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ntagious-skin-diseases/scabies
Scabies
Overview
SCABIES: OVERVIEW
A mite causes this common skin condition. Called the human itch mite, this
eight-legged bug is so small that you cannot see it on the skin. People get
scabies when the mite burrows into the top layer of skin to live and feed.
When the skin reacts to the mite, an extremely itchy rash develops.
This mite can travel from the infected person to another person. Most people
get scabies from direct, skin-to-skin contact. Less often, people pick up mites
from infested items such as bedding, clothes, and furniture. The mite can
survive for about 3 to 4 days without being on a human. Worldwide, there are
millions of cases of scabies each year.
Anyone can get scabies. It strikes people of all ages, races, and income
levels. People who are very clean and neat can get scabies. It tends to spread
easily in nursing homes and extended-care facilities. The good news is that a
dermatologist can successfully diagnose and treat scabies. With today’s
treatments, scabies need only cause short-term distress.
Overview
Symptoms
Scabies: While spending
time in a rehabilitation facility, this 75-year-old man developed scabies.
o Itching, mainly at night: Itching is the most common symptom. The itch can
be so intense that it keeps a person awake at night.
o Rash: Many people get the scabies rash. This rash causes little bumps that
often form a line. The bumps can look like hives, tiny bites, knots under the
skin, or pimples. Some people develop scaly patches that look like eczema.
o Sores: Scratching the itchy rash can cause sores. An infection can develop in
the sores.
o Thick crusts on the skin: Crusts form when a person develops a severe
type of scabies called crusted scabies. Another name for crusted scabies is
Norwegian scabies. With so many mites burrowing in the skin, the rash and
itch become severe. You'll find more information about crusted scabies
below.
The severe itch can lead to constant scratching. With non-stop scratching, an
infection can develop. Non-stop scratching can even lead to sepsis, a
sometimes life-threatening condition that develops when the infection enters
the blood.
Scabies can develop anywhere on the skin. The mites, however, prefer to
burrow in certain parts of the body. The most common places to have itching
and a rash are:
o Hands: Mites like to burrow in the skin between the fingers and around the
nails.
o Arms: Mites like the elbows and wrists.
o Skin usually covered by clothing or jewelry: The buttocks, belt line, penis,
and skin around the nipples are likely places for mites to burrow. Mites also
like to burrow in skin covered by a bracelet, watchband, or ring.
In adults, the mites rarely burrow into skin above the neck.
Scabies in children
Some children develop widespread scabies. The scabies rash can cover most
of the body. Even a child’s palms, soles, and scalp can be infested with mites.
In babies, the rash often appears on the palms and soles. Babies who have
scabies are very irritable and often do not want to eat or sleep. Children, too,
are often very irritable. The itch can keep them awake at night.
Crusted scabies
Also called Norwegian scabies, crusted scabies is a severe form of scabies.
People who have crusted scabies have 100s or even 1,000s of mites in their
skin. By comparison, most people who get scabies have 15 to 20 mites on
their skin.
Crusted scabies develops in people who have a weak immune system due to
a medical condition, the elderly, and people who are living in institutions.
Crusted scabies develops when the person’s body cannot develop any
resistance to the mites. Without resistance, the mites quickly multiply.
References
Chosidow O. Clinical practices. Scabies. N Engl J Med 2006; 354: 1718-27.
Children
Mothers of young children
Sexually active young adults
Residents of nursing homes, assisted-living residences, and extended-care facilities
Hospitalized patients
Having a weakened immune system also increases the risk of getting scabies. The
elderly and people who have a weak immune system due to disease such as
HIV/AIDS, lymphoma, or leukemia have an increased risk. People who received an
organ transplant also have a higher risk.
Crusted scabies is especially contagious. A crust filled with mites can fall off. This
shed crust can provide food and protection for the mites, allowing them to live for as
long as 1 week without human contact.
Scabies among people in nursing homes and extended-care facilities has become a
common problem in the United States. The residents often need help with daily
tasks, so there is frequent skin-to-skin contact. Scabies can spread to nursing staff.
The staff can then spread scabies to other residents. This can happen quickly.
