FRI FOR FNATMIDER

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Vi har i øjeblik en fnatepidemi forskellige steder i danmark april2017-januar2020
Efter sigende så dukker epidemier op med ca 30 års mellemrum og jeg kan da heller ikke huske at jeg har hørt om fnat siden jeg var barn og til det dukkede op blandt teenagere i 2017.

Et halvt år og 16 tuber Nix tog det 4 teenagere IKKE at komme af med Fnat. Herefter fik de Stromectol/ivermectin tabletter og siden har jeg ikke hørt om udbrud hos dem.

 

I skrivende stund er det imidlertid opstået igen andre steder..... Der har været fnat alarm på Kolding sygehus og på et gymnasie på øst sjælland, på en kaserne hvor alle blev sendt hjem, i en Børnehave på Lolland, og på Nyk.F sygehus, barselsafsnittet, hvilket er slemt da hverken ammende mødre eller børn under 15kg kan behandles med gængse medicinal midler. Desuden en patient der var indlagt til knæoperation ligeledes Nyk.F. Sygehus

OBS se i bunden af dokumentet hvis du er gravid ammende eller har børn under 15 kg.

De største årsager til at fnat er så langvarig en plage, er at der er 6-8 ugers ventetid på at komme til hudlæge !
Alm Praktiserende læger må gerne udskrive Nix creme men de fleste er uvidende om at det skal på-smøres mindst 2-3 gange med max en uges mellemrum.
 

Jo længere tid lidelsen står på, desto flere mider æg og larver  - og ergo jo sværere er det at komme lidelsen til livs – det siger egentlig sig selv

En anden årsag til den langvarige lidelse er den horrible pris på Nix 300 kr og Stromecto/ivermectin 800kr for en behandling til een person !! Hele hustanden skal behandles !
(Diabetes patienter kan efter forlydende få Nix for 42kr pr. behandling)

3. årsag er at man fejlfortolker larvernes overlevelsesevne. Det værste er at pakke tøj i en plastpose i 5 dage et køligt sted. Når man så pakker tøj eller puder, dyner o.l ud igen er der en stor mængde fnatlarver der råber juhu !! og vips udvikler sig til en ny omgang gravende og æglæggende mider. Teorien er at fnatmider og eller larver går i dvale når det er køligt/koldt – muligvis alt under 22-25 grader

 

Korrekt Fnatbehandling.

1. Fjern alle fingerringe, armbåndsure og smykker en hel uge eller mere, hvis du ikke er i behandling

2. Fjern alle stoflignende genstande, puder, plaider, mindre stofmøbler og sæt dem på loftet eller i et værelse i mindst 5 dage såfremt det er et opvarmet værelse og mindst 14 dage såfremt det er et uopvarmet værelse.

3. vask hænder i køkkenet, i badeværelset og på toilettet med svovl sæbe eller tea tree og kryddernellike olie. Fortsæt med dette et par måneder EFTER husstanden er blevet fnatfri !

4. Der skal vaskes tøj, sengetøj, plaids ved 60 grader HVER DAG i mindst 14 dage eller til husstanden er fnatfri

5. Kroppen kan evt. vaskes med skrub-/hamphandske eller lignende hver dag – gerne med 30 dråber tea tree olie i både shampoo og dusch. Del ikke hverken håndklæder eller hamphandsker !! miderne kan overføres fra person til person via håndklædet. Læg evt. hamphandsken/hamphandskerne i en skål eddike imellem hver brug. OBS vi har oplevet en faktuel smitte fra et håndklæde der havde været brugt af een person efter et brusebad.
   Del heller IKKE karbad med nogen idet miderne også kan overføres på denne måde

6. Håndklæder lægges straks til vask, da der hyppigt forefindes levende mider selv efter et bad med svovl shampoo

7. Smør kroppen i enten en kombination teatree og kryddernellike olie blanding i en alm bodylotion. Ca. 30 dråber Tea Tree og 20 dråber kryddernellike til ca 300ml lotion – de gængse tea tree vask og lotion er IKKE stærke nok, men du kan evt. komme ekstra olie i.
   husk at smøre nakken og nakkehårene og rundt om ørerne. (obs kryddernellike er effektivt men svier meget hvis det er ufortyndet.
   Smør hver dag i mindst 14 dage – i stedet for Body lotion kan man evt brug Aloe Vera tilsat mint fra ”Normal til 16kr tuben – tilsæt ekstra tea tree og kryddernellike som beskrevet ovenfor.

