Scabies

If you have had scabies before, signs and symptoms may develop within a few days of exposure. If you’ve never had scabies, it can take as long as six weeks for signs and symptoms to begin. A person may have scabies if the following symptoms are present:

• A severe itching sensation in the affected areas of the skin that usually worsens at night.
• Rash or bumps on the skin with a burrow-like appearance.
• Although scabies can affect any part of the skin, common sites of infestation include armpits, between fingers, inner elbows, around the waist, scalp, palms, and soles of feet.
• Occasionally, there may be scaly patches on the skin that resemble eczema.
• A severe type of scabies, called Norwegian scabies, leads to the formation of thick crusts on the skin.

Note: In infants and young children, common sites of infestation usually include the scalp, palms of hands, and soles of feet.

Scabies is not an infection; it is an infestation caused by an 8-legged mite known as Sarcoptes scabiei. This mite can enter the skin through:

• Direct human-to-human contact with an infected individual
• Sharing personal items, such as bed sheets, towels, and linen

Once the mite comes into contact with human skin, it begins to burrow into the upper layer of the skin and lays eggs. The eggs hatch within a couple of days and develop into adult mites in two to three weeks, spreading to other parts of the body.

A severe infestation of scabies, known as crusted scabies or Norwegian scabies, occurs when there is a significant presence of mites and eggs. This condition is commonly observed in individuals with compromised or weakened immune systems.

• Living in close proximity to individuals in overcrowded environments, such as nursing homes, prisons, and daycare centers.
• Engaging in sexual relationships with multiple partners.
• Sharing toiletries, bed sheets, and linens with others in the vicinity.

The physician takes a detailed history of the onset of symptoms and performs a thorough physical examination to identify the site and type of skin lesions. Usually, the close contacts of the person are also examined to check for the spread of scabies.

Scabies can be confirmed by the following tests:

• Microscopic examination of a skin scraping
• Direct visualization of magnified skin lesions or dermatoscopy
• Burrow ink test to evaluate the burrowing lesions of scabies

Routine laboratory tests or imaging studies play a minimal role in establishing a diagnosis of scabies. Occasionally, if a patient presents with crusted lesions or Norwegian scabies, routine laboratory tests like Complete Blood Count (CBC) may be performed to assess the person's overall health and immunity status.

Scabies is a highly communicable disease that spreads rapidly through prolonged, close human-to-human contact. It can also spread through fomite contact, such as sharing personal items. To prevent reinfestation or transmission of scabies, the following precautions should be taken:

• Do not share personal items, such as bed sheets, linens, and pillow covers, with others, especially those with an active infestation of scabies.
• Avoid visiting overcrowded areas that have reported an outbreak of scabies.
• If you live with someone who has scabies, wash all clothing, towels, and similar items with hot water and detergent. Items that cannot be washed should be kept isolated in a separate room for 2-3 days. The scabies mites cannot survive long without a human host, which helps break the cycle of transmission.
• All household members should undergo scabies treatment simultaneously if someone in the house has scabies to prevent reinfection and transmission of the disease in close proximity.

Scabies is treated with the topical application of anti-scabies creams or lotions. The creams or lotions must be applied all over the body and not just the area of itch, as the scabies mite may be present in different areas of the body. It is recommended to simultaneously treat all members living in close proximity to the patient to eradicate the parasite completely.

The following medicines are used to treat scabies:

• Antiparasitic medications and antipruritics (anti-itch drugs) are commonly recommended to treat scabies. In some cases, lotions are also advised to relieve itching.
• 5% Permethrin topical preparations are the first line of treatment for scabies and are highly effective in killing the scabies mites.
• Crotamiton formulations can be applied to scabies lesions.
• 0.5% Malathion, 5-10% Sulphur ointment, and 10-25% Benzyl Benzoate emulsion are other compounds used for topical application to treat scabies.
• Ivermectin preparations may occasionally be given orally or prescribed for topical applications.
• Over-the-counter (OTC) preparations in the form of lotions can be used to provide relief from skin itch.

Tips to apply anti-scabies topical medications:

• After taking a tepid bath or shower and patting your body dry, apply a thin layer of cream/lotion to the whole body from neck down. Avoid applying on your face due to the risk of medicine side effects.
• Make sure to carefully wash off the ointment after 12 hours.
• Reapply the medication topically after 24 hours and follow the same instructions.

It may take 4-8 weeks for the symptoms of scabies to appear after coming into contact with the mite. As symptoms begin to manifest, the severity of the itching sensation increases. Care must be taken to avoid aggressive scratching, as this may lead to further irritation, skin breakdown, and bleeding.

Application of topical emollient creams and lotions may help alleviate severe itching.

Apply the medication all over your body from the neck to the toes. Take a bath before applying the prescribed lotions.

As scabies is a highly contagious disease, special care must be taken to break the transmission chain and prevent others around you from becoming infected.

It is advisable to seek anti-scabies treatment for all close contacts simultaneously.

Additionally, it is necessary to thoroughly wash all personal items, such as clothes, towels, bed sheets, etc., that you have used in the three days preceding scabies treatment.

Scabies infestation leads to a severe itching sensation. If the patient does not refrain from scratching aggressively, it may lead to breaking of the skin, which can result in secondary bacterial infection.

Crusted scabies, also known as Norwegian scabies, is a severe form of scabies that affects individuals with weakened immune systems, such as those with HIV. It can result in:

• Millions of scabies mites affecting larger areas
• A crusty appearance of the skin
• High contagion potential
• Resistance to treatment

Ayurveda: Ayurvedic formulations, such as lotions, creams, and soaps made from naturally occurring substances, may provide symptomatic relief to patients with scabies. These include:

• Tea tree oil
• Aloe vera gel
• Neem oil
• Camphor oil
• Eucalyptus oil
• Turmeric

These herbal remedies are known for their medicinal properties and provide a soothing effect when applied to the skin, reducing the itching sensation.

If you are suffering from scabies, you may experience symptomatic relief by:

• Applying tea tree oil or aloe vera gel directly to the lesions
• Bathing with soaps made from neem oil extract or eucalyptus oil extract, known for their antimicrobial action

Constant itching can considerably hamper the quality of life of a scabies patient. Scabies itch usually worsens at night, which may disturb the patient's sleep schedule and leave them feeling restless and tired.

There is also a risk of transmission of scabies from one person to another. Thus, a scabies patient needs to take considerable precautions to avoid disease transmission. This is especially important if the scabies patient is living in close proximity to others in confined spaces.

It is understandable that scabies can lead to isolation and a lot of frustration. Proper medical treatment, along with psychological support from family and friends, can help the patient overcome the condition.