Scabies can spread when people do not have any signs or symptoms. A person who
has never had scabies often does not have any signs or symptoms for 2 to 6 weeks.
You cannot get scabies from an animal that has mites. Only humans get this type of
scabies.
Most people will not get scabies from a handshake or hug. The skin-to-skin contact
must be longer for a mite to crawl from one person to another. Adults often get
scabies through sexual contact.
Images used with permission of the American Academy of Dermatology National
Library of Dermatologic Teaching Slides.
To make sure that a patient has scabies, a dermatologist may remove some skin.
This is painless. Your dermatologist will put the skin on a glass slide and look at the
slide under a microscope. If your dermatologist sees scabies mites or their eggs, it is
certain that you have scabies.
Most people can be cured with a medicine that they apply to their skin. These
medicines are often applied to all skin from the neck down. Infants and young
children often need treatment for their scalp and face, too. A dermatologist will
provide specific instructions to follow.
Most medicine is applied at bedtime. The medicine is then washed off when the
patient wakes up. You may need to repeat this process one week later.
It is important to follow your dermatologist’s instructions. Treating the skin more often
than instructed can worsen the rash and itching.
5% permethrin cream: This is the most common treatment for scabies. It is used to
treat patients 2 months of age and older and women who are pregnant.
10% crotamiton cream
25% benzyl benzoate lotion
Sulfur (5%-10%) ointment
1% lindane lotion
Treatment for widespread scabies: Scabies that covers much of the body and
crusted scabies often require stronger medicine. A patient with this type of scabies
may receive a prescription for ivermectin. This medicine can be prescribed to
children and patients who are HIV-positive. Some patients need only to take 1 dose,
but many need to take 2 or 3 doses to cure scabies. The pills are usually taken once
every two weeks.
When scabies infects many people at a nursing home, extended-care facility, and
other institution, ivermectin may be prescribed to everyone who has a risk of
catching scabies.
Other signs and symptoms: Some patients need other treatment, too. Your
dermatologist may prescribe:
Outcome
Treatment can get rid of the mites, eliminate symptoms such as itch, and treat an
infection that has developed. For the first few days to a week, the rash and itch can
worsen during treatment. Within 4 weeks, your skin should heal.
If your skin has not healed within 4 weeks, you may still have mites. Some people
need to treat 2 or 3 times to get rid of the mites. Be sure to see your dermatologist
for treatment. You should never use a scabicide used to treat crops or livestock.
People who develop crusted scabies, also known as Norwegian scabies, often need
repeat treatments to get rid of the mites.
To get rid of the mites and prevent getting scabies again, you have to do more than
treat the skin or take a pill. You will need to wash clothes, bedding, and towels to get
rid of mites that may have fallen off your skin. You also should vacuum your entire
home.
Overview
Symptoms
Causes
Treatment
Tips
SCABIES: TIPS FOR MANAGING
The mite that causes scabies is hardy. These tips can help you get rid of the
mites.
4. Apply the medicine from your neck to your toes. This includes all
skin between your neck and toes — the skin around your nails, the
crease between your buttocks, and the skin between your toes. Infants,
children, and the elderly often need to treat their scalp, temples, and
forehead. You should never apply medicine to the nose, lips, eyelids,
nor around the eyes or mouth.
Washing clothes,
bedding, and towels is necessary to get rid of the mites that cause
scabies.
6. The day you start treatment, wash your clothes, bedding, towels,
and washcloths. Mites can survive for a few days without human skin.
If a mite survives, you can get scabies again. To prevent this, you must
wash clothes, sheets, comforters, blankets, towels, and other items. Be
sure to follow these instructions when washing:
7. Vacuum your entire home on the day you start treatment. Vacuum
carpeting, area rugs, and all upholstered furniture.
8. Do not treat your pets. The human itch mite cannot survive on
animals. Pets do not need treatment.
References:
Habif, Campbell, Chapman, et al. In: Dermatology DDxDeck. 2006. China.
Mosby Elsevier. Card #92: Scabies.
Jacobson CC, Abel EA. Parasitic infestations. J Am Acad Dermatol 2007; 56:
1026-43