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Scabies: What's Under My Skin?

Scabies: What's Under My Skin?

Scabies is a skin infestation caused by the human mite Sarcoptes scabiei var. hominis. (Other types of mites include dog, cat, cow, bird, and rodent.) All mites, along with scorpions, ticks, spiders, and chiggers belong to the arachnid family. Scabies occurs when the female mite burrows into the top layer of the skin, making a tunnel up to 3 mm (0.1 inch) long. This is where the she lives and lays 2-3 eggs at a time, for a total of 10-25, and then dies in place after 1-2 months. The larvae hatch in 3-4 days, leave the burrow for the surface, mate, and repeat the cycle. On a person, mites can live for as long as 1-2 months. Off a person, they usually do not survive more than 48-72 hours.

Transmission of Scabies:

·         Direct, prolonged, person-to-person contact with someone who has scabies. (Schools do not ordinarily provide the level of contact necessary for transmission)

·         Sexual contact 

·         By wearing or handling heavily contaminated clothing, or by sleeping in an unchanged bed recently occupied by an infested individual

·         Crowded conditions increase the prevalence of scabies. It can occur in epidemics in institutional settings, such as nursing homes and childcare centers

·         Typically fewer than 10-15 mites can be present on the entire body of an infested person who is otherwise healthy

Transmission through clothing or linens is more likely with higher mite infestations as seen in crusted (Norwegian) scabies: a severe form of scabies that can occur in the elderly, disabled, or debilitated, and in those who have a weakened immune system. Persons with crusted scabies

·         Can be infested with thousands of mites and eggs in their thick, crusted skin 

·         Are highly contagious to other persons, and can spread the infestation easily both by direct skin-to-skin contact and by contamination of items, such as their clothing, bedding, and furniture

·         May not show the usual symptoms of scabies

·         Should receive quick and aggressive medical treatment for their infestation to prevent outbreaks

Symptoms:

If a person has never had scabies before, symptoms may take as long as 4-6 weeks to begin. It is important to remember that an infested person can spread scabies during this time, even if they do not have symptoms yet. In a person who has had scabies before, symptoms usually appear 1-4 days after exposure:

·         Intense itching, especially at night

·         Pimple-like itchy rash

·         Burrows: tiny, raised, and crooked grayish-white or skin-colored lines on the skin surface. They are found most often in the webbing between the fingers, in the skin folds on the wrist, elbow, or knee, and on the penis, breast, or shoulder blades

·         The head, face, neck, palms, and soles often are involved in infants and very young children, but usually not adults and older children

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Diagnosis:

·         Based on the typical appearance and distribution of the rash, and the presence of burrows

·         Confirmation by identifying the mite, eggs, or mite feces. This can be done by carefully removing a mite from the end of its burrow using the tip of a needle or by obtaining skin scraping to examine under a microscope

·         It is important to remember that a person can still be infested even if mites, eggs, or feces cannot be found

Treatment:

Scabies medications kill mites, some also kill eggs. Treatment is only available with a healthcare provider’s prescription. No over-the-counter products are approved for humans.

·         Carefully follow the instructions provided by the healthcare provider and/or pharmacist, as well as those contained in the box or printed on the label

·         When treating adults and older children, the cream or lotion is applied to all areas of the body from the neck down to the feet and toes

·         When treating infants and young children, the cream or lotion also is applied to the head and neck

·         The medication should be left on the body for the recommended time (typically between 8-14 hours) before it is washed off

·         Clean clothes should be worn after treatment

·         Treatment is recommended for household members and sexual contacts, particularly those who have had prolonged skin-to-skin contact with the infested person. All persons should be treated at the same time in order to prevent re-infestation

·         Retreatment may be necessary if itching continues more than 2-4 weeks after treatment or if new burrows or rash continue to appear. Consult with your provider as to the next step

Can I get scabies from my pet?

No. Animals do not spread human scabies. Pets can become infested with a different kind of mite that does not survive or reproduce on humans but causes ‘mange’ in animals. If an animal with mange has close contact with a person, the animal mite can get under the person’s skin and cause temporary itching and skin irritation. However, the animal mite can't reproduce on a person and will die on its own in a couple of days. Although the person does not need to be treated, the animal should be treated because its mites can continue to burrow into the person’s skin and cause symptoms until the animal has been treated successfully.

Home Treatment:

·         Items such as bedding, clothing, and towels used by a person with scabies can be decontaminated by machine-washing in hot water and drying using the hot cycle or by dry-cleaning

·         Items that cannot be washed or dry-cleaned can be decontaminated by removing them from any body contact or placing them in a plastic bag for at least 3 days

·         Because persons with crusted scabies are considered very infectious, careful vacuuming of furniture and carpets in rooms used by these persons is recommended

·         Fumigation of living areas is unnecessary

After treatment:

·         The rash and itching of scabies can persist for several weeks to a month after treatment, even if the treatment was successful and all the mites and eggs have been killed. The dead mites and eggs that remain under the skin can be an irritant

·         Your healthcare provider may prescribe additional medication to relieve itching, if it is severe

Symptoms that persist for longer than 2 weeks after treatment can be due to a number of reasons, including:

·         Incorrect diagnosis

·         Re-infestation

·         Treatment failure caused by resistance to the medication, by faulty application of the medication, or by failure to do a second application when necessary. No new burrows should appear 24-48 hours after effective treatment

·         Treatment failure of crusted scabies because of poor penetration of the medication into thick scaly skin. Repeated treatment with a combination of both topical and oral medication may be necessary to treat crusted scabies successfully

·         An allergic skin reaction to the medication

 

For information on scabies, visit the CDC at https://www.cdc.gov/parasites/scabies/index.html

 

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