Overview

Scabies is an itchy skin condition caused by tiny burrowing mites called Sarcoptes scabiei. These microscopic mites dig into the top layer of your skin to live and lay their eggs, which then triggers an allergic reaction.

It's primarily caused by direct, prolonged skin-to-skin contact with someone who already has scabies, making it common in crowded conditions like nursing homes, childcare facilities, and households. Anyone can get scabies, regardless of age, race, or how clean they are. It is highly contagious through close personal contact. Living with scabies can be incredibly frustrating due to the intense itch, especially at night, which can significantly impact sleep and overall well-being.

Symptoms

You might notice a few different things if you or your child has scabies. The symptoms are your body's reaction to the mites.

• Intense itching: This is often the most noticeable symptom and tends to be much worse at night, sometimes disrupting sleep.
• Pimple-like rash: Small, red bumps or blisters may appear on the skin.
• Burrows: Tiny, raised, and crooked (serpentine) grayish-white or skin-colored lines on the skin surface. These can be very difficult to see.
• Sores: Caused by scratching the itchy areas, which can sometimes lead to secondary skin infections.
• Thick crusts on the skin (in severe cases): This form, called crusted scabies, is more common in people with weakened immune systems, the elderly, or those who are disabled or debilitated.
• Common locations: The mites prefer certain areas, including between the fingers, on the wrists, elbows, armpits, nipples, waistline, belt-line, buttocks, and male genitals. In infants and young children, the rash may also appear on the head, face, neck, palms, and soles.
• Delayed reaction: If you've never had scabies before, symptoms might take 4-8 weeks to appear after infestation. If you've had it before, symptoms can appear much sooner, often within 1-4 days.

Diagnosis

Diagnosing scabies usually starts with a healthcare professional looking closely at the rash and asking about your symptoms, especially the intense itching at night.

To confirm the diagnosis, a doctor might perform a simple, painless test called a skin scraping. They will gently scrape a small area of affected skin and look at the sample under a microscope to see if mites, eggs, or mite feces (scybala) are present. Sometimes, just seeing the characteristic burrows is enough for a diagnosis.

Management & Treatment

Dealing with scabies can be incredibly stressful, but it's important to know that it is treatable. The goal of treatment is to kill the mites and their eggs, and this requires prescription medication. There are no over-the-counter products approved to treat scabies.

Your healthcare provider will prescribe a medication called a "scabicide." The most common treatments are:

• Permethrin cream (5%): This is a topical cream that is considered the first-line treatment for scabies. You will be instructed to apply the cream over your entire body, from your neck down to your toes. For infants and the elderly, the scalp and face may also need to be treated. The cream is typically applied at bedtime and washed off in the morning, after 8 to 14 hours.
• Oral Ivermectin: In some cases, especially for severe or crusted scabies, or when topical treatments are difficult to use, a doctor may prescribe medicated pills.

It is absolutely essential that all household members and close contacts (including recent sexual partners) are treated at the same time as the infected person, even if they don't show any signs of scabies. This is the only way to prevent passing the mites back and forth.

Home Care is Critical for Success: On the day you start treatment, you must take steps to decontaminate your home:

• Wash everything: Machine wash all bedding, clothing, towels, and washcloths used in the last three days in hot water and dry them on a high heat setting.
• Seal it up: For items that cannot be washed, seal them in a plastic bag for at least 72 hours, as scabies mites cannot survive more than 2-3 days away from human skin.
• Vacuum: Thoroughly vacuum your entire home, including carpets, rugs, and all upholstered furniture, and discard the vacuum bag afterward.

What to Expect After Treatment: It's very important to understand that itching may continue for several weeks after treatment, even if all the mites are dead. This is because your body is still having an allergic reaction to the dead mites under your skin. Your doctor may recommend cool baths, calamine lotion, or over-the-counter antihistamines to help manage the itch. Do not re-apply the prescription medication unless your doctor tells you to.

If you see new burrows or a new rash appear two to four weeks after treatment, you may need another round of medication. Always follow up with your healthcare provider if your symptoms don't improve or if you develop skin sores from scratching.

Duration & Outlook

Without treatment, scabies will not go away on its own and can persist for months or even years, continuing to cause discomfort and remaining contagious. Once effective treatment is started (which we aren't discussing here but your doctor will), the mites are killed quickly. However, the itching and rash can sometimes continue for several weeks after treatment as your body's allergic reaction to the mites and their byproducts slowly subsides.

