2 Name of disease: Sarcoidosis
3 English name scabies
4. The alias of scabies is scabies; scabies
5 classification dermatology > parasites, insects and other animal dermatoses >: dermatoses caused by arthropods.
6 ICD number B86
7 Epidemiology Until 1687, scabies became a disease with definite etiology abroad. Sarcoidosis can occur in all age groups, with no gender difference. It can be infected through close skin contact, and it is very common to spread it through sexual contact or non-sexual contact within the family. The more scabies there are in patients, the greater the possibility of transmission.
Sarcoidosis was widely prevalent in the old society of our country, and it was basically eliminated after liberation, but it has been prevalent everywhere in the past 30 years. Other countries in the world have similar situations. It is considered that sarcoidosis can be epidemic periodically, with a period of 30 years, and the interval from the end of one epidemic to the beginning of the next epidemic is 15 years. The reasons for it were not known It may be caused by many factors, such as poverty, sanitary conditions, chaotic sexual relations, wrong diagnosis, increased tourism, climate change, population growth, ecological conditions and immune abnormalities. These may be the trigger factors for the epidemic of sarcoidosis, and the reasons are very complicated.
Sarcoidosis spread through sexual relations is more common in Europe and America. Although it is possible in China, it can also be spread by other means, such as close contact, crowded homes, poor sanitary conditions, poor collective living conditions, and contact with people in cars, boats and hotels.
Sarcoidosis was prevalent in China before liberation. After liberation, people's living standards improved, and medical prevention and control work was rapidly developed and improved. By the 1950s, sarcoidosis had been basically eliminated (except Xinjiang), but it has gradually become popular in recent 20 years. According to preliminary investigation, Xinjiang residual sarcoidosis has never stopped. Sarcoidosis found in Changsha 1969 was also spread by Vietnamese interns. 199. Therefore, it is considered that the re-epidemic in Xinjiang may be the re-spread of unsolved sarcoptic mites, and the re-epidemic in China is related to the worldwide epidemic, that is, it was introduced from Vietnam. The epidemic situation is characterized by fierce momentum, which spread from south to north and from cities to rural pastoral areas in a few years or so. Now it has spread all over the country. It is distributed in southern areas such as Guangdong, Guangxi, Fujian, Sichuan, Yunnan, Guizhou, Hunan, Jiangsu, Anhui, Jiangxi, Zhejiang and other places, and less in the north except Xinjiang.
Chinese medicine, also known as sarcoidosis or sarcoidosis, was discovered as early as the Sui Dynasty. For example, in the theory of disease source, there are several sarcoidosis, such as sarcoidosis, equine sarcoidosis, water sarcoidosis, dry sarcoidosis and wet sarcoidosis. ..... and there are bugs, and people often pick them with needles, just like bugs in water. Another example is the record of sarcoidosis in Jin Jian: "Sarcoidosis includes dryness, dampness, insects, sand and pus ... Sarcoidosis starts from hands and feet, spreads all over the body, and itches excessively". (Figure 1, 2)
The causes of TCM are mostly wind, dampness, heat stagnation in the skin and contact infection [2]. "Pathogenic Staging Theory" Volume 50: "Sarcoidosis mostly occurs between the toes and gradually develops into the body, itching and pus ... There are worms in the sores, which are hard to see." Sarcoptes scabies has been identified as its pathogen [2].
9 etiology of sarcoidosis sarcoidosis is a chronic infectious skin disease caused by human sarcoidosis parasitic on the surface of human skin. The disease is highly contagious, mainly through close contact, but also indirectly through clothes, underwear and towels, and can be popular in families or collective people. Female worms can survive for at least a few days after leaving the human body, and the incubation period is about 1 month or as long as 2 months. Severe itching of skin may be caused by acquired sensitivity of human body to worms.
