SCABIES

Scabies, caused by the Sarcoptes scabiei mite, is a skin condition where these tiny bugs burrow under your skin to live, eat, and reproduce, resulting in an itchy rash. This condition easily spreads from person to person, especially in close living quarters. If one family member is diagnosed with scabies, it’s essential for healthcare providers to check and treat other family members and close contacts simultaneously.

Scabies are a global issue, often found in crowded, tropical regions, particularly in countries with limited resources. However, it can affect anyone regardless of age, race, or economic status, and cleanliness doesn’t prevent it. Treatment typically involves applying medicated creams to the skin or taking oral medication.

Forms of Scabies

Different forms of scabies exist, aside from the classic type:

Crusted (Norwegian) Scabies: This severe form is more common in individuals with weakened immune systems. It results in crusty areas covering large portions of the skin and may involve millions of mites, unlike typical scabies, which usually have around 10 to 15 mites.
Nodular Scabies: This variation, more prevalent in children, affects areas like the genitals, groin, or armpits, causing raised bumps that can persist even after the mites are eradicated.

This skin condition affects over 400 million people worldwide annually, with a higher prevalence in tropical regions with limited medical facilities. However, outbreaks can still occur in developed countries, particularly in places where people share living spaces such as nursing homes, dormitories, or correctional facilities.

What causes scabies?

This itchy rash is primarily caused by a mite infestation. These minuscule creatures burrow beneath the skin to feed, excrete waste, and lay eggs, triggering skin swelling and itching similar to an allergic reaction.

How contagious is scabies?

The transmission of this skin condition occurs through direct skin-to-skin contact with an infected individual. Less commonly, it can spread through sharing bedding, clothing, or towels with someone who has the condition.

Symptoms of scabies

This skin condition manifests through an intensely itchy rash on the skin, typically taking up to six weeks to develop if you’ve never had it before. However, if you’ve experienced scabies previously, the rash tends to appear within a few days.

This rash spreads gradually over several weeks or months. Alongside the rash, common signs and symptoms of this skin condition include:

Intense Itching: The itching sensation is particularly severe at night, often disrupting sleep.
Sores or Painful Bumps: Continuous scratching can lead to the formation of sores or painful bumps on the skin, which may become infected.
Burrowing Tracks or Bumps: These appear as raised, skin-colored lines, indicating the pathways where the mites have burrowed.

In children, scabies can cause itching all over their bodies, leading to irritability and fatigue due to disrupted sleep patterns caused by nighttime itching.

Where scabies live

Sarcoptes scabiei mite take up residence in the folds and crevices of your skin. Common areas where these tiny pests can be found include:

Between Fingers and Toes: The webs of skin between digits are favorable spots for scabies mites.
Thighs and Genital Area: Folds in the skin around the thighs and genital region provide ideal hiding spots for the mites.
Wrists and Knees: Bends in the skin at the wrists and knees are also common sites for scabies infestation.
Waist Area: The area around your waist, where skin folds may occur, can harbor scabies mites.
Under Nails and Jewelry: Scabies mites may hide under fingernails and beneath rings, watch bands, or bracelets.
Around Nipples: In women, the area around the nipples can be affected by scabies mites.

Risk factors of scabies

While this itchy rash can affect anyone regardless of hygiene practices, certain factors can increase the risk of infestation, including:

Living in close, crowded conditions.
Infancy and childhood due to frequent physical contact.
Elderly individuals, especially those residing in nursing homes,.
Healthcare workers who care for individuals unaware of their scabies infection.
Sexually active individuals.
People with weakened immune systems.

Complications of untreated scabies

Scabies, if left untreated, can lead to several complications, including:

Painful Skin Sores: Continuous scratching can result in painful sores on the skin.
Septicemia: In severe cases, scabies can lead to septicemia, which is an infection in the blood.
Heart Disease: Although rare, untreated scabies may contribute to heart disease in some cases.
Kidney Disease: Prolonged, untreated scabies may also lead to kidney complications.

Diagnosis of scabies

To diagnose scabies, it’s essential to schedule an appointment with your healthcare provider. Diagnosis typically involves a visual examination of the skin. In some cases, your provider may apply mineral oil to the rash and collect a small skin sample (scraping) for microscopic examination to confirm the presence of mites and their eggs.

