Zmiany skórne u osób chorych na świerzb
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Zmiany skórne u osób chorych na świerzb

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Świerzb jest chorobą wywołaną przez roztocze Sarcoptes scabiei. Charakteryzuje się intensywnym świądem, nasilającym się w nocy. Pasożytuje wyłącznie na człowieku. Powikłaniem po tej chorobie może być problem psychologiczny, jakim jest akarofobia, czyli lęk przed nawrotem zakażenia pomimo podjętego leczenia.

Jak dochodzi do zarażenia świerzbem?

Głównym wektorem zakażenia są bliskie kontakty osobiste z osobą zakażoną. Choroba polega na drążeniu przez samicę roztocza tuneli w naskórku, tuż poniżej warstwy rogowej. Tam składa jaja oraz wydala odchody.

Początkowe zakażenie może nie dawać symptomu choroby nawet przez kilka tygodni. Dopiero wówczas, kiedy dojdzie do rozwoju odpowiedzi immunologicznej pojawia się główna oznaka choroby, czyli świąd.

Jakie objawy kliniczne wskazują na świerzb?

Wśród symptomów klinicznych, które mogą wskazywać na chorobę wywołaną przez roztocze Sarcoptes scabieinory świerzbowcowe, intensywny świąd, stan zapalny skóry oraz inne odmiany choroby.

Nory świerzbowcowe charakteryzują się wąskimi, nieregularnymi, lekko wypukłymi, a czasem także rumieniowymi wykwitami linijnymi, które zakończone są zgrubieniem. To właśnie tam znajduje się samica roztocza. Nory najczęściej występują w przestrzeniach międzypalcowych, powierzchniach zgięciowych nadgarstka, na bocznych powierzchniach rąk i stóp, przednich fałdach pachowych, prąciu czy brodawkach sutkowych.

Chorobie wywołanej przez roztocze Sarcoptes scabiei towarzyszy stan zapalny skóry, ogólny świąd oraz osutka. Czynniki te związane są z reakcją immunologiczną typu IV, która skierowana jest wobec antygenów roztocza. Zmiany pojawiają się głównie na udach, pośladkach i tułowiu.

Świerzb może objawiać się również w postaci ropnego zapalenia skóry, które ma związek z wtórnym zakażeniem przeczosów i nadżerek, a które dodatkowo może nieść za sobą powikłania w postaci liszajca i kłębuszkowego zapalenia nerek. U osób, które wyjątkowo dbają o higienę osobistą świerzb (Scabies incognita) może nie wywoływać zmian skórnych, a jedynie powodować świąd.

Wyróżnia się również świerzb guzkowy, który objawia się w postaci grudek. Występuje zazwyczaj u dzieci, najczęściej w pachwinach, fałdach pachowych, a także na narządach płciowych, ale również i u dorosłych. U mężczyzn grudki pojawiają się na narządach płciowych, a u kobiet mogą otaczać brodawki sutkowe. Co ważne, powyższe zmiany mogą pozostać jeszcze przez wiele miesięcy po leczeniu.

Odmiana w postaci świerzbu norweskiego (crusted scabies) to zakażenie, któremu towarzyszą łuszczycopodobne hiperkeratotyczne nawarstwienia i strupy, a także zmiany podpaznokciowe. Zmiany te występują najczęściej u osób wyniszczonych, coraz częściej zakażonych HIV/AIDS. Niekiedy dotykają również osoby z zespołem Downa.

Jak zdiagnozować świerzb?

Podstawą wykrycia tej choroby jest potwierdzenie obecności roztocza, które najłatwiej jest znaleźć w zakończeniu tunelu skórnego. Do potwierdzenia świerzbu dochodzi po badaniu mikroskopowym zeskrobin, które zostają pobrane przez specjalistę za pomocą cienkiego skalpela.

Co szczególnie ważne, w przypadku każdej dermatozy, której towarzyszy świąd, szczególnie silny w nocy, której objawy występują również u innych członków rodziny, a których przyczyna nie jest znana należy brać pod uwagę właśnie świerzb.

Źródło: Sterry W., Paus R., Burgdorf W., „Dermatologia”, Wydawnictwo Czelej, Wydanie I Polskie Lublin 2009

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