skin : scabies 7 Examination Support

1. Laboratory
On microscopic examination, expected to be found in the mites, either in the form of adults, larvae, or eggs through the skin scrape. The procedure of the microscopic examination through the skin is scrape (Cordoro, 2008):
- Mineral oil dripping on the glass object. Then with a scalpel blade no. Spoon curette 15 or 7 mm, after it is applied to the oil, carried out at scrape skin lesions found, mainly primary lesions, such as vesicles, papul, and tunnels. Avoid the occurrence of bleeding.
- Results scrape was then placed on an object glass and covered with glass for the deck and then examined on a microscope with magnification 400 x.
scrape skin can be done over and over again for more help in finding scabies (in various stages) or product (skibala, broken eggs). In scabies krustosa patients, may be added potassium hydroxide (KOH) to dissolve the keratin that is the skuama, but required a more thorough examination.
To find the existence of the tunnel (Burrow) on the skin, can be known by the following test (Cordoro, 2008):
- Test the ink; tip ink pen / ink dripped on the suspected area of the tunnel there. The ink is then going to fill the tunnel, unlike the surrounding area. The ink is cleaned out with alcohol. This method is useful in children - children and patients with a very small tunnel.
- Alternative ink tests (using tetracycline ointment) is an alternative topical tetracycline in ink testing. After smeared with tetracycline and cleaned with alcohol, the suspected area was examined under Wood's lamp. Tetracycline is left in the tunnel would cause flourensi yellowish color. This method is preferred because it is colorless and tetracycline skin area can be examined more widely.
Other laboratory tests can help diagnose include scabies (Binder, 2006):
- Increased levels of IgE and eosinophils in the blood.
- The health center can do a complete examination videodermatoskopi, epiluminens microscopy, and DNA amplification by PCR (polymerase chain reaction) using the ELISA method (enzyme-linked assay Immunosrbent).
2. Histopathology
Histological examination of scabies enough to determine a diagnosis, although there are a variety of arthropods reaction. If found in a tunnel, then the mites, larvae, eggs, and can be identified in skibala stratum korneum. Infiltrates of the superficial skin layer and a deeper, composed of lymphocytes, histiosit, mast cells, and eosinophils. Sometimes also obtained spongiosis and vesicle eksositosis composed of eosinophils and neurofil.
In scabies krustosa indicates massive hiperkeratosis stratum korneum with mites in large numbers and in various stages. Sometimes psoriasiform hyperplasia was also found under a layer of the epidermis with focal epidermal spongiotik and mikroabses. Dermis layer, chronic inflammatory infiltrates seem superficial and deep with some interstitial eosinophils (Cordoro, 2008).