Treatments for scabies

Treatment for scabies aims to eradicate the mites, although itching may persist for several weeks afterward. Treatment options include:

Topical Medications: Your healthcare provider may prescribe creams, lotions, or ointments to be applied to the entire body, including the neck, hands, palms, and feet. Children may require medication on their faces and scalps as well. Common topical medications include:
- Permethrin cream
- Crotamiton cream or lotion,
- Benzyl benzoate lotion and
- Sulfur ointment. These medications typically need to remain on the skin for eight to 14 hours and are often applied at bedtime and washed off in the morning.
Oral Medications: In some cases, oral medications may be recommended, particularly if stronger medication is needed or if topical medications are not suitable. The most common oral medication for scabies is Ivermectin, which is administered as a single dose followed by a second dose one to two weeks later. However, Ivermectin is not suitable for children weighing less than 35 pounds (15 kilograms) or for pregnant or nursing individuals.

Additional Medications for Relief:

Antihistamines: These medications can help manage the intense itching associated with scabies.
Antibiotics: If a skin infection develops due to scratching, your doctor might prescribe antibiotics.
Steroid Creams: In some cases, steroid creams can help reduce the redness and swelling caused by the scabies rash.

What to Expect After Treatment

After treatment, the red bumps on the skin typically disappear within four weeks. The mites are usually killed with just one treatment, although itching may persist for up to two weeks afterward. Complete relief from itching may take two to four weeks.

It’s crucial to note that this skin condition will not resolve on its own and will require prescription medication for treatment. Without proper treatment, scabies can continue to spread to others and may result in skin infections due to constant scratching.

While scabies are treatable, they can indeed be challenging to completely eradicate. Certain forms of scabies, such as the crusted variety, may pose greater treatment difficulties. Additionally, multiple rounds of treatment may be necessary to ensure the complete elimination of the mites.

Prevention

To prevent the spread of scabies, several measures can be taken:

Laundry Hygiene: Wash bed linens, towels, and clothing in hot water and dry them thoroughly in a dryer to kill any mites present.
Prompt Treatment for Close Contacts: Ensure that family members and close contacts are promptly checked and treated if scabies are diagnosed in one individual.
Limit Close Contact: If you receive a scabies diagnosis, it’s advisable to limit close contact with others to prevent transmission.
Quarantine Unwashable Items: For items that cannot be laundered, such as stuffed animals, large pillows, and toys, place them in sealed garbage bags and store them in a garage or basement for approximately seven days. Mites on these surfaces will die without human skin contact. Afterward, these items can be removed from the bags and washed by hand.

As for preventing oneself from contracting this skin condition, there is currently no vaccine available. The primary preventive measure is to avoid contact with individuals or places known to have scabies outbreaks. This skin condition spreads easily among individuals sharing living spaces or close quarters, so avoiding such environments can reduce the risk of transmission.

Signs to See Your Doctor

Symptoms or skin issues linger after a month.
Redness or pus-filled sores develop (potential signs of a bacterial infection).
You experience concerning side effects from the medication or the condition itself.

When in Doubt, Get Checked:

If you have a severely itchy rash that disrupts your sleep, see your doctor. It could be scabies, and prompt treatment is crucial for you and those close to you.
Remember, many rashes are treatable with medication, so don’t hesitate to consult your doctor if you have a persistent rash.

FAQs

Can you see scabies without a microscope?

Despite their tiny size, scabies mites are difficult to see with the naked eye, measuring about the size of a needle tip. They appear white to creamy white and have eight legs and a round body, which can only be discerned under a microscope.

How does a scabies rash look?

The rash caused by scabies can vary in color, appearing red, brown, or gray, depending on your skin tone. It may resemble hives, insect bites, or pimples and can even appear in a linear pattern across the skin.

Can a pet transmit scabies?

Contrary to common misconceptions, pets cannot transmit this skin condition to humans, as the mites that affect animals are unable to survive on human skin.

What is the risk of re-infection?

This skin condition is contagious, and you can get it again through close contact with someone who’s infected.

Can you feel the mites?

Nope! These mites are tiny and slow, so you won’t physically feel them crawling. The itchiness and inflammation are your body’s reaction to them.

What are the chances of mites surviving on mattresses?

While mites might briefly live on or in mattresses, they can’t survive long without human skin. They can be present on various surfaces but will die within days.

Can dirty sheets cause scabies?

Dirty sheets don’t cause this skin condition. It’s not a hygiene issue. However, scabies can be spread through shared bedsheets.

Sources

UpToDate
Centers for Disease Control and Prevention
Cleveland Clinic
Center for Disease Control (CDC)
Mayo Clinic