8. Vask AL sengetøj ved 60 grader – tag engangshandsker på når du håndterer sengetøj

9. sprit hænderne før du håndterer rent tøj og rent sengetøj

10. Overtøj skiftes også HVER DAG – hvis muligt stryg nakke og håndledsområder på overtøj der ikke kan vaskes ved 60 grader. Hvis du vælger at stille overtøjet væk, skal det være i varm stuetemperatur i mindst 5 dage

11. spray evt. sengens madras med exner petguard fra zooplus.dk til 70kr / maxizoo 149kr Det samme med sofaen og stof stole. Kan møblerne tåle det så kan du i stedet bruge en klorin opløsning på 1dl – 4 liter vand. Brug en alm.karklud og tør møblerne med den let opvredede klud

12. punkterne gælder for ALLE i hustanden ! det kan vare op til 8 uger inden man kan se at en person er smittet.
    Dette gælder for førstegangssmittede. Øvrige får symptomer efter 1-4 dage. OBS ikke alle klør sig som gale, nogen har høj tolerancetærskel og føler bare en let rockwools kløen af og til.

13. Glem alt om håndklæder i køkken og på toilettet – køb ekstra ind af køkkenrulle og toiletpapir og brug i stedet dette til at tørre hænder i !!

14. tilføj enten tea tree eller 10%svovl til flydende håndsæber

15. Hav mindst et par håndsprift flasker stående i køkken og ved vaskemaskine e.l. steder og indgnid hyppige hænder, fingre og håndled i dette.

16. Bed din egen læge om en henvisning til hudlæge, så kommer du hurtigere til. Bed hudlægen  om Stromectol/Ivermectin piller 12mg pr behandling. Ved lettere angreb er det nok med én behandling, ved svære tilfælde vil det være nødvendigt med flere omgange Nix OG tabletter.

17. Der findes en permetrinolie i udlandet hvor der er set total helbredelse efter 6 dages indsmøring af hele kroppen, efter brug af hamphandske. Permetrin er også det aktive stof i Nixcremen men da der er sprit i permetrinolien, er det som om den virker bedre….

18. OBS 1 indsmøring er aldrig nok !! det er her de fleste fejler… Så bed lægen om recept på 2 tuber NIX pr. person. Hvis I kun er lettere angrebne kan I nøjes med NIX og ovenstående rengøring.

Larverne er den største årsag til gensmitning. Tabletter beskytter i max 3 dage mod gensmitning. Derfor brug tea tree bodylotion som prevention mod gensmitning.

Det er ikke beskrevet nogen steder men der en en tendens til at larver går i dvale når der er koldt i rummet.. Derfor er det, at det ikke duer at stille tøj eller møbler væk eller i plastiposer i 5 dage. Der skal være 22-25 grader i rummet, ellers liver bæsterne bare op igen!

 

Noter:
 

Vi har ekstra invermectin tabl til overs efter en vellykket behandling, desuden kan vi lave svovlsæber og svovllotions hvis du ikke kan selv, men vi er bare en familie der har prøvet at være i denne skrækkelige situation længe ! og fået en del erfaring for hvad der hjælper og ikke hjælper, vi er IKKE behandlere.

Behandlingspræparater er en økonomisk belastning for 90% af alle familier og der bruges enten Nix samt stromectol/ivermectin for lidt eller/og for sent !! dette øger resistens risiko – desuden er der 6-8 ugers ventetid til en konsultation hos en dermatolog/hudlæge som har tilladelse til at udskrive Ivermectin/stromectol
NIX SKAL bruges ad 2 gange ! det er der mange læger der ikke ved. – Faglæge/Dermatolog Roskilde Universitetshospital. – Bed den praktiserende læge om en henvisning, så kommer du hurtigere til hos Hudlægen

Det mest effektive middel har vist sig at være 12mg Ivermectin, meget gerne i forbindelse med en NIX kur
Brug også TEA TREE æterisk olie direkte på de kløende steder, de dage hvor der ikke tages NIX.
Hvis du håndterer vasketøj eller du allerede er smitte på håndleddet så gnid med Nix eller tea tree – lad tørre og kør derefter et par runder englehuds tape rundt om håndleddet for ikke at smitte – mindst 2 cm ekstra tape i alle retninger

NIX CREME VIRKER KUN HVIS MAN TAGER DET mindst 2 gange !! dvs en hel tube påsmøres hele kroppen og nakken, og gentages en uge efter. Ved svære angreb gentag hver 3.dag. Diabetes patienter kan købe Nix creme til 42kr…..

