement of the vulva. Crusted scabies is a differential for scaly plaques that appear “like heaps of beige sand” in any location or of any size.[42]

Scabies incognito

Topical and oral steroids may alter the presentation of scabies. There is cutaneous atrophy, reduced inflammation, increased vascularity, and increased secondary infection. There may be vesicles, pustules, and nodules along with manifestations of steroid use.[38]


   Complications Top


Secondary infections

Scabies can disrupt the skin barrier, and predispose to staphylococcal and streptococcal infections. There may be impetigo, ecthyma, furuncles, lymphangitis, and cellulitis. Streptococcal infections may lead to poststreptococcal glomerulonephritis.[23]

Sepsis and death may occur in immunocompromised patients. Infections in the genital region can cause inguinal lymphadenopathy and bubo formation.[37],[43]

Psychological effects

Genital scabies has deleterious effect on the psychosexual well-being of patients. Patients may have disbelief, shame, guilt, and persistent delusions of parasitosis. Counseling on the nature of the disease and its transmission of the disease is needed.[37]

Others

Genital scabies has also been associated with male genital edema [Figure 5].[44]
Figure 5: Penile edema with burrows of scabies

Click here to view


Post-scabetic pruritus

Post-scabetic pruritus may be present for days to weeks after treatment due to hypersensitivity to the mite antigens.[37]


   Scabies as a Sexually Transmitted Disease Top


Scabies is recognized as a sexually transmitted disease.[8] The localization of lesions over the genital area may cause diagnostic difficulties with other sexually transmitted infections.[16] The distribution of the mite is not related to the site of infection.[45] Scabies is transmitted by close physical contact. The fertilized female mite is implicated in transmission, but numerous immature mites on the skin surface may have a more significant role.[43] Sexual transmission is not the common route, and the association with other sexually transmitted diseases is controversial.[25] It does not have the classical pattern of sexually transmitted diseases, and the incidence trends do not parallel other sexually transmitted infections.[43] Nonsexual transmission may occur among family members. Fomite transmission can occur.[2] This is rare in classical scabies, but fomites may be important in crusted scabies. Men who have sex with men and sporadic sexual contact are risk factors for scabies.[3]

Singh et al. reported scabies as the most common venereal disease among juvenile inmates in a prison in India. This was attributed to common bedding and homosexual abuse by senior criminals.[46] Otero et al. studied 9751 patients in a sexually transmitted infection clinic over a period of 15 years and found that the annual infestation percentage varied from 0.6% to 2.7%. A range of 0.3%–2.4% was reported by other authors. Cases were more frequent in autumn and winter. Scabies was most common in men who have sex and more common in heterosexual men compared to women.[47]


   Scabies and Other Sexually Transmitted Infections Top


Scabies is common in venereal disease clinics and has been reported to coexist with other sexually transmitted infections such as syphilis, gonorrhea, and pediculosis pubis. David et al. reported higher prior sexually transmitted diseases without significant coexisting sexually transmitted diseases.[48] Evaluation of patients for other sexually transmitted disease is often recommended.[8],[49]


   Scabies and Syphilis Top


“Chancre galeuse” is the syphilitic chancre occurring on the cutaneous lesions of scabies.[25],[49] Infiltrated papules found on the penis and scrotum may be confused with early syphilis.[50]


   Scabies and Hiv Top


The prevalence of scabies in HIV is around 2%–4%.[29] The mite does not transmit HIV.[3] Typical scabies may be seen in HIV patients with minimal immunosuppression. As immunosuppression advances, two highly contagious and severe types of scabies are seen: papular or atypical or exaggerated scabies and crusted or hyperkeratotic or Norwegian scabies. Exaggerated scabies is intensely pruritic and characterized by generalized papules that may be topped by scaly burrows. Scabies must be suspected when there are atypical or itchy lesions in HIV and HIV should be ruled out in atypical manifestations of scabies particularly in patients with risk factors for HIV.[51]


   Diagnosis Top


Demonstration of scabies mite, eggs, or feces in skin scrapings is the standard test for diagnosis. Web spaces, hands, feet, wrist, and penis are among the good sites to examine for the mite. Burrows and nearby vesicles and papules are scraped and examined under the microscope with mineral oil, potassium hydroxide, or saline.[2],[37] Repeated scrapings from different sites may be needed as sensitivity is low. It is cumbersome to do and may be uncomfortable for the patient. Other tests include burrow ink test, adhesive plaster test, and polymerase chain reaction-based test for identifying the mite DNA in skin scrapings.[52]