Sarcoptes scabies, commonly known as Sarcoptes scabies, is a wide variety of internal parasites. Human scabies are mainly caused by human scabies. There are two kinds of scabies, male and female. The female is about 400μm long and visible to the naked eye. Mature females are oval and flat, yellow and white. They don't have definite heads, but their mouths protrude from the front edge of their bodies, which is often mistaken for heads. It has four pairs of feet, each pair has five joints. The first two pairs have suckers at the ends, and the last two pairs are long-tailed bristles. There is a spawning hole in the center of the abdomen, and the center of the trunk area is * * *. The male worm is half smaller than the female worm, and the sarcophagus crawls quickly on the warm skin, walking 2.5cm 1 min. Mature females enter the stratum corneum in appropriate skin areas and hide under it. The first two pairs of claws extend into the junction of stratum corneum and granular layer to absorb nutrients from the cells there.
The life history of sarcoptes scabies can be divided into four stages: egg, larva, nymph and adult. Mature females can lay 40-50 eggs a day when digging a tunnel of 0.5-5 mm, and lay the first batch of eggs within a few hours. When laying eggs, they also excrete feces and die at the blind end of the tunnel after laying eggs. The average survival time of females is 6-8 weeks.
Eggs are oval, yellowish in color and thin in shell, about half the size of female insects. After the eggs hatch in the tunnel for 3 ~ 4 days, they form larvae, which are similar in shape to adults. Only three feet. It can remain in the tunnel for 1 day. Then it moves on the skin surface, quickly digs a tunnel in the skin, and hides and ingests food in the tunnel. After about 3 days, the larva becomes a nymph, which has four pairs of feet and can be divided into male and female. At this time, male and female nymphs mate in the epidermis at night, and most males die after mating. Female nymphs bore into the stratum corneum of human skin for 2 ~ 20 minutes after mating, and soon shed their shells into adults, and fertilized eggs in the body after 2 ~ 2 minutes. It takes about 7 ~ 10 days from egg production to adult.
There are two pathogenic factors of sarcoptic mites, one is the mechanical damage to the skin caused by tunneling in the stratum corneum, and the other is the itching of the skin caused by the toxin secreted by sarcoptic mites.
Sarcoidosis is mainly caused by close infection between sarcophagus and human body, and can also be spread through clothes, underwear and towels. Female worms can survive for at least a few days after leaving the human body, and the incubation period is about 1 month or as long as 2 months. Severe itching of skin may be caused by acquired sensitivity of human body to worms.
10 pathogenesis delayed allergic reaction plays a very important role in the pathogenesis of sarcoidosis. However, the detection of serum immunoglobulin level can slightly reflect the activity of B cells during the infection period of sarcoptic mites. During the infection period, IgA decreased significantly, IgG and IgM levels increased significantly, and returned to normal after treatment. The serum IgE level of sarcoidosis patients was significantly higher than that of normal people, and the IgE level decreased after the patient was cured. IgE produced by scabies infection is specific and does not cross with dust mite antigen.
Hoefling found that IgM and C3 were deposited on the dermal vascular wall of sarcoidosis patients, similar to cutaneous vasculitis, while granular IgM and IgG were deposited at the dermal junction, similar to lupus erythematosus, indicating that sarcoidosis has humoral immune components. Neste et al. detected the antigen-antibody complex binding to complement C 1q in the serum of sarcoidosis patients. Another study found that Langerhans cells in patients' epidermis were damaged, the density decreased, the dendrites decreased or shortened or the cell body increased, and the intracellular vacuoles and mitochondrial cristae were broken. Sarcoidosis patients who have been treated for one year are often allergic to sarcoidosis extracts. In sarcoidosis patients, the function of inhibitory T cells in regulating B cells is defective.
There may be several reasons for skin damage caused by sarcoidosis:
① The pruritic red papule of sarcoidosis is directly caused by the infiltration of sarcoptic mites into the skin;
(2) The formation of blisters or pustules may be due to the expansion and exudation of blood vessels of epidermal and dermal cells caused by the excrement of scabies mites or cuticle as sensitizers;
③ The tunnel was caused by the excavation of sarcophagus;
(4) Nodules are an allergic reaction to scabies antigen.
1 1 The most common clinical manifestation of sarcoidosis is finger suture, which is also common in armpit, elbow fossa, umbilicus, groin, buttocks and legs, and even the whole body [2]. Miliary papules and blisters, severe itching, especially at night [2]. Common scratches and scabs on the body surface; If the skin is scratched and then infected and suppurated, it is called abscess scabies [2].