Brug Tea Tree i shampoo, eller 10% svovl i shampoo idet fnat i nogle tilfælde desværre også kan finde op til hovedbunden.

LÆS OGSÅ studier af æteriske oliers egenskab til at dræbe fnatmider https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5120413/
in vitro studier har vist at bla. Tea Tree olier og Kryddernellike olier dræber fnatmider i petriskåle på 20-50 min. I huden vil det tage lidt længere tid – Tea Tree kan påføres ufortyndet, æterisk Kryddernellike olie skal helst påføres sammen med kokosolie eller lignende, ellers svier det for meget.

Hæld 10% svovl i alle husstandens flydende håndsæber. Obs kan fjerne hår ! fx i armhulen ved brug i mere end en uge.

Eller Hæld 30 dråber Tea Tree og Kryddernellike olie i alle husstandens flydende håndsæber.
Kryddernellike olie dræber fnatmider, men svider i 100% opløsning så det tilrådes at bruges sammen med lotion, creme, kokosolie – i øvrigt skal man vælge mellem ente sæbe eller indsmøring dagligt med ovenstående så virker indsmøring bedre, idet det er set at fnatmider vågner op på håndklædet efter et svovl bad…. Men begge dele er tilrådeligt hvis muligt…

SKIFT OG VASK SENGETØJ VED 60 GRADER HVER DAG !!

SKIFT OG VASK HÅNDKLÆDER HVER DAG !! der er fundet fnatmideoverførsel til en anden del af kroppen via et håndklæde der lige varf brugt efter et bad. Håndklædet i siddende stilling lagt henover knæene en time eller to og dagen efter var der udbrud af fnat, exactly på det sted håndklædet havde ligget.
evt. køb ekstra køkkenruller og toiletpapir og skip håndklæderne i 14 dage.

SKIFT OG VASK TØJ HVER DAG – i 14 dage efter påbegyndt behandling

FJERN ALT UNØDVENDIGT STOF, TÆPPER, PUDER, MØBLER o.l. OG LÆG DET I POSER VED STUETEMP EN UGE. HVIS LAVERE TEMPERATUR SÅ 14 DAGE.

TØRRETUMBLING OG ISÆR STRYGNING DRÆBER OGSÅ FNATMIDER.
10 minutter i en 50 grader varm ovn dræber fnatmider.

Fnatmider kan skylles af i et varmt karbad, dvs at de også kan overføres til en anden person hvis karbadet deles.

Vil du hurtigere af med kløe efter påbegyndt effektiv behandling, så brug en hamphandske i badet hver dag, Det er set at en  person der brugte hamphandske dagligt i 6 dage var fuldstændig fri for spor efter sår og mider. N.B. det er ikke tilrådeligt at dele en hamphandske. Læg Hamphandsken i en balje ren lagereddike til dagen efter. Hvis hamphandsken deles, skal den ligge 1 time i eddike blandingen før næste person bruger den.

SMØR DIG IND I SALVE ELLER LOTION DAGLIGT HVOR DU HAR TILFØJET 30DRÅBER TEA TREE OG KRYDDERNELLIKE OLIE (ÆTERISK 100%) det dræber fnatmidens små larver der hopper af og på kroppen fx via sengetøj eller lang tids ophold i sofaen på samme sted. Hav altid tøj på i sofaen så intet bar hud berører sofaen.

Sprøjt gerne sofa og møbler med EXNER PETGUARD billigst hos zooplus.dk 69kr men fås også i maxizoo 149kr.
alternativt kan møbler tørres over med en klud med opblandet klorin. 1dl til ca 4 liter vand.

OBS din krop vil klø i mindst 14 dage efter fnatmiderne er døde.. det er det der gør det så svært at vurdere samt føle sig fri for fnat…..

Mvh. info@fnat-kur.dk

KILDER :

Artikel for persisterende Fnat behandling oralt dag 1,2,8,15 https://www.cdc.gov/parasites/scabies/health_professionals/meds.html se nederst i dette dok.

