A tiny mite has infested humans for at least 2,500 years. It is often hard to detect, and causes a fierce, itchy skin condition known as scabies. Dermatologists estimate that more than 300 million cases of scabies occur worldwide every year. The condition can strike anyone of any race or age, regardless of personal hygiene. But there is good news: with better detection methods and treatments, scabies need not cause more than temporary distress.

More Than an Itch:

How Scabies Develops The microscopic mite that causes scabies can barely be seen by the human eye. A tiny, eight­legged creature with a round body, the mite burrows within the skin. Within several weeks the patient develops an allergic reaction. This results in severe itching, often intense enough to keep sufferers awake all night.

Human scabies is almost always caught hom another person by close contact – it could be a child, a friend, or another family member. Dermatologists, who frequently treat patients with scabies, point out that scabies is not a condition only of low-income families, neglected children, or poor hygiene. Although, more prominent in crowded living conditions, and poor hygiene – everyone is susceptible.

Attracted to warmth and odor, the female mite burrows into the skin, lays eggs, and produces secretions that cause allergic reactions. Larvae, or newly hatched mites, travel to the skin surface, lying in shallow pockets where they will develop into adult mites. If the mite is scratched off the skin, it can live in bedding up to 24 hours. It may be up to a month before a newly infested person will notice the itching, especially in people with good hygiene and who bathe regularly.

What to Look for:

The earliest and most common symptom of scabies is itching, especially at night. Early on, little red bumps, like hives, tiny bites, or pimples appear. In more advanced cases, the skin may be crusty or scaly.

Scabies prefers warmer sites on the skin such as skin folds where clothing is tight. These areas include between the fingers, on the elbows or wrists, buttocks or belt line, around the nipples, and on the penis. Mites also tend to hide in, or on, the skin under rings, bracelets or watchbands, or under the nails. In children, the infestation may involve the entire body, including the palms, soles, and scalp. The child may be tired and irritable as a result of loss of sleep from itching or scratching all night long.

Bacterial infection may occur secondarily with scabies due to scratching. In many cases, children are treated because of infected skin lesions rather than for the scabies itself. Although treatment of bacterial infections sometimes provides relief, recurrence is almost certaing if the scabies infection is not treated.

Crusted Scabies

Crusted scabies is a form of the disease in which the symptoms are far more severe than usual. Large areas of the body, including hands and feet, may be scaly and crusted. These crusts hide thousands of live mites and their eggs, making treatment difficult because medications applied directly to the skin may not be able to penetrate the thickened skin. This type of scabies occurs mostly among the elderly, in some AIDS patients, or in people whose immunity is decreased. These cases are extremely infectious.

Diagnosis

A thorough head-to-toe examination in good lighting, with careful attention to skin crevices, will usually be recommended and performed at your dermatologist’s office. Many cases of scabies can be diagnosed by dermatologists without special tests. To confirm scabies your dermatologist can perform a painless test that involves applying a drop of oil to the suspected lesion. The site is then scraped and transferred to a glass slide which is then examined using a microscope. A diagnosis is made by finding scabies mites or their eggs.

Who is most at risk?

Scabies is most common in those who have close physical contact with others, particularly children, mothers of young children, and elderly people in nursing homes.
All in the family – Studies of families have shown that children under two years of age are most at risk, followed by mothers and older female siblings, and then by other family members who have frequent and close physical contact.

Among the elderly – Scabies among resident patients of nursing homes and extended care faci lities has become a common problem due to delayed diagnosis since it can often be mistaken for other skin conditions. The delay allows time for scabies to spread to nursing home staff and other residents. Because residents require assistance in daily living activities, this intimate exposure provides an opportunity for the scabies mite to spread.

Getting Rid of Scabies

Scabies is easy and quick to treat with prescription drugs: 5 percent permethrin cream is applied to the skin from head-to-toe at bedtime, and washed off the next moming. Dermatologists recommend that the cream be applied to cool, dry skin, over the entire body (including the palms of the hands, soles of the feet, groin, under finger nails, and the scalp in small children) and left on for 8 to 14 hours. A second treatment one week later may be recommended for infants with scabies of the palms and soles, or if new lesions appear after treatment. The only reported side effect of 5 percent pcrmethrin cream is a mi Id, temporary burning and stinging, particularly in bad cases of scabies. All lesions should be healed within four weeks after the treatment. If a patient continues to have trouble, he or she may be getting reinfested and require further evaluation and treatment by a dermatologist.

Another effective prescription treatment is 1 percent lindane lotion. Also an overnight treatment, lindane is effective after 1 to 2 doses. Patients using lindane are instructed to wash the lotion off after 8 to 12 hours, not to exceed recommended doses, and to avoid a second treatment within a 7-day period.

Lindane should not be used on infants, small children, pregnant or nursing women, or people with seizures or other neurological diseases.

Sulfur ointment and Crotamiton cream are other special care treatment options.
(Note: Antihistamines may be prescribed to relieve itching, which can last for weeks.)

Ivermectin is an oral medicine which may be prescribed for certain cases of scabies, especially the difficult to treat crusted form. Like lindane, it is not for use by infants or pregnant women.

The critical factor in the treatment of scabies is getting rid of the mite. Each individual in the family or group, whether itching or not, should be