Sarcoptes often invade the thin and tender parts of the skin, so the onset of sarcoptic disease mostly starts from the fingers and symmetrically occurs in wrist flexion, axilla, areola, umbilicus, * * and inner thigh. Sarcoidosis in infants and young children is often secondary to eczema-like changes with atypical distribution, which can involve the head, neck, palms and toes (Figure 3). Those who wash their hands often have no or only a few injuries to their hands.
The skin lesions of sarcoidosis are mainly red papules, blisters, pustules and sarcoidosis tunnels. Papules are often scattered or densely clustered, rarely fused, and some can evolve into papules. Blisters generally range from rice grains to mung beans, which are more common between fingers. The tunnel is about 0.5 ~ 1 cm long, with gray or light black arc and papules and blisters at the top. Some typical tunnels are not easy to see and may be destroyed by cleaning, scraping or secondary lesions. Long-term scratching can lead to suppurative infection, eczema-like transformation or lichenization. In addition, in the scrotum, * * *, * * and other places, reddish-brown nodular damage can occur. It can also cause systemic wheal papules and urticaria due to allergies to sarcophagus feces (Figure 4). Severe cases may occasionally be accompanied by acute nephritis.
Itching at night, itching slightly during the day, may be caused by the frequent activities of the sarcophagus at night, the toxin secreted by the sarcophagus, and the nerve endings of the skin when digging tunnels in the skin. Scratching often leads to scratches, scabs, pigmentation, eczema-like changes or secondary infections, such as impetigo, folliculitis, furuncle, lymphadenitis and even nephritis. When the damage is found, the scabies can be diagnosed.
There are several special forms of sarcoidosis that are very difficult to treat, as follows:
1 1. 1 Sarcoidosis of people who pay attention to hygiene. Because sarcoidosis patients pay great attention to hygiene, it is difficult to find skin lesions, tunnels and caves.
1 1.2 The application of glucocorticoid (local or systemic) in occult sarcoidosis may cover up the symptoms or characteristics of sarcoidosis, but it does not affect the spread of sarcoidosis, so it often leads to atypical clinical manifestations and wide spread of sarcoidosis.
1 1.3 The probability of suspected sarcoidosis in infants is very low. Secondly, eczema and improper treatment will lead to misdiagnosis. Infantile sarcoidosis is mainly characterized by itching and rash, which often involves the face, scalp, palms and soles. The most common skin lesions are papules, pustules and nodules. Secondary eczema and pustular herpes are common, but sarcophagus caves are very difficult to find. In a family, the youngest child is often infected because it is often taken by sick adults. Sarcoidosis is the most common among children under two years old. There are different diagnoses, such as atopic dermatitis and papular urticaria.
1 1.4 sarcoidosis in the elderly, the response to sarcoidosis is weak, just like allergies or dermatitis, but the itching is serious. Obvious inflammatory reaction is common in young people, but in the elderly, it is often not realized as sarcoidosis, but classified as "senile skin itching", dry skin or anxiety. For the elderly who are often taken care of, especially those who stay in bed for a long time, sarcoidosis is prone to occur on their backs confined to continuous contact with sheets, which is more special than young people.
1 1.5 Scabies (Norway) Scabies (Norway) Scabies are uncommon and highly contagious because there are countless scabies in the scales that fall off. There may be nail malnutrition and erythema scale-like changes, similar to psoriasis. Patients tend to itch slightly. Common in people with mental retardation, physical weakness or immunosuppression. Some patients developed T-lymphocytic leukemia.
1 1.6 Sarcoptes and AIDS Sarcoptes and AIDS have some overlap. About 2% ~ 4% of AIDS patients develop sarcoidosis. It is often sarcoidosis and atypical sarcoidosis. Most patients were considered as drug reactions, but the symptoms did not disappear after stopping the drug. Atypical can increase the possibility of sarcoidosis spreading to others. Once AIDS patients have itching symptoms, sarcoidosis can be suspected. It may also coexist with its opportunistic infection or occur after other opportunistic infections.