Yderligere info: https://www.healthline.com/health/tea-tree-oil-for-scabies
brug 100% ren tea tre olie der hvor du kan se der er fnat – laboratorie forsøg viste en dødelig af alle mider efter 20-50min ved påførsel af Tea tree olie – dog kun 5% olie i en opløsning. Men da 100% æterisk Tea tree olie er en af de få æteriske olier der må påføres huden, er det tilrådeligt ikke at opblande tea tree. Der sælges sæbe og lotion med Tea tree, det kan meget vel forhindre en smitte med fnat, men det er desværre ikke påvist at det er nok til at behandle effektivt mod fnat.
Kur når NIX ikke virker, eller sammen med NIX - Dilute 100 percent tea tree oil in a carrier oil such as coconut oil or jojoba oil. (The usual recipe is 3 to 5 drops of pure tea tree oil in 1/2 to 1 ounce of carrier oil.) Apply head-to-toe twice per day for seven days.

Kokos olie og Aloe Vera creme, gel, lotion kan bruges i behandling mod fnat, meget gerne tilsat pebermynte/mint for at tage kløen – findes i grønne tuber til 16kr. i ”Normal” Butikker

Ivermectin har en halveringstid i kroppen på 12-36 timer og forefindes i kroppen tre dage efter indtagelse
 

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SVÆRE ANGREB AF FNAT – dvs. ved mere end 10-15 sår/gange

https://www.cdc.gov/parasites/scabies/health_professionals/meds.html samme som nedenstående artikel
Depending on infection severity, ivermectin should be taken in three doses (approximately days 1, 2, and 8), five doses (approximately days 1, 2, 8, 9, and 15), or seven doses (approximately days 1, 2, 8, 9, 15, 22, and 29).

Topical permethrin should be administered every 2-3 days for 1-2 weeks to treat crusted scabies – dvs. Hvis der er megen sårskorpe-dannelse skal der smøres med NIX hver 2. eller 3.dag i 1-2 uger.

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Medications

Products used to kill scabies mites are called scabicides. No “over-the-counter” (non-prescription) products have been tested and approved to treat human scabies.

The following medications for the treatment of scabies are available only by prescription.

Classic scabies: one or more of the following may be used

1. Permethrin cream 5% Brand name product: Elimite* Permethrin is approved by the US Food and Drug Administration (FDA) for the treatment of scabies in persons who are at least 2 months of age. Permethrin is a synthetic pyrethroid similar to naturally occurring pyrethrins which are extracts from the chrysanthemum flower. Permethrin is safe and effective when used as directed. Permethrin kills the scabies mite and eggs. Permethrin is the drug of choice for the treatment of scabies. Two (or more) applications, each about a week apart, may be necessary to eliminate all mites. Children aged 2 months or older can be treated with permethrin.

2. Crotamiton lotion 10% and Crotamiton cream 10% Brand name products: Eurax*; Crotan* Crotamiton is approved by the US Food and Drug Administration (FDA) for the treatment of scabies in adults; it is considered safe when used as directed. Crotamiton is not FDA-approved for use in children. Frequent treatment failure has been reported with crotamiton.

3. Sulfur (5%-10%) ointment (multiple brand names) Sulfur in an ointment base (petrolatum) is safe for topical use in children, including infants under 2 months of age. The odor and cosmetic quality may make it unpleasant to use (CITE KARTHIKEYAN 2007).

4. Lindane lotion 1% Brand name products: None available Lindane is an organochloride. Although FDA-approved for the treatment of scabies, lindane is not recommended as a first-line therapy. Overuse, misuse, or accidentally swallowing lindane can be toxic to the brain and other parts of the nervous system; its use should be restricted to patients who have failed treatment with or cannot tolerate other medications that pose less risk. Lindane should not be used to treat premature infants, persons with a seizure disorder, women who are pregnant or breast-feeding, persons who have very irritated skin or sores where the lindane will be applied, infants, children, the elderly, and persons who weigh less than 110 pounds.

5. Ivermectin Brand name product: Stromectol* Ivermectin is an oral antiparasitic agent approved for the treatment of worm infestations. Evidence suggests that oral ivermectin may be a safe and effective treatment for scabies; however, ivermectin is not FDA-approved for this use. Oral ivermectin should be considered for patients who have failed treatment with or who cannot tolerate FDA-approved topical medications for the treatment of scabies. If used for classic scabies, two doses of oral ivermectin (200µg/kg/dose) should be taken with food, each approximately one week apart. The safety of ivermectin in children weighing less than 15 kg and in pregnant women has not been established.
   Note that although ivermectin guidelines recommend taking on an empty stomach, scabies experts recommend taking with a meal to increase bioavailability (CITE NEJM Currie article).

