Definition
Scabies is the name given to a contagious disease caused by a mite Sarcoptes scabiei.
Description
This mite is smaller than ‘crabs’ and hard to see.
The impregnated female of the Sarcoptes scabiei burrows and leaves her eggs along a burrow under the skin. There is intense itching caused by the female mite as it works its way under the skin to lay its eggs. After several days the larvae hatch and move around the hair follicles. As the patient becomes sensitised to the mites the Scabies rash appears and the area of infected skin becomes very itchy. The most common parts of the body to be infected are the warm moist areas. They include the groin and armpits especially. The itching is usually worse at night or when the patient is in a warm bed.
Scabies is transmitted from person to person by skin contact and generally not from contaminated clothing. Sexual transmission is one of the most common methods of transmitting the Scabies mite as it does not live long away from human skin. It is relatively easy for the mite to be transferred to another person if an infected person is sleeping in the same bed with an uninfected person.
Sometimes a secondary bacterial infection will be set up and has to be treated as well as the Scabies.
Scabies lesions can be identified as small, fine, wavy, dark lines up to 1cm in length with a minute raised section at one end. The scabies mite can look like a pinpoint dark dot at the end of the burrow.
The common sites for scabies infection includes wrists, finger webs, about the elbows, about the areolae of the breasts on the female, on the genitals of the male, along the belt line, on the lower buttocks, sides of the hands and feet and in bed ridden patients, on pressure sites. The face of an adult is usually not involved although infants may be infected on the face. In infants the scalp, palms and soles of the feet are possible areas to be affected.
Signs to watch for include:
- an itchy rash with sometimes intense itching
- the itch is worse during the night
- the itch is worse when the patient is in bed because of the warmth
- the rash is worse after exercise or a shower.
Scratching and secondary infections may make it difficult to see the burrows caused by the Scabies mite. The correct diagnosis should be done by a Doctor. This is usually done by a microscopic examination of the scrapings of the adult mites.
The itch and rash of scabies are due to a reaction (allergy) to the mites (or their saliva, faeces or eggs).
Scabies symptoms usually take 2-6 weeks to occur after you are first infected
The itch and rash can develop on any part of the skin, away from where the mites are actually burrowing. This means that you are infectious and can spread scabies before you even know that you have scabies.
How do you get scabies?
You need close skin-to-skin contact with an infected person to catch scabies. This is because the scabies mite cannot jump or fly.
Most cases of scabies are probably caught from prolonged hand-holding with an infected person. The hand is the most common site to be first affected.
Close skin-to-skin contact when having sex is another common way of catching scabies.
The skin-to-skin contact needs to be for a reasonable time to catch the mite. You usually need to be in skin contact for 15-20 minutes to catch scabies. Therefore, you are unlikely to catch scabies from an infected person by casual short contact such as a handshake or a hug. The more mites there are, the faster they can spread to another person.
The mites live in skin and can survive away from the host human for about 24-36 hours. You are unlikely to catch scabies from bedding and towels unless you use them immediately after being used by someone with scabies. However, just in case, it is best to treat bedding and towels by hot washing (described later).
Sometimes outbreaks of scabies occur in places such as nurseries and residential homes, where people are in regular close contact.
Who should be treated?
Scabies can stay in your skin for ever if not treated. Treatment is needed for:
- Anybody who has scabies; AND
- All household members, close contacts, and sleeping/sexual partners of the affected person – even if they have no symptoms. This is because it can take up to six weeks to develop symptoms after you become infected. Close contacts may be infected, but have no symptoms, and may pass on the mite.
Note: everyone who is treated should be treated at the same time – that is, on the same day.
Treatment options
Scabies is curable.
The usual scabies treatment is with permethrin cream, which is an insecticide that kills the mites. Permethrin is known to be the treatment that works the best, but for anyone allergic to permethrin, an alternative is to use a lotion called malathione liquid.
Re-apply the same treatment 7 days after the first application. This helps to make sure that all the mites are killed.
Consult your Health Care Professional for a diagnosis of this condition and for advice about the latest treatments available.
Before using any creams, lotions or other treatments for Scabies, consider the following list of precautions and recommendations.
Tips for successful scabies treatment
- Read the leaflet that comes with the product, for exact instructions as to where to apply. Usually treatment is applied to the whole body including the scalp and face, whilst others are to be applied just from the neck down. Remember to include awkward places such as the back, soles of the feet, between fingers and toes, under fingernails, and the genitals. Pay special attention to the areas where mite tunnels (burrows) most commonly occur. That is, in between the fingers, the front of the wrists and elbows, beneath the breasts, the armpits, and around the nipples in women.
- An adult needs at least 30 g of cream or 100 ml of lotion to cover the whole body. So, for two applications you will need at least 60 g of cream or 200 ml of lotion per adult.
- Apply cream or lotion to cool dry skin (not after a hot bath).