1 1.7 scabies can occur in infants, the elderly who receive special care, people who live in tropical areas and suffer from sarcoidosis and AIDS patients with sarcoidosis. Besides these, sarcoidosis is rare.
1 1.8 bullous sarcoidosis blisters are common in children with sarcoidosis, but rare in adults. Adult bullous sarcoidosis may be similar to bullous pemphigoid in clinic, and most patients are over 65 years old. Most patients were mistaken for bullous pemphigoid and given corticosteroids. It is common to form caves in the skin.
12 patients with severe complications of sarcoidosis may occasionally be accompanied by acute nephritis.
13 histopathological examination: irregular spinous layer thickening, inflammatory cells extravasation, sponge formation and even blisters appeared on the epidermis. Most tunnels are located in the stratum corneum, and worms or eggs can be seen. Dermal perivascular inflammation with obvious cell infiltration.
14 diagnosis of sarcoidosis According to the contact history and infection history, the most common skin lesions are soft skin, itching, severe itching at night, and rash with tunnel and mound herpes as the main parts. It's not difficult to diagnose. This diagnosis is especially correct if it can be found in the broken part of the sarcophagus.
Test method of scabies mite:
14. 1 The way to find the tunnel is to drop blue ink on the suspected tunnel skin lesion, rub it with a cotton swab for 30 seconds to 1 min, and then remove the black mark on the surface with an alcohol cotton ball, and the tunnel mark dyed light blue can be seen.
14.2 Needle picking revealed finger scabies tunnel, wrinkles on palms and wrists, blisters and pustules. And carefully find the end of the tunnel, find the white spot, which is the easiest place to find scabies rash.
Methods: No.6 injection needle was selected, the included angle between the needle and the skin plane was10 ~ 20, and the inclined plane of the needle mouth was upward. At the wormhole point at the end of the wormhole, insert the needle at about 1mm perpendicular to the wormhole long-wheelbase wormhole point, directly insert it at the bottom of the wormhole point and bypass the worm, then level the needle bar (at 5 ~ 10) and slightly rotate it, so that the sarcophagus falls into the hole slot of the needle mouth, and slowly pick out (or directly pull out) the needle. Move to a glass slide with water (or 10%KOH, NS), and then examine the sarcophagus under a microscope.
14.3 advocate scraping method to check papules. First, soak the sterilized surgical blade in a little mineral oil to find new inflammatory papules. Scrape the horny part at the top of the pimple several times until tiny spots appear in the oil droplets. After scraping out 6-7 papules, move to the slide. Under the microscope, larvae are often found, and occasionally eggs and insect droppings are found.
15 The differential diagnosis of sarcoidosis should be differentiated from the following diseases:
15. 1 Itchy prurigo mostly starts from young children. Chronic course of disease, with large papules, often occurs on the extension side of limbs. After a chronic course of disease, it begins in early childhood and gets worse in autumn and winter, often accompanied by swollen inguinal lymph nodes.
15.2 Eczema Eczema is a polymorphic skin lesion, which often fuses into sheets and is easy to wet and ooze. There is no specific preferred location.
15.3 The skin lesions of lice disease are mainly secondary scratches, which are common in armpit flanks, waistline, * * and skin in contact with wrinkles at the seams of clothes. Lice and eggs can be seen, and there is no rash between fingers.
15.4 pustulosis pustulosis is more common in children, mainly in exposed parts such as the head and face, with small pustules at first and yellow pus scabs after rupture, mostly in summer and autumn.
15.5 Papillary urticaria Papillary urticaria is mostly scattered small papules, papules or hard blisters, which form small wind masses after scratching, and there are still small papules after the wind masses subside. Most children are allergic, often accompanied by gastrointestinal dysfunction and tonsillar enlargement, which easily occurs after insect bites.
15.6 itchy skin with no fixed parts and few fingers. Patients with pruritus are mainly itchy skin, and the skin lesions are mostly scratched twice. The onset is often related to mood swings, visceral diseases or menopause.
