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Scabies

Apr 1, 2015
2015 / March 2015

Scabies is an itchy skin condition caused by Sarcoptes scabiei, a microscopic burrowing mite. The scabies mite tunnels into the upper layer of the skin, where it lives and lays eggs. Scabies occurs worldwide and affects people of all races and social classes. It is contagious and spreads rapidly under crowded conditions where close body contact is frequent, with outbreaks often occurring in families, child day care centers, extended-care facilities, prisons, schools, college dorms and nursing homes.

The mites often begin to cause symptoms first at the site where they enter the body. Transmission during sexual intercourse may cause skin lesions on the penis, vaginal area or groin; however, scabies is not always a sexually transmitted disease and may be acquired through any skin-to-skin contact.

Less commonly, infestation happens through the sharing of clothes and bedding. Theoretically, a person can get scabies from touching something the mite is on, but this is not a major mode of transmission. The mite only lives for two to three days away from human skin. Human scabies is not spread by contact with animals or pets.

Symptoms appear two to six weeks after a person is infested; however, in people who have had scabies before, symptoms appear in one to four days. The most common symptoms are intense itching, especially at night, and a pimplelike skin rash. You will see thin, irregular, pencil-like burrow tracks made of tiny blisters or bumps on your skin. In adults, scabies can be found between fingers, in armpits, around the waist, along the insides of wrists and elbows, on the soles of the feet, around breasts, around the male genital area, on buttocks, on knees and on shoulder blades. In children, common sites of infestation include the scalp, face and neck, palms of the hands and soles of the feet.

Immune suppression or old age may predispose patients to more extensive disease. In crusted (Norwegian) scabies, the body is covered with a thick, dry, scaly rash which may or may not itch; it contains thousands to millions of mites. Crusted scabies is the most contagious form and the hardest to treat. Other skin rashes may look like scabies, including allergic drug reactions, contact dermatitis and viral rashes such as shingles.

The intense itching of scabies leads to scratching, which can cause skin breakdown and a secondary infection such as impetigo. The sores become infected with skin bacteria such as Staphylococcus aureus or Beta-Hemolytic Streptococci. Sometimes the bacterial infection can lead to an inflammation of the kidneys called post-streptococcal glomerulonephritis.

If you think you have scabies, see your physician or dermatologist. While waiting at home for your appointment, try over-the-counter remedies to reduce itching, such as cool water, antihistamines and calamine lotion. Ask your pediatrician which medications or lotions are safe for your baby or child. Your physician will examine your skin from head to toe for burrows or the characteristic rash and may take a skin specimen (through a painless scraping) to send to a lab for microscopic inspection for mites or eggs.

Scabies treatment involves eliminating the infestation with prescription scabicide creams and lotions which you apply all over your body from your neck down and leave on for eight hours. A second treatment is needed if new burrows and rash appear. Because scabies spreads so easily, family members, sexual partners and other close contacts may need treatment even if they show no symptoms.

Medications commonly prescribed for scabies include Permethrin 5%, Lindane and Crotamiton. Permethrin (Elimite) contains chemicals that kill the mites and eggs and is generally considered safe for children and adults of all ages, including women who are pregnant or nursing. Your health care provider may recommend you apply this cream twice, with a week between applications.

Lindane is also a chemical treatment in a cream, lotion or shampoo. It is not safe for children younger than 2 years, women who are pregnant or nursing or those with a weakened immune system. Crotaminton (Eurax) is a non-chemical medication that is applied once a day for two to five days, often recommended for babies.

Although these medications kill mites and their eggs immediately, the itching may last for several weeks. Health care providers sometimes prescribe an oral medication, ivermectin (Stromectol), for people with altered immune systems, those with crusted scabies or people who do not respond to prescription lotions. Continue to cool and soak your skin with a wet wash cloth to reduce itching, apply a soothing lotion like calamine and take an antihistamine. Most cases are cured without long-term problems. A severe case with a lot of scaling or crusting may indicate a disease such as HIV.

Since mites cannot survive outside the human body for more than 72 hours, wash all clothing, towels and bedding you have used for the three days before treatment in hot, soapy water. Dry with high heat in your clothes dryer. Dry-clean items you cannot wash at home. Vacuum all carpeting, rugs and furniture; discard the vacuum bags or clean the canister with hot, soapy water. Starve the mites by placing items you cannot wash in a sealed plastic bag and leaving it in the garage for a couple of weeks. Pets do not need to be treated because the mites only live on humans.

Usually adults and children can return to work, school or child care the day after starting treatment. The Centers for Disease Control and Prevention recommend contacting local and state health departments for guidance pertaining to workplace restrictions for persons with scabies.

The content of this article is for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition.

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