“Jetliner with a trail” appearance on dermoscopy can be used in the diagnosis of scabies. This may be difficult to appreciate in dark skin and hairy areas. Proximity of the examiner's head to the genital area with handheld dermoscope may be embarrassing to the patient. Videodermoscopy can offer fast and clear demonstration of burrows, scabies mite, larvae, eggs, and feces.[52]

Confocal reflectance microscopy and optical coherence tomography can demonstrate the burrows, scabies mite, larvae, and feces. However, both these diagnostic tests are expensive, have a long learning curve and low sensitivity, and are available only at specialized centers.[52]

Skin biopsy may be done but is usually nonspecific.[3] “Pink pigtail” structures connected to the stratum corneum are suggestive of scabies.[28]

Detection of antibodies by ELISA which are present prior to onset of symptoms is a promising test.[52]

Differential diagnosis

Scabies has been described as the easiest and yet the most difficult to diagnose.[43] The differential diagnosis includes almost all pruritic dermatoses and includes urticarial, atopic dermatitis, lupus erythematosus, animal scabies, eczema, lichen planus, pityriasis rosea, dermatitis herpetiformis, necrotizing vasculitis, papular urticaria, delusion of parasitosis, and pruritic dermatoses of pregnancy. Sexually transmitted diseases mimicked by scabies include syphilis, pediculosis pubis, and phthiriasis pubis. The differential diagnosis of atypical manifestations of scabies is summarized in [Table 1].[23],[25],[36],[37],[38],[53],[54]
Table 1: Differential diagnosis of atypical scabies

Click here to view



   Management Top


Topical agents

Topical agents are the mainstay of therapy for genital scabies. Isolated genital involvement does not preclude from whole-body application of the agent. Genital skin is sensitive with increased systemic absorption of topical agents.[16] Increased local absorption may occur from erosions of bullous scabies.[38] Permethrin is the most effective agent against scabies. It is synthetic pyrethroid that acts on sodium channels causing delayed repolarization, paralysis, and death. It can cause burning, stinging, and itchy, especially in sensitive eroded areas. The preservative formaldehyde may also cause allergic contact dermatitis.[36],[55] It is recommended, especially for infants, young children, and pregnant and lactating women.

Lindane is a second-line agent for scabies in view of its neurotoxicity. It is not recommended in children below 10 years. Increased absorption may occur immediately after bath or in patients with extensive dermatitis causing seizures. It may cause ulcerative irritant contact dermatitis, aplastic anemia, thrombocytopenia, and pancytopenia. Sulfur is among the oldest agents used for scabies. It can be used in pregnancy, infants, and in children but is irritant, messy, smelly, and stains clothes.[36],[56] Other agents include benzyl benzoate, malathion, esdepallethrine, monosulfiram, and crotamiton.[57]

Compliance to topical therapy may be poor in situ ations where there are inadequate privacy and facilities. It may be difficult to apply in certain special situations such in aged care institutions in mentally and physically disabled individuals.[55]

Ivermectin

Ivermectin is a synthetic macrocyclic lactone that blocks gamma-aminobutyric acid-gated chloride channels and causes paralytic death of the mite. It is a well-tolerated efficacious drug that ensures better compliance and avoids irritation of topical scabicides and convenient for bedridden patients.[22],[36] It is not recommended in pregnant and breastfeeding women and children weighing <15 kg. Moxidectin is a promising second-generation macrocyclic lactone that may be effective in a single dose. Other modalities being investigated include immunotherapy, vaccination, and direct targeting scabies mite molecules.[55]

Special situations

Nodular scabies can be managed with topical or intralesional corticosteroids, topical pimecrolimus, and methotrexate in recalcitrant cases.

Postscabetic pruritus may require treatment with oral antihistaminics and emollients; topical and oral corticosteroids may be required in severe cases.[36],[37] The pruritus may last for several weeks, particularly in individuals with atopy. Test for cure by examination for living mite may be done, especially in crusted scabies.[58]

Management of outbreaks, especially in institutions and epidemics, requires treatment of cases as well as at-risk population. Ivermectin along with topical scabicides is useful in such situations.[56]

Scabies with HIV

Uncomplicated scabies in HIV-affected individuals are treated with the same regimens as HIV-negative individuals.[56]

Crusted scabies

Combination therapy with 5% topical benzyl benzoate or 5% permethrin (daily for 1 week followed by twice-weekly till discharge or cure) along with oral ivermectin 200 μg/kg on 1, 2, 8, 9, and 15 has been recommended for crusted scabies. Severe cases can be administered additional doses on days 22 and 29. Lindane is not recommended as systemic absorption from the eroded areas can cause neurotoxicity.[56]