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Crusted scabies/fnat med sårskorber: brug bade NIX og Tabletter / both oral and topical agents should be used

1. Ivermectin Brand name product: Stromectol* Ivermectin is an oral antiparasitic agent approved for the treatment of worm infestations. Evidence suggests that oral ivermectin may be a safe and effective treatment for scabies; however, ivermectin is not FDA-approved for this use. The safety of ivermectin in children weighing less than 15 kg and in pregnant women has not been established.
   For crusted scabies, ivermectin should be administered together with a topical agent. Oral ivermectin (200µg/kg/dose) should be taken with food. Depending on infection severity, ivermectin should be taken in three doses (approximately days 1, 2, and 8), five doses (approximately days 1, 2, 8, 9, and 15), or seven doses (approximately days 1, 2, 8, 9, 15, 22, and 29).

2. Permethrin cream 5% Brand name product: Elimite Permethrin is approved by the US Food and Drug Administration (FDA) for the treatment of scabies in persons who are at least 2 months of age. Permethrin is a synthetic pyrethroid similar to naturally occurring pyrethrins which are extracts from the chrysanthemum flower. Permethrin is safe and effective when used as directed. Permethrin kills the scabies mite and eggs. Permethrin is the drug of choice for the treatment of scabies. Topical permethrin should be administered every 2-3 days for 1-2 weeks to treat crusted scabies.

3. Benzyl benzoate 25% (with or without tea tree oil) Benzyl benzoate may be used as an alternative topical agent to permethrin. However, this agent may cause immediate skin irritation. Lower concentrations may be used in children (10% or 12.5%).

4. Keratolytic cream A topical keratolytic cream may also be used to help reduce the crusting of the skin and aid in the absorption of the topical permethrin or benzyl benzoate.

References:

Currie B, McCarthy J. Permethrin and ivermectin for scabies. N Engl J Med 2010; 362:717–725. Karthikeyan, K. Scabies in children. Arch Dis Child Educ Pract Ed 2007;92:ep65-ep69 doi:10.1136/adc.2005.073825

Pasay C, Mounsey K, Stevenson G, et al. Acaricidal activity of eugenol based compounds against scabies mites. PLoS One 2010; 5:e12079.

Strong M, Johnstone PW. Interventions for treating scabies (update). Cochrane Database Syst Rev 2010:CD000320.

Sharma R, Singal A. Topical permethrin and oral ivermectin in the management of scabies: A prospective, randomized, double blind, controlled study. Indian J Dermatol Venereol Leprol 2011; 77:581–586.

Currie B, Davis J. Crusted (Norwegian) Scabies Grading Scale and Treatment Planpdf icon. Department of Health and Families. Northern Territory Government. 2012.

Udbrud af fnat hos vaskeriarbejdere i USA – så bær handsker eller desinficer hænder efter berøring af sengetøj og tøj.
https://www.aafp.org/afp/2003/0915/p1089.html

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LÆS OGSÅ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2805991/

Paediatr Child Health. 2001 Dec; 6(10): 775–777.

doi: 10.1093/pch/6.10.775

PMCID: PMC2805991

PMID: 20084154

Scabies management

Copyright and License information Disclaimer

Cet article est disponible en français. Voyez "La prise en charge de la gale".

Scabies has been a problem for humans since before the first millennium and was reported by the earliest writers who described mankind’s health problems (1). It is caused by a mite, Sarcoptes scabiei var hominis, and is transmitted from person to person by skin-to-skin contact. The more parasites that are on a person, the greater the chance for spread. This also suggests that spread can occur from clothing and bed linen; however, the mites do not survive long once they are off the skin (2,3).

Burrowed into the epidermis, the mite, its feces and ova laid by females seem to cause the irritation that leads to itching and secondary infection from scratching (1,3). The itching is worse at night. Scabies can be a problem for all age groups and is often confused with other conditions such as impetigo or eczema, particularly in infants and young children (1).

It is estimated that there may be 300×106 cases of scabies worldwide each year. In some areas, scabies has a much higher prevalence than diarrhea or upper respiratory disease. It is particularly a problem in situations of overcrowding, and in less developed countries and communities. Noncompliance or a lack of adequate treatment can result in scabies as a public health problem. It can be a ‘marker’ disease for immunocompromised patients, and the crusted form of scabies is not only difficult to treat, but is also highly contagious and presents a risk to health care workers.