16 treatment of sarcoidosis the principle of local treatment of sarcoidosis is to kill insects and relieve itching and deal with complications. Treat with 10% sulfur ointment or Youlifu. After the treatment, Qin Ying took a bath and disinfected his clothes and bedding. Residents should pay attention to isolation and disinfection.
16. 1 commonly used drugs16.1(1) 10% ~ 20% sulfur, 20% benzyl benzoate, 1% lindane cream/kloc. Benzyl benzoate emulsion has strong insecticidal activity and no * * *. Apply 1 ~ 2 times a day for * * * 2 ~ 3 days, and the effect is good.
You can also use 1% lindane cream, that is, 666 cream (benzene hexachlorobenzene, GBH) solution, which is the most commonly used and effective insecticide to control sarcophagus at present. The medicine should be applied from the neck down to the whole body, and special attention should be paid to the prone parts such as fingers, wrists, elbows, armpits, buttocks and external parts. Generally, it takes an average of 30 ~ 60g or 60 ~ 120ml for an adult to rub his trunk and limbs. After external use of this medicine, keep it for a certain period of time and wash it off completely within 24 hours. Drugs should not touch eyes and mucous membranes. This medicine can be absorbed through the skin. If the concentration is too high or stays in the skin for too long, it is easy to cause neurotoxicity. Therefore, it is not suitable for infants, pregnant women and lactating women, as well as patients with seizures or other nervous system diseases.
16.1.2 (2) 10% clomiphene citrate (10% ethyl o-butyltoluidine, Youlisi) was smeared with cold cream twice a day, kept for 48 hours after smearing, and then washed off. This medicine has antipruritic effect and can also have primary effect.
16.1.3 (3) 5% ~ 10% thiabendazole 5% ~10% thiabendazole emulsion, twice a day for 5 days, or orally take 2 1 thiabendazole [25mg
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16. 1.4 (4) Corticosteroid preparation For patients with severe itching, corticosteroid preparation can be used externally, or corticosteroid preparation such as prednisone can be taken orally for a short time (7 ~ 10 days), and gradually decrease after itching is relieved, and hormone is injected into scabies and external hormone ointment or focus.
1 6.10.5 (5) pesticide derris root powder 30g pesticide derris root powder, soap powder (or broken soap) 30g, hot water 300ml, mixed and kneaded, dried, bandaged,1time, once a day, and the effect is very good for two days.
16. 1.6 (6)5% permethrin and 5% sulfur emulsion can be used to treat infantile sarcoidosis, and the curative effect is very good.
16.2 prescription treatment is mainly external treatment [2]. Firstly, 9g of Zanthoxylum bungeanum and 30g of Kochia scoparia were decocted and fumigated, and then externally applied with Fructus Cnidii powder, smelly elixir, broom sweeps and sulfur ointment [2].
16.3 treatment of routine sarcoidosis: take a bath and change clothes before treatment, and don't take a bath and change clothes during rubbing to maintain the curative effect. When applying the medicine, apply 1 time to the prone areas and injury-intensive areas, and then generally apply it to the whole body. The kneading time is 1 time, every morning and evening, 3 days is a course of treatment, and a second course of treatment can be carried out if necessary.
After the treatment, put on clean clothes. After treatment, it needs to be observed for 1 ~ 2 weeks (because it takes about 10 days for sarcophagus eggs to become adults). If no new injury occurs, it can be considered as cured. If a new rash is found after 2 weeks, the second course of treatment should be repeated.
After each course of treatment, take a shower and change clothes first. After changing clothes, mattresses, sheets and other things, you can boil them in water or soak them in disinfectant (such as benzalkonium bromide) to completely eliminate sarcophagus and eggs. Cohabitation patients should be treated at the same time to eradicate the source of infection.
The prognosis of 17 is that severe sarcoidosis may occasionally be accompanied by acute nephritis. Prognosis is closely related to diagnosis and treatment.
18 Pay attention to personal hygiene and wash clothes and quilts frequently in the prevention of sarcoidosis. Patients should be isolated and actively treated after they appear. Patients at home should be treated at the same time to eliminate the source of infection and prevent the spread of infection. Avoid contact with others before healing, including shaking hands. Clothes and bedding worn by patients must be disinfected or dried.
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