The entire skin including the head should be treated. Isolation till cure is needed, along with epidemiological measures to treat contacts. Clothing and bedding may be washed at temperatures above 50°C, dry-cleaned or kept in a plastic bag for 7 days.[58]


   Management of Contacts Top


Treatment of contacts at the same time as the case will reduce the chances of re-infestation.[4] However, the Centers for Disease Control and Prevention recommends that close personal, household, and sexual contacts in the previous 1 month should be examined and treated if found to be infested.[56] European guidelines recommend that sexual contacts in the previous two months are evaluated and treated. Sexual contact is to be avoided until both partners are treated condoms do not prevent transmission.[58]


   Conclusion Top


Genital involvement in scabies is often neglected. Awareness of the diverse manifestations of genital scabies is needed to diagnose and manage the deceptive itch mite and its debilitating impact on humanity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
FitzGerald D, Grainger RJ, Reid A. Interventions for preventing the spread of infestation in close contacts of people with scabies. Cochrane Database of Syst Rev 2014. Art. No.: CD009943. DOI: 10.1002/14651858.CD009943.pub2.  Back to cited text no. 1
    
2.
Orion E, Matz H, Wolf R. Ectoparasitic sexually transmitted diseases: Scabies and pediculosis. Clin Dermatol 2004;22:513-9.  Back to cited text no. 2
    
3.
Chosidow O. Clinical practices. Scabies. N Engl J Med 2006;354:1718-27.  Back to cited text no. 3
    
4.
Strong M, Johnstone P. Interventions for treating scabies. Cochrane Database of Syst Rev 2007. Art. No.: CD000320. DOI: 10.1002/14651858.CD000320.pub2.  Back to cited text no. 4
    
5.
Perna AG, Bell K, Rosen T. Localised genital Norwegian scabies in an AIDS patient. Sex Transm Infect 2004;80:72-3.  Back to cited text no. 5
    
6.
Pomares C, Marty P, Delaunay P. Isolated itching of the genitals. Am J Trop Med Hyg 2014;90:589-90.  Back to cited text no. 6
    
7.
Karthikeyan K. Crusted scabies. Indian J Dermatol Venereol Leprol 2009;75:340-7.  Back to cited text no. 7
[PUBMED]  [Full text]  
8.
Leone PA. Pubic lice and scabies. In: Holmes KK, Sparling PF, Stamm WE, Piot P, Wasserheit JN, Corey L, et al., editors. Sexually Transmitted Diseases. 4th ed. New York: McGraw-Hill; 2008. p. 0839-51.  Back to cited text no. 8
    
9.
Walton SF, Holt DC, Currie BJ, Kemp DJ. Scabies: New future for a neglected disease. Adv Parasitol 2004;57:309-76.  Back to cited text no. 9
    
10.
Kenawi MZ, Morsy TA, Abdalla KF, Nasr ME, Awadalla RA. Clinical and parasitological aspects on human scabies in Qualyobia governorate, Egypt. J Egypt Soc Parasitol 1993;23:247-53.  Back to cited text no. 10
    
11.
Sehgal VN, Rao TL, Rege VL, Vadiraj SN. Scabies: A study of incidence and a treatment method. Int J Dermatol 1972;11:106-11.  Back to cited text no. 11
    
12.
Jackson A, Heukelbach J, Filho AF, Júnior Ede B, Feldmeier H. Clinical features and associated morbidity of scabies in a rural community in Alagoas, Brazil. Trop Med Int Health 2007;12:493-502.  Back to cited text no. 12
    
13.
Das S, Chatterjee T, Banerji G, Biswas I. Evaluation of the commonest site, demographic profile and most effective therapy in scabies. Indian J Dermatol 2006;51:186-8.  Back to cited text no. 13
  [Full text]  
14.
Bandi KM, Saikumar C. Sarcoptic mange: A zoonotic ectoparasitic skin disease. J Clin Diagn Res 2013;7:156-7.  Back to cited text no. 14
    
15.
Johnson C, Mellanby K. The parasitology of human scabies. Parasitology. 1942;34:285  Back to cited text no. 15
    
16.
Meeuwis KA, de Hullu JA, Massuger LF, van de Kerkhof PC, van Rossum MM. Genital psoriasis: A systematic literature review on this hidden skin disease. Acta Derm Venereol 2011;91:5-11.  Back to cited text no. 16
    