The incubation period for scabies is about three weeks, but reinfestation can occur much faster. The main symptom is itching, which is worse at night. In older children and adults, the main areas infested are the web spaces between the fingers, the flexor aspect of the wrists and elbows, the axillae, male genitalia and women’s breasts. Skin scrapings are used to make a definitive diagnosis, if they are taken from the burrows or other lesions and examined under a low power microscope. Mites, feces or eggs can be seen on the microscope slide; however, the diagnosis is usually made clinically, rather than by microscope. The diagnosis of infants and children can be a problem because they often have atypical lesions that are generally distributed; however, the lesions usually are concentrated on the hands and feet, and in body folds. These lesions can be confused with impetigo or eczema, but if treatment is prescribed for impetigo or eczema, it does not cure the scabies. Lesions are often also seen on the scalps of infants and children.

The Aboriginal population in all countries (including Canada), and in both rural and urban areas is particularly at risk because of a number of factors:

• crowded housing, shared beds, and crowded schools and day care centres;

• a high paediatric population;

• failure to recognize an infestation;

• reduced access to medical or nursing care;

• faulty application of treatment regimens;

• failure to treat close contacts;

• failure to eradicate scabies from clothing and bed linen; and

• a lack of running water, which may predispose people to secondary skin infection.

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COMMUNITY CONTROL OF SCABIES

There is no recent estimate of the extent and prevalence of endemic scabies in Aboriginal communities across Canada. As in other parts of the world, epidemics tend to follow a cyclical pattern, occurring every 15 to 30 years. For the most part, health care workers treat symptomatic cases and contacts as they present. This approach, while eradicating symptoms in patients, often does little to alter the overall prevalence of scabies infestation within a community. Only by introducing mass treatment programs for a whole community, within a short period of time, may the prevalence of infestation be reduced. Studies have shown that this is possible by using either permethrin or ivermectin (ivermectin is not licensed for use in Canada). When properly applied, 5% permethrin (Kwellada-P Lotion, Reed & Carnick, Canada; Nix Dermal Creme, Glaxo Wellcome, Canada) has been found to be as effective as ivermectin. The advantage of ivermectin is that it is a one dose, oral medication (1,3,4).

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TREATMENT OF SCABIES

The first-line drug for scabies is 5% permethrin cream. It has low toxicity and excellent results. It is at least as effective as lindane (Hexit, Odan Laboratories Ltd, Canada; PMS-Lindane, Pharmascience Inc, Canada) and more effective than crotamiton (not available in Canada). Permethrin should be washed off after 8 to 12 h.

Permethrin acts by disrupting the sodium channel current, resulting in delayed repolarization, paralysis and death of the parasite. It is effective during all stages of the life cycle of the parasite. It is not recommended for infants younger than two months of age, but has been used successfully and safely in a 23-day-old infant. It is also not recommended during pregnancy, but has been successfully and repeatedly used in pregnant women with crusted scabies (3,5,6).

There is also a preparation of permethrin to treat head lice, which is a 1% solution (Kwellada-P Creme Rinse, Reed & Carnick; Nix Creme Rinse, Glaxo Wellcome) that is not effective in treating scabies. The two preparations should not be confused because they are not interchangeable.

Lindane cream or lotion is an alternative when 5% permethrin is not available. It should be washed off after 12 h and reapplied 24 h later. Lindane should be prescribed cautiously for infants younger than two years of age, and in pregnant and lactating women.

Precipitated sulphur (7%) in petroleum jelly is a safe alternative therapy for very young infants, and pregnant and lactating women. The pharmacist prepares it. It is applied on three consecutive days, left on for 24 h after application and washed off before the next application (1).

The infested patient, his or her family and any close contacts must be treated at the same time, regardless of whether they have symptoms. The reason for the treatment must be clearly and thoroughly discussed with the patient (if old enough to understand), as well as with the family and close contacts. Written instructions are helpful, particularly in a language understood by the family, eg, Syllabics and languages other than English or French. The prescribed treatment is applied after a tepid bath or shower and drying. The creme must be applied to the whole body, with particular attention being paid to skin folds, fingernails, toenails, behind the ears and the groin. The mite is found in all areas, even those without signs; therefore, the face and scalp must also be treated, particularly in young infants and children. Clothing should be changed daily, and clothes and bed linen should be washed in hot water (60°C).