It's important to follow your doctor's treatment plan carefully to ensure all mites and eggs are eliminated. If itching persists for more than 2-4 weeks after treatment or if new burrows or rashes appear, it's crucial to see your doctor again, as treatment may need to be repeated. A warning sign for complications includes developing signs of a bacterial skin infection (like increased redness, warmth, swelling, pain, or pus) from scratching.

Prevention

Preventing scabies primarily involves avoiding direct, prolonged skin-to-skin contact with an infested person.

• Avoid sharing clothing, towels, and bedding - used by an infested person or anyone who has been recently treated for scabies.
• If someone in your household has scabies - all household members and other close contacts should be treated at the same time, even if they don't show symptoms yet. This helps prevent re-infestation.
• Wash bedding, clothing, and towels - used by the infested person in hot water and dry on a hot setting on the day treatment begins.
• Items that cannot be washed - should be sealed in a plastic bag for at least 72 hours, as scabies mites cannot survive more than 2-3 days away from human skin.

Causes & Triggers

Scabies is caused by an infestation of the skin by the human itch mite, Sarcoptes scabiei var. hominis. The intense itching is an allergic reaction to the mites, their eggs, and their waste.

• Cause: The direct cause is the mite itself burrowing into the skin.
• Transmission: Scabies is almost always spread by direct, prolonged, skin-to-skin contact with a person who has scabies. A quick handshake or hug usually doesn't spread it. It can also be spread, though less commonly, by sharing clothing, towels, or bedding.
• Who is most likely to develop it?: Anyone can get scabies. However, it tends to spread more easily in crowded conditions where close body and skin contact is frequent. This includes:
  • Families
  • Child care groups
  • School classrooms
  • Nursing homes
  • Prisons
  • People with multiple sexual partners
• Risk Factors:
  • Living in crowded conditions.
  • Close physical contact with an infested person.
  • Having a weakened immune system (this can lead to a more severe form called crusted scabies).
  • Being a young child or an older adult.

When to see a doctor

It's important to consult a healthcare professional if you suspect you or your child might have scabies. Don't try to diagnose or treat it on your own.

Look for these signs:

• Intense itching - especially if it's worse at night and disrupts sleep.
• A pimple-like rash - appearing, particularly in common scabies locations like between fingers, wrists, or the beltline.
• Visible burrows - on the skin (though these can be hard to spot).
• If someone you have had close contact with - (like a family member or partner) has recently been diagnosed with scabies.
• If over-the-counter itch relief doesn't help or symptoms worsen.
• If you see signs of skin infection - from scratching, such as increased redness, warmth, swelling, pain, or pus.

A dermatologist or your primary care doctor can accurately diagnose scabies and discuss the appropriate next steps. Early diagnosis is key to getting relief and preventing spread to others.

Frequently Asked Questions (FAQs):

• Can pets spread human scabies? No, pets get a different kind of mite infection called mange. If a pet's mite gets on your skin, it might cause temporary itching and irritation, but it can't reproduce on human skin and will die off on its own.
• Does having scabies mean I'm not clean? Absolutely not. Scabies can affect anyone, regardless of personal hygiene. It's about close contact, not cleanliness.
• If I had scabies before, can I get it again? Yes, unfortunately, you can get scabies multiple times. Previous infestation does not make you immune.
• How long can scabies mites live off a person? Scabies mites generally do not survive more than 2-3 days away from human skin.
• Why is the itching worse at night? The exact reason isn't fully understood, but it's thought to be related to the mites being more active at night, or possibly changes in your body's rhythms that affect how you perceive itch.

I hope this information helps you understand scabies a bit better. Remember, if you have any concerns about your skin, it's always best to reach out to a healthcare professional. They are there to help you.

References

• Centers for Disease Control and Prevention. (2023, October 5). Scabies. Retrieved from https://www.cdc.gov/parasites/scabies/index.html
• American Academy of Dermatology Association. (n.d.). Scabies. Retrieved from https://www.aad.org/public/diseases/a-z/scabies-overview
• World Health Organization. (2023, May 22). Scabies. Retrieved from https://www.who.int/news-room/fact-sheets/detail/scabies