17.
Arlian LG, Morgan MS, Rider SD Jr. Sarcoptes scabiei: Genomics to proteomics to biology. Parasit Vectors 2016;9:380.  Back to cited text no. 17
    
18.
Lane AT. Scabies and head lice. Pediatr Ann 1987;16:51-4.  Back to cited text no. 18
    
19.
Buxton PA. Parasitology of scabies. Br Med J 1941;2:397-401.  Back to cited text no. 19
    
20.
Arlian LG, Vyszenski-Moher DL. Response of Sarcoptes scabiei var. Canis (Acari: Sarcoptidae) to lipids of mammalian skin. J Med Entomol 1995;32:34-41.  Back to cited text no. 20
    
21.
Arlian LG, Vyszenski-Moher DL. Responses of Sarcoptes scabiei (Acari: Sarcoptidae) to nitrogenous waste and phenolic compounds. J Med Entomol 1996;33:236-43.  Back to cited text no. 21
    
22.
Hay RJ, Steer AC, Engelman D, Walton S. Scabies in the developing world – its prevalence, complications, and management. Clin Microbiol Infect 2012;18:313-23.  Back to cited text no. 22
    
23.
Monsel G, Delaunay P, Chosidow O. Arthropods. In: Griffith CE, Barker J, Bleiker T, Chalmers R, Creamer D, editors. Rook's Textbook of Dermatology. 9th ed. Chichester: John Wiley and Sons; 2016. p. 34.39-34.47.  Back to cited text no. 23
    
24.
McCarthy JS, Kemp DJ, Walton SF, Currie BJ. Scabies: More than just an irritation. Postgrad Med J 2004;80:382-7.  Back to cited text no. 24
    
25.
Alexander JO. Scabies. Arthropods and human skin. New York: Springer-Verlag; 1984. p. 227-92.  Back to cited text no. 25
    
26.
Meinking T. Infestations. Curr Probl Dermatol 1999;11:73-118.  Back to cited text no. 26
    
27.
Currier RW, Walton SF, Currie BJ. Scabies in animals and humans: History, evolutionary perspectives, and modern clinical management. Ann N Y Acad Sci 2011;1230:E50-60.  Back to cited text no. 27
    
28.
Golant AK, Levitt JO. Scabies: A review of diagnosis and management based on mite biology. Pediatr Rev 2012;33:e1-12.  Back to cited text no. 28
    
29.
Buechner SA. Common skin disorders of the penis. BJU Int 2002;90:498-506.  Back to cited text no. 29
    
30.
Orkin M. Scabies: Clinical aspects. In: Orkin M, Maibach HI, Parish LC, Schwartzman RM, editors. Scabies and Pediculosis. Philadelphia: Lippincott; 1977. p. 23-30  Back to cited text no. 30
    
31.
Knowles FC. Scabies in military and civil life: Its differentiation, complications and treatment. JAMA 1918;71:1657-8.  Back to cited text no. 31
    
32.
Weichert GE. An approach to the treatment of anogenital pruritus. Dermatol Ther 2004;17:129-33.  Back to cited text no. 32
    
33.
Stewart KM. Clinical care of vulvar pruritus, with emphasis on one common cause, lichen simplex chronicus. Dermatol Clin 2010;28:669-80.  Back to cited text no. 33
    
34.
Fischer G, Rogers M. Vulvar disease in children: A clinical audit of 130 cases. Pediatr Dermatol 2000;17:1-6.  Back to cited text no. 34
    
35.
Heukelbach J, Feldmeier H. Scabies. Lancet 2006;367:1767-74.  Back to cited text no. 35
    
36.
Hicks MI, Elston DM. Scabies. Dermatol Ther 2009;22:279-92.  Back to cited text no. 36
    
37.
Chouela E, Abeldaño A, Pellerano G, Hernández MI. Diagnosis and treatment of scabies: A practical guide. Am J Clin Dermatol 2002;3:9-18.  Back to cited text no. 37
    
38.
Cestari TF, Martignago BF. Scabies, pediculosis, bedbugs, and stinkbugs: Uncommon presentations. Clin Dermatol 2005;23:545-54.  Back to cited text no. 38
    
39.
Thomson J, Cochrane T, Cochran R, McQueen A. Histology simulating reticulosis in persistent nodular scabies. Br J Dermatol 1974;90:421-9.  Back to cited text no. 39
    
