Syyhy vuonna 2025 / miten lähtee pitkittynyt syyhy pois, kun lääkkeet ja voiteet eivät auta

Liki vuoden kestänyt syyhy ja sitä on tutkittu myös erikoissairaanhoidossa, jossa väitetään vain, ettei ole syyhyä (kun ei löydy punkkeja eikä käytäviä). Suomessa ainoat syyhyn poishäätökeinot ovat ivermektiini, permitiini, rikkivaseliini ja bentsyylibensoaatti. Kaikki kokeiltu ja syyhy vaan elää, sillä se tarttuu kumppaniin seksin ja samassa sängyssä nukkumisen myötä. Lääkeresistenttiin ei erikoissairaanhoidossa uskota. Kuinkakohan monta vuotta vielä saan pitää etäisyyttä muihin ihmisiin ja säännöllisin väliajoin käyttää hyödyttömiä lääkkeitä ja voiteita?

Jos on lääkärissä todettu ettei punkkeja tai käytäviä ole niin sitten sopii epäillä onko syyhystä kyse ensinkään. Tenutex on tosi vahvaa tavaraa, iho on varmasti aivan paskana jos sillä jatkuvasti läträä. Suosittelisin vielä kerran lääkärille palaamista. Uusia syyhylääkkeitä on tekeillä joten varmasti jossain vaiheessa tulee apuja lisää, siihen asti neuvoisin vielä kerran tarkistamaan ympäristön; onko jotain mistä punkit voisi tulla kotiin aina takaisin. Täysin hoitoresistenttiä punkkia ei ole maailmalla ainakaan diagnosoitu.

Edellinen kommentoija tässä vielä, jos enkku taipuu jätän tähän erään lääketieteellisen artikkelin 11 vuoden syyhystä, ja miten se saatiin kys. Potilaalta siltikin pois. Ehkä antaa toivoa asian kanssa taisteleville. On myös tekeillä/ valmistunut kaksi uutta syyhylääkettä maailmalla; moxidektiini ja spinosad jotka ovat osoittautuneet lupaaviksi hoitomuodoiksi. Syyhy ei ole parantumaton sairaus mutta joskus tosi sitkeä.

Eleven Years of Itching: A Case Report of Crusted Scabies
Cutis. 2014 August;94(2):86-88, 95
August 7, 2014|Cutis
Nurdan S. Kutlu, MD;Enver Turan, MD;Asli Erdemir, MD
Author and Disclosure Information

Crusted scabies is a rare and highly contagious form of scabies that is characterized by uncontrolled proliferation of mites in the skin, extensive hyperkeratotic scaling, crusted lesions, and variable pruritus. We report the case of a 48-year-old man with an 11-year history of pruritic, hyperkeratotic, psoriasiform plaques and widespread erythematous papules that was diagnosed as crusted scabies.
  
• Scabies usually is found in individuals with a compromised immune system as well as those with decreased sensory functions. Thus patients should be investigated for an underlying immunodeficiency.
• Treatment can be challenging, and effective management of the condition requires a keratolytic agent in conjunction with a scabicidal agent.

Case Report
A 48-year-old man presented to our dermatology clinic with pruritus of 11 years’ duration that worsened at night. He had been followed at a different clinic for several years and was unsuccessfully treated with topical permethrin and oral antihistamines on multiple occasions for scabies. He also had been intermittently treated for contact dermatitis with topical and systemic steroids, which also brought no relief. Just prior to his presentation, the patient’s wife and 8-year-old son had sought medical attention at our institution for chronic pruritus and elevated IgE levels. They had been unsuccessfully treated with topical permethrin, topical steroids, and oral antihistamines for atopic dermatitis at a different clinic. When they presented to our clinic, they were both diagnosed with and treated for scabies. At this visit the patient revealed similar concerns and subsequently underwent examination.

Physical examination revealed large erythematous, hyperkeratotic, scaly plaques on the gluteal fold, um-bilicus, glans penis, scrotum, bilateral elbows, knees, nipples, and ear helices (Figure 1). Numerous small erythematous papules and wavy threadlike gray burrows measuring 1 to 10 mm in diameter were distributed primarily around the wrists, ankles, proximal extremities, abdominal and pubic area (Figure 2), and interdigital spaces. Wide oval patches of nonscarring alopecia developed on the scalp, and atrophic glossitis and angular cheilitis were noted on the oral mucosa, along with a white pseudomembranous exudate on the palatum. The patient’s nails also were thickened and discolored (Figure 3). His medical history was remarkable for hypoparathyroidism (42 years), alopecia areata (15 years), oral candidiasis and angular cheilitis (10 years), and primary hypothyroidism (1 year) that was currently being treated with levothyroxine.

Laboratory studies revealed normal hemogram with an eosinophil level of 0% (reference range, 0.9%–6%). The patient tested negative for human immunodeficiency virus.
Dermoscopic examination of the gray threadlike burrows revealed distinctive brown-colored triangular structures that were removed with a fine scalpel. Microscopic examination of the tissue revealed moving mites, eggs, and red-brown scybala.
A biopsy was taken from the thick, scaly, crusted white plaques in the gluteal area. The epidermis showed massive hyperkeratosis and burrows in the subcorneal layer containing a large number of female mites and feces, while the remainder of the epidermis was substantially psoriasiform. A substantial lymphohistiocytic infiltrate with numerous eosinophils was seen diffusely throughout the dermis, though it was most prominent within the upper half. The patient subsequently was diagnosed with crusted scabies.
Crusted scabies typically develops in patients with defective T-cell immunity or a reduced ability to mechanically debride the mites. Because our patient had a history of persistent oral candidiasis, further investigation for immunosuppression was initiated.
The patient and his family were successfully treated with modified Wilkinson ointment (goudron végétal 12.5%; sulfur 12.5% in petrolatum) for 3 consecutive days. Within 1 week, the scaly plaques had disappeared and the erythematous papules had faded. The pruritus had resolved and no new papules emerged. Treatment was reapplied once more the following week and complete cure was achieved. We have been following this family for 12 months and no recurrences have occurred.

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