CASE ANALYSIS

SCABIES
Scabies is a very contagious skin condition that is caused by a mite that is so
small it can only be seen with a magnifying glass or under a microscope. The
mite cannot live more than three days without a human host, but it can
survive up to a month when living on a human. The mite also lays eggs in
human skin, which hatch and grow into adult mites. This means that
symptoms of the condition can last for months or even years.

The rash caused by scabies is extremely itchy and is sometimes called "the
seven-year itch." The rash can be subtle, and sometimes scabies is hard to
diagnose. The mite is spread from person to person by close contact.
Animals can harbor a similar mite, but when the animal mite is passed to
people, it cannot reproduce and dies within a few days.

Scabies Causes
Scabies is caused by an eight-legged mite (Sarcoptes scabiei var. hominis)
that is less than 0.5 mm long. The life cycle of the scabies mite starts when
the female tunnels (burrows) into the skin and deposits her eggs. Larvae
hatch from the eggs within three to 10 days and molt to become nymphs.
Nymphs mature into adults that deposit additional eggs and live
approximately 4 weeks. Burrowing and movement of the mites cause intense
itching due to a type of allergic reaction. If the person has never been
exposed to scabies before, he or she may not show symptoms until four to
six weeks after the initial infestation. Individuals who have been exposed in
the past usually show symptoms within a few days.

Where does scabies come from? Scabies is almost always spread by

protracted skin-to-skin contact with a person who carries the mite. The mites
often begin to burrow at the site where they enter the body. Thus, skin
transmission during sexual intercourse results in an infestation in the groin
area. It is important to point out that scabies is not always asexually
transmitted disease (STD) and may be acquired through casual contact. Less
commonly, scabies infestation can happen through the sharing of clothes
and bedding. Theoretically, you can get scabies from touching something
that the mite is on, but that is not a major mode of transmission.
Scabies Symptoms and Signs
Symptoms include severe and continuous itching, especially at night. An
indication that you may have scabies is if other members of your household
are experiencing the same symptoms.

• What do scabies look like? The skin may show signs of small insect-
type bites, or the lesions may look like pimples. The skin may also be red
and or have sores due to scratching of the area. Open scabs or sores are
susceptible to infection with bacteria. A burrow (a short S-shaped track
that indicates the mite's movement under the skin) may also be visible.
The average affected person has only five to 10 mites on their body at a
time. Burrows may be small enough to be overlooked. Thus, scabies also
should be considered whenever there is intense itching without an obvious
rash, bite, or burrow.
• Scabies frequently occur in the crevasses of the body such as
between the fingers and toes, the buttocks, the elbows, the waist area,
the genital area, and under the breasts in women.

Scabies Diagnosis
Most cases of scabies can be diagnosed by describing the symptoms to the
doctor and by examination of the skin. There is no blood test for scabies.

• Sometimes, the doctor will do a skin scraping to make or confirm the

diagnosis. This is performed by placing a drop of oil or saline on top of an
affected area. Then using a scalpel, the area is scraped, and the material
that was collected is placed on a slide to examine under a microscope.
The doctor will look for the mite or its eggs.
• The doctor may perform a felt-tip-marker test by drawing a washable
felt-tip marker across the rash and then wiping it off with alcohol. This
may help to identify a burrow because the ink penetrates deep into the
skin.
• Often, there are very few mites that can be hard to find. Therefore,
even if the scrapings are negative, the doctor may still recommend
treatment if he or she is very suspicious that scabies is present.
Scabies Prevention
It is difficult to prevent scabies. If a person is known to have scabies, they
should not have close skin-to-skin contact with others until they have been
treated. If one member of a household has scabies, all other household
members, sexual partners, and close contacts should be treated
simultaneously.

In the hospital, staff should use gloves and gowns when treating patients
who have a suspicious rash and itching.

Scabies Prognosis
Once properly diagnosed, treatment is generally very effective at curing
scabies.

Scabies Medications

Follow your doctor's instructions for prescription anti-scabies agents, if

prescribed for you.

• Do not apply to eyes, face, or mucous membranes.

• Discuss treatment with your doctor if you are pregnant, breastfeeding,
or you are treating your newborn or a toddler.
• Common prescription agents for scabies
o permethrin 5% cream (Elimite)
• Less common prescription agents
o lindane 1% cream (Kwell)
o ivermectin pill(s) (Stromectol)
o malathion 0.5% lotion (Ovide)
o benzyl benzoate
o crotamiton lotion or cream (Eurax)
o sulfur-based lotions, creams, or soaps

Scabies Treatment

Self-Care at Home
Although you cannot cure a case of scabies without prescription medication
from a doctor, there are certain things you can do at home to keep from re-
infesting yourself or your family.

• Wash all clothing, towels, and bed linens that you have used in the
last three days. Use hot water. You should use the dryer at high heat
rather than air drying. Since the mites can survive on nonliving objects for
several days, place the objects that are not machine washable (such as
coats and stuffed toys) into a bag and store for a week.
• Use the medication as prescribed and instructed. Do not use it more
than instructed because you risk causing chemical irritation of your skin.
• You can also treat itching with antihistamine medications such
asdiphenhydramine (Benadryl), hydroxyzine(Atarax), cetirizine (Zyrtec),
and promethazine (Phenergan).
• Cut your nails, and clean under them thoroughly to remove any mites
or eggs that may be present.
• Thoroughly vacuum your rugs, furniture, bedding, and car interior and
throw the vacuum-cleaner bag away when finished.
• Try to avoid scratching. Keep any open sores clean.