Patients should be advised that itching may last after the mites are dead due to a reaction to material still in the skin. The persistence of symptoms may be due to a reaction to the prescription, but is more frequently caused by an inadequate application of the treating agent and the inadequate treatment of contact cases, both in the family and in the community. An oral antihistamine may be used to control the itching, and skin infections can be treated with oral antibiotics.

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CONTROL MEASURES

Prophylactic therapy is essential for all household members, especially because signs of scabies may not appear for two to three weeks after contact. The following control measures are recommended.

• To prevent reinfection, treat all household members at the same time as the patient is being treated.

• All bed linen (sheets, pillow cases, blankets) and clothing worn next to the skin (underwear, T-shirts, socks, pants) should be laundered in a hot cycle wash and hot drying cycle.

• If hot water is not available, place all linen and clothing into plastic bags and store it away from the family for five to seven days. The mite does not survive beyond four days without skin contact.

• Children may return to day care or school the day after treatment is completed.

• Health care workers who have close contact with scabies patients may require prophylactic treatment.

• Community education (ie, early recognition and awareness of scabies) is recommended.

In widespread scabies epidemics, prophylactic treatment of the whole community may be optimal (1,3).

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FUTURE MEASURES

Ivermectin, a member of a family of macrolytic lactones, the avermectins, has broad spectrum activity against parasites. It binds to glutamate-gated chloride ion channels, which are present in invertebrate nerve and muscle cells, causing paralysis and the death of the parasite. It does not easily cross the blood-brain barrier in humans and has a low affinity for mammalian ligand-gated chloride channels. Ivermectin has been used for many years in veterinary medicine to control a wide variety of parasites in farm and domestic animals. Since 1987, it has been used to control onchocerciasis and strongyloidiasis. The United States Food and Drug Administration has licensed it for the treatment of these diseases, but not for the treatment of scabies. As noted above, ivermectin has not been licensed in Canada. However, since 1993, it has been successfully used in other countries to treat human scabies that is resistant to other treatment. The advantage of using ivermectin is that it is given orally as a single dose. It has been used as a public health measure to control widespread scabies in population groups.

Currently, any advantage of ivermectin over standard topical therapy is questionable. One study did not find any advantage over permethrin, which acts at all stages of the parasite’s life cycle (6). Ivermectin acts only at certain stages of the life cycle of the parasite, as reported with onchocerciasis and strongyloidiasis (6–12).

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SUMMARY

Scabies is a public health problem for many reasons. The oral preparation used in some countries is not licensed in Canada. Secondary infection due to scratching complicates the diagnosis, but once the diagnosis is confirmed, the first-line treatment is 5% permethrin creme and the control of contacts.

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Footnotes

INDIAN AND INUIT HEALTH COMMITTEE

Members: Drs Garth Bruce, Royal University Hospital, Saskatoon, Saskatchewan (director responsible); Jim Carson, University of Manitoba, Winnipeg, Manitoba (chair); James Irvine, La Ronge, Saskatchewan; Keith Menard, Stanton Medical Clinic, Yellowknife, North-West Territories; Brian Postl, Winnipeg Hospital Authority, Winnipeg,

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Gravid, ammende eller børn under 15kg er der ingen der rigtig vil tage ansvar for. Men homøopati har vist sig virksomt hos foreløbig en familie. Psorinum D30 fx Dr Reckeweg R21

20 dråber i en lille mundfuld vand til voksen 3x dagligt til symptomerne har været væk i en uge. 2 dråber på tungen til baby 1x daglig til symptomer har været væk en uge.
https://www.helsebixen.dk/shop/dr-reckeweg-r-3179p.html

Kolloid sølv kan også bruges til at få bugt med æg, men ikke med voksne mider – det er usikkert om kolloid sølv er virksomt mod laver – men det er virksomt mod æg og kan bruges af ovennævnt særgrupper.
Dette ved vi fordi et familiemedlem kom hjem fra Nyk.F sygehus efter fødsel og et par dage på barselsgangen MED Fnat FRA SYGEHUSET. Et vennepar fik ligeledes fnat fra nyk. F sygehus da manden var indlagt til operation med dårligt knæ. De 2 episoder ligger 2år fra hinanden. I 2017 og i 2019 ! barselsgangen blev informeret men det kendte sekretæren ikke noget til ……