Scabies

Scabies is a common skin condition caused by a microscopic mite that burrows into the top layer of skin to live and feed. An extremely itchy rash develops as a reaction to the mite. The mite can move from one person to another through direct, skin-to-skin contact or contact with infested items such as bedding, clothing or furniture.

Dermatologists treat millions of cases worldwide each year and scabies is not a condition limited to low-income families, neglected children or those with poor hygiene. Anyone can get scabies. However, with today’s improved detection methods and treatment, dermatologists can diagnose and treat scabies successfully so the distress is only temporary.

Symptoms

With a first scabies infection, symptoms may not appear for four to six weeks. The most common signs and symptoms are:

  • Itching, mainly at night, that can be so intense that it disturbs sleep.
  • Rash appears early as little red bumps that can look like hives, tiny bites or pimples. 

Symptoms of scabies usually begin in folds and crevices in the body, such as between the fingers, on the elbows or wrists, buttocks or beltline, around nipples in women or on the penis in men. The skin under rings, bracelets, watchbands and around the nails may also be affected.

In children, scabies infestation can be widespread involving the entire body.

Bacterial infection can also occur, usually as the result of scratching the itchy skin.

Crusted or “Norwegian” scabies is a more severe form of the disease, in which large areas of skin become scaly and crusted. These crusts house 100s to 1,000s of mites and their eggs, which makes the rash and itching much worse and makes this crusted scabies extremely contagious. Crusted scabies can be more difficult to treat because it is more difficult for medication the penetrate the thick, crusted skin. This form of scabies is more common in the elderly and those with a weakened immune system.

Risk Factors

The scabies mite can infect anyone regardless of age, income or personal hygiene. Because skin-to-skin contact is the most common way the infected is transmitted, those who have frequent, close physical contact with others are most susceptible including children, mothers of young children, elderly people who reside in nursing homes, assisted living residences or extended care facilities and others in group living arrangements.

Diagnosis and Treatment

A dermatologist can diagnose scabies with a thorough examination of the skin. To confirm the diagnosis, your dermatologist may examine a small scraping of a skin lesion under a microscope to find mites or their eggs.

Treatment with a prescription medication is essential to get rid of scabies. Medications to cure scabies are usually applied to cool dry skin over the entire body (including the palms, soles and scalp in young children). Because the medication must be left of the skin for at least 8 hours, most people apply medication at bedtime and wash it off in the morning. Patient using any of these medications should follow their dermatologist’s instructions carefully.

Medications that may be prescribed include:

  • 5% Permithrin cream applied at bedtime and washed off in the morning
  • Lindane 1% lotion, another overnight treatment

Lindane should not be used on infants or small children, women who are pregnant or nursing or people with seizures or other neurological conditions

Other treatment options are:

  • 10% sulfur ointment and 10% crotamiton cream
  • Antihistamines prescribed to relieve itching

Stopping the spread of scabies and reinfestation

The critical factor is treating scabies is to get rid of the mites, which can prevent scabies from spreading or recurring. Both the person infected and everyone who has had close contact with that person must be treated, even those without symptoms since scabies can be spread before symptoms develop.

Everyone who is at risk, such as all members of a family or all the patients and caregivers in an institution, must be treated at the same time.

The following steps should also be taken the day you start treatment to get rid of the mites:

  • Wash clothes, bedding, towels, and washcloths in a washing machine, using the hottest water possible and dry using the hot setting. Items that cannot be washed can be dry cleaned or sealed in a plastic bag for at least a week.
  • Vacuum your entire home including carpeting, area rugs, and all upholstered furniture, then discard the vacuum bag.

Do not attempt to treat scabies with home remedies, such as detergents, strong soaps or kerosene as these will make the condition much worse. You should also avoid steroids or other creams unless prescribed by your dermatologist.

The most important step for managing scabies is to see your dermatologist as soon as possible to begin treatment. Though the thought of a parasite may be disturbing, you should not be embarrassed about seeking treatment. Dermatologists know that scabies is no reflection or your personal cleanliness and can provide treatment to quickly and easily cure the condition.