What is scabies?
Human scabies is a skin infestation with Sarcoptes scabiei var. Hominis, the skin mite. It is highly contagious and affects around 130 million people worldwide. It has no racial or gender preference and usually spreads rapidly in crowded places.
Scabies outbreaks are usually found in extremely crowded spaces like nursing homes, primary schools, and military bases. It can be transmitted via direct contact between a healthy person and an infected individual or through infested bedding and clothes.
Scabies can also transmit through intimate contact associated with sexual intercourse but it is not a sexually transmitted disease and should not be classified as one.
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What are the types of scabies?
There are three types of scabies, however, the causative agent is the same for all of them.
- Typical scabies
- Nodular scabies: This type presents with pruritic, raised bumps that are located in the armpit or groin
- Norwegian scabies: Also known as crusted scabies, this type generally presents with thick, gray crusts containing thousands of mites. It is a more severe type and is highly contagious.
It usually affects patients undergoing chemotherapy, using corticosteroids, or are immunocompromised/immunosuppressed as would be the case for advanced HIV. Older individuals are more likely to be affected by Norwegian scabies rather than typical scabies.
What are the signs and symptoms of scabies?
Symptoms of scabies may take a couple of weeks to appear after being exposed to the skin mite. It can take up to six to eight weeks for the symptoms to appear for the first infection, however, recurrent infections may become symptomatic faster.
The characteristic common symptom is a papular, pruritic rash that worsens at night. The rash can become vesicular or blister over. Over scratching associated with intense pruritus can result in the development of sores that can be easily infected.
The rash usually appears on the wrist, elbow, armpit, nipple, penis, waist, buttocks, and the webbing between the fingers in adults. In infants and toddlers, and the immunocompromised, the rash can present on the head, face, neck, hands, and soles of the feet.
Sometimes, raised or discolored lines may be visible. These are the burrows made by the female skin mite. However, they are very hard to find since scabies infestation involves only 10-15 mites on one person. These burrows are most commonly found on the webbing between the fingers, in the skin folds on the wrist, elbow, or knee, and on the penis, breast, or shoulder blades.
How is scabies diagnosed?
Scabies diagnosis is usually clinical. The characteristic rash and burrows are enough for the diagnosis. A physician may perform a scabies ink test or Burrows Ink Test to identify burrows in the skin. For this test, a drop of ink may be dropped on an infested area of the skin and then, wiped away. If the ink forms lines underneath the surface of the skin, burrows have been located.
Sometimes the diagnosis may be made based on the mites, mites eggs, and/or mite fecal matter. This can be obtained by scraping of rash and viewing the scrapings under a microscope. It is important to note that the absence of mites or their eggs and fecal matter does not exclude the diagnosis of scabies. Due to this, clinical diagnosis is the best bet for scabies.
How is scabies treated?
Scabies treatment depends on getting rid of the mite infestation using topical lotions and ointments and oral medications. Ointments should be used at night since the mites are the most active then.
Topical creams used include
- Permethrin cream
- Benzyl benzoate lotion
- 10 percent sulfur ointment
- 10 percent crotamiton cream
- 1 percent lindane lotion
These medications are usually prescribed with other medications like antihistamines and steroids to relieve the itching and swelling. Antibiotics might be prescribed to treat the bacterial infection of exposed sores.
Sulfur-containing ointments are used widely for the treatment of scabies. And many of these ointments are available over the counter however, none of it is FDA approved. If a patient shows no response to ointments and antihistamines, or if scabies affects the whole body or is of crusted type, then an antiparasitic drug named ivermectin may be used. This drug is FDA-approved for widespread scabies only.
However, it is important to know that symptoms of scabies get worse within the first week of treatment and then reduce after. NB: The post-scabies itch may last for a month after the infestation and this should not be mistaken as a poor or no response to treatment.
Personal hygiene is extremely important for one’s physical and mental health. Plus cleaning beddings, furniture, and towels regularly can help prevent a bedbug or skin mite infestation. It is also important to not share personal hygiene products and beddings. After starting the treatment, it is extremely important to know that symptoms might persist since the mites and their eggs are still burrowed in your skin. To start a higher dose of treatment because of these increased symptoms can cause more problems than solving any problems.
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