Scabies

Although the entire body may itch, the most common locations for the lesions of scabies include:

• The areas between the fingers (finger webs)
• Inner wrists, inner elbows, and armpits
• Breasts of females and genitalia of males
• Navel (umbilicus)
• Lower abdomen
• Buttocks
• Backs of knees

The most obvious signs of scabies are pink-to-red bumps, and the burrow, which is a fine, thread-like, scaly line (3–10 mm long), sometimes with a tiny black speck (the burrowing mite) at one end.

Scabies is intensely itchy, especially at night.

Scratching the itchy lesions can create breaks in the skin, and these breaks can become infected with bacteria.

A severe form of scabies, called Norwegian scabies or crusted scabies, is seen in:

• Elderly people
• Individuals with weakened immune systems (such as organ transplant recipients or people with HIV/AIDS)
• Malnourished people
• People who are physically and/or mentally impaired or disabled

Scabies is extremely contagious. It is easily spread to sexual partners and to other members of the household. Less commonly, it may be spread by sharing towels, clothing, or bedding.

Wash all clothing, bedding, and towels used by the infested person and dry these items in a hot dryer. Vacuum all carpets, rugs, and upholstered furniture.

Your physician may be able to diagnose scabies simply by examining your skin for typical lesions such as burrows. A skin scraping, called a scabies preparation, may be examined under the microscope for mites, eggs, or mite droppings (faeces).

In most cases of scabies, your doctor may recommend a topical cream or lotion to be applied to all areas of the body, such as:

• Permethrin cream – After application, wash the cream off after 8–14 hours, and use the permethrin cream again in 1 week.
• Crotamiton lotion or cream – Apply once daily for 5 consecutive days.
• Sulfur ointment – Apply nightly for 3 consecutive nights. This is often the best choice for babies and for pregnant and nursing women because it is very safe to use.
• Lindane lotion or cream – Wash the cream or lotion off after 8 hours. Lindane may be toxic to some people. Therefore, avoid using it for young children, pregnant or breast- feeding women, or people with diseases affecting the nerves (neurological diseases).
• Ivermectin pills – Take once and then repeat 1–2 weeks later.
• Antihistamine pill.
• Antibiotic pills, if any scratched areas appear to be infected with bacteria.

Itching may take up to 3 weeks to go away, as your immune system continues to react to dead mites.

Household members, sexual partners, and anyone else with prolonged skin-to-skin contact with the infested person should also be treated simultaneously.