- The cream or lotion should be left on for the full recommended time. Permethrin cream should be left on for 8-12 hours. Malathion lotion should be left on for 24 hours.
- Children should stay off school until the first application of treatment has been completed.
- If you wash your hands or any other part of your body during the treatment period, you should re-apply the cream or lotion to the washed areas.
- Breast-feeding mothers should wash off the lotion or cream from the nipples before breast-feeding, and re-apply treatment after the feed.
- Permethrin cream is not usually used for babies under the age of 2 months, and malathion is not usually used under the age of 6 months.
- Put mittens on babies to stop them licking the cream or lotion off their hands.
- Clothes, towels, and bed linen should be machine-washed at 50°C or above after the first application of treatment. This kills the scabies mites. Keep any items of clothing that cannot be washed, in plastic bags for at least 72 hours to contain the mites until they die. Alternative options to kill any mites on clothes and linen are ironing the item with a hot iron, dry cleaning, or putting items in a dryer on the hot cycle for 10-30 minutes. It is not necessary to fumigate living areas or furniture, or to treat pets.
- Some people who develop a secondary skin infection may also need antibiotics. If you suspect this is the case, you should consult a doctor.
See a doctor if the itch persists longer than 2-3 weeks after treatment. Sometimes the first treatment does not work, and a different one is then needed. The most common reasons why treatment fails, and scabies returns (recurs), are:
- The cream or lotion is not applied correctly for the recommended time.
- A close contact is not treated at the same time, and the infection is passed back.
Note: you will still be itchy for a while after successful treatment. It is normal to take up to 2-3 weeks (and sometimes up to six weeks) for the itch to go completely after the mites have been killed by treatment.
Also, even after successful treatment, in a small number of cases there remain some itchy brownish-red lumps (nodules) up to 2 cm in diameter. If these remain, they most commonly occur on the genitals and armpits. These lumps are neither infectious, nor mean that the mite is still present. They occur in some cases as a prolonged skin reaction to the scabies mite. If they occur, they usually go within three months, but occasionally last up to one year.
Treatment for itching
Itching can be a distressing symptom. It can be eased either with topical treatments that you apply to the skin (such as creams or lotions), or with medication taken by mouth. Your GP or pharmacist can usually give advice regarding suitable products. Even cold moisturisers (emollients), especially if they contain menthol, can provide temporary relief. Avoid applying strong steroid creams, especially if the diagnosis of scabies is uncertain.
- Crotamiton cream or lotion has soothing qualities and may help to relieve itch. Apply crotamiton 2-3 times a day (but only once a day for children under 3 years old).
- Hydrocortisone cream. This is a mild steroid cream that may ease any inflammation and help to ease itch. It can be bought from the chemist, or obtained by prescription. It can be applied once or twice per day, for up to a week.
- An antihistamine medicine that makes you drowsy. This does not ease the itch directly, but can help you to sleep if itching is a problem at night (particularly for children).
If you think that the Scabies was sexually transmitted, it is a good idea to have a thorough Sexually Transmitted Disease check-up by a Doctor.
Diet hints
- The diet plays only a small part in treating Scabies although it is always important to have a nourishing nutritious diet.
- To build up the body’s natural health reserves, it is always important to include foods which are high in nutritional value so that the patient is in the best of health.
- It follows that increasing foods which are high in the B group vitamins may be a good idea. In this group there are peas, beans, raw nuts, sardines and wholegrain bread. The latter is good because of its fibre content and this will help to keep the bowels working.
- Some general guide-lines include avoiding heavy, hard to digest meals e.g. fried food.
- Eat plenty of fruit and that includes some three serves a day. If any is left over, make your own fresh fruit juice at home and drink a glassful at least twice a day.
Vitamins/minerals/herbs
- Echinacea is used for infection and b group vitamins and vitamin C are used to help the body’s natural immune system.
Notes
All current sexual partners, household members and other close contacts should be treated at the same time. Inform partners of the previous 4 weeks. Remember that Scabies is contagious.
Pharmacist’s advice
Ask your Pharmacist for advice on creams and lotions available to treat Scabies.
- Your Pharmacist will be able to give you a suitable scabies treatment. Some preparations should not be used on pregnant women and others should not be used on young children.
- Your Doctor or Pharmacist may recomment a cream to control the itch while the scabies treatment is working.
- Even if they do not appear to be affected, all members of the household should undergo treatment.
- Avoid physical contact with an infected person.
- Tea tree oil has a history of traditional use in treating scabies. It is thought that tea tree oil may penetrate the skin and suffocate the insects. Tea tree oil should be used with caution, and may need to be diluted 1:1 with water before applying to sensitive skin.
For more information on successful treatment, simply call in to Inverell Pharmacy at 132 Byron Street (next to Telstra) or phone us on 0267 223146.
Inverell Pharmacy – your locally owned and operated Pharmacy with 5 Pharmacists to Assist and Advise You.