40.
Weedon D. Arthropod-induced diseases. In: Weedon D, editor. Weedon's Skin Pathology. 3rd ed. London: Churchill Livingstone; 2010. p. 652-63.  Back to cited text no. 40
    
41.
Luo DQ, Huang MX, Liu JH, Tang W, Zhao YK, Sarkar R, et al. Bullous scabies. Am J Trop Med Hyg 2016;95:689-93.  Back to cited text no. 41
    
42.
Bakos L, Reusch MC, D'Elia P, Aquino V, Bakos RM. Crusted scabies of the vulva. J Eur Acad Dermatol Venereol 2007;21:682-4.  Back to cited text no. 42
    
43.
Leone P, Gopalkrishnan TV, Usha V. Scabies and Pediculosis. In: Gupta S, Kumar B, editors. Sexually Transmitted Infections. 2nd ed. New Delhi: Elsevier; 2012. p. 621-32.  Back to cited text no. 43
    
44.
Weinberger LN, Zirwas MJ, English JC 3rd. A diagnostic algorithm for male genital oedema. J Eur Acad Dermatol Venereol 2007;21:156-62.  Back to cited text no. 44
    
45.
Mellanby K. The development of symptoms, parasitic infection and immunity in human scabies. Parasitology 1944;35:197-206.  Back to cited text no. 45
    
46.
Singh S, Prasad R, Mohanty A. High prevalence of sexually transmitted and blood-borne infections amongst the inmates of a District Jail in Northern India. Int J STD AIDS 1999;10:475-8.  Back to cited text no. 46
    
47.
Otero L, Varela JA, Espinosa E, Sánchez C, Junquera ML, del Valle A, et al. Sarcoptes scabiei in a sexually transmitted infections unit: A 15-year study. Sex Transm Dis 2004;31:761-5.  Back to cited text no. 47
    
48.
David N, Rajamanoharan S, Tang A. Are sexually transmitted infections associated with scabies? Int J STD AIDS 2002;13:168-70.  Back to cited text no. 48
    
49.
Orkin M. Today's scabies. JAMA 1975;233:882-5.  Back to cited text no. 49
    
50.
Obermayer ME. Medical entomology in relation to tropical dermatoses. JAMA 1943;123:454-8.  Back to cited text no. 50
    
51.
Czelusta A, Yen-Moore A, Van der Straten M, Carrasco D, Tyring SK. An overview of sexually transmitted diseases. Part III. Sexually transmitted diseases in HIV-infected patients. J Am Acad Dermatol 2000;43:409-32.  Back to cited text no. 51
    
52.
Micali G, Lacarrubba F, Verzì AE, Chosidow O, Schwartz RA. Scabies: Advances in noninvasive diagnosis. PLoS Negl Trop Dis 2016;10:e0004691.  Back to cited text no. 52
    
53.
Fujiyama T, Tokura Y. Clinical and histopathological differential diagnosis of eosinophilic pustular folliculitis. J Dermatol 2013;40:419-23.  Back to cited text no. 53
    
54.
Hoyt BS, Cohen PR. Cutaneous scrotal metastasis: Origins and clinical characteristics of visceral malignancies that metastasize to the scrotum. Int J Dermatol 2013;52:398-403.  Back to cited text no. 54
    
55.
Mounsey KE, Bernigaud C, Chosidow O, McCarthy JS. Prospects for moxidectin as a new oral treatment for human scabies. PLoS Negl Trop Dis 2016;10:e0004389.  Back to cited text no. 55
    
56.
Workowski KA, Bolan GA. Centers for disease control and prevention. sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015;64:1-37.  Back to cited text no. 56
    
57.
Karthikeyan K. Treatment of scabies: Newer perspectives. Postgrad Med J 2005;81:7-11.  Back to cited text no. 57
    
58.
Salavastru CM, Chosidow O, Boffa MJ, Janier M, Tiplica GS. European guideline for the management of scabies. J Eur Acad Dermatol Venereol 2017;31:1248-53.  Back to cited text no. 58
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1]



 

Top
Print this article  Email this article
 

    

 
  Search
 
  
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Article in PDF (1,648 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
   Etiology
    Genital Involvem...
   Clinical Features
   Atypical Scabies
   Complications
    Scabies as a Sex...
    Scabies and Othe...
   Scabies and Syphilis
   Scabies and Hiv
   Diagnosis
   Management
    Management of Co...
   Conclusion
    References
    Article Figures
    Article Tables

 Article Access Statistics
    Viewed948    
    Printed61    
    Emailed0    
    PDF Downloaded52    
    Comments [Add]    

Recommend this journal