Fujimoto K
Department of Dermatology, Nippon Medical School, Tokyo, Japan.
Nihon Ika Daigaku Zasshi. 1994 Nov;61(6):572-89. doi: 10.1272/jnms1923.61.572.
Scabies has become a common disease, not sexually transmitted but transmitted in households. Although it is also known to cause an epidemic in hospitals for the aged patients or residential homes, no effective treatment was taken for it at the present time. From January 1985 to December 1992, 424 patients with scabies (249 males and 175 females) visited the Dermatological clinic of Nippon Medical School Main Hospital. In these cases, only 13 patients (3.1%) were recognized as having STD. The sources of infestation were unclear in most cases where the disease was transmitted in households, which account for 38.5% of the patients. In 68 cases (16.0%), outbreaks of scabies in hospitals and residential homes affected the patients as well as the staffs and their families. The number of scabies cases which were infested in hospitals is increasing yearly. It is speculated that the hospitals for the aged patients and residential homes are becoming the main source of scabietic infestation. Only 16.6% of the patients were previously diagnosed or suspected to have scabies by their family doctors. It seems that the diagnosis of scabies is extremely difficult for the general practitioner. A considerable number of the patients who had been diagnosed or suspected to have scabies changed their doctor or stop visiting them. This is because an appropriate treatment is not available in most of medical facilities. At the time of the first visit to our clinic, 93.6% of the patients was diagnosed or suspected to have scabies, and the mite was demonstrated in 63.2% of the patients. It is suggested that careful inspection of scabietic burrows and the skillful technique to demonstrate the mite are essential to establish the diagnosis of scabies. Atopic dermatitis was the most common diagnosis of the patients who were misdiagnosed at the first time and later turned out to have scabies. These patients did have atopic dermatitis besides scabies. After the treatment with benzyl benzoate with crotamiton, 70.3% of the patients were cured and up to 94.9% of the patients were over improved. We compared the therapeutic effect of phenothrin to that of benzyl benzoate. Benzyl benzoate had more antipruritic effect and a little more improvement of skin lesion than phenothrin. However, there was no significant difference between benzyl benzoate and phenothrin in the period of time until the skin lesion cleared. Phenothrin is considered to have an adequate therapeutic effect for scabies.
疥疮已成为一种常见疾病，并非性传播疾病，而是在家庭中传播。虽然已知它也会在老年患者医院或养老院引发疫情，但目前尚无有效的治疗方法。1985年1月至1992年12月，424例疥疮患者（男性249例，女性175例）前往日本医科大学附属病院皮肤科就诊。在这些病例中，只有13例（3.1%）被认定为患有性传播疾病。在大多数家庭传播的病例中，感染源不明，这类病例占患者总数的38.5%。在68例（16.0%）病例中，医院和养老院的疥疮暴发不仅影响了患者，还波及了医护人员及其家属。医院内感染疥疮的病例数逐年增加。据推测，老年患者医院和养老院正成为疥疮感染的主要源头。只有16.6%的患者此前被家庭医生诊断或怀疑患有疥疮。看来，全科医生对疥疮的诊断极为困难。相当一部分被诊断或怀疑患有疥疮的患者更换了医生或不再就诊。这是因为大多数医疗机构没有合适的治疗方法。在首次来我院就诊时，93.6%的患者被诊断或怀疑患有疥疮，63.2%的患者查到了疥螨。提示仔细检查疥疮隧道和熟练掌握查找疥螨的技术对于疥疮的诊断至关重要。特应性皮炎是初次误诊后来确诊为疥疮的患者最常见的误诊疾病。这些患者除了疥疮外确实患有特应性皮炎。用苯甲酸苄酯加克罗米通治疗后，70.3%的患者治愈，高达94.9%的患者病情明显好转。我们比较了苯醚菊酯与苯甲酸苄酯的治疗效果。苯甲酸苄酯的止痒效果更好，皮肤损害的改善程度也比苯醚菊酯稍大。然而，在皮损消退所需的时间方面，苯甲酸苄酯和苯醚菊酯之间没有显著差异。苯醚菊酯被认为对疥疮有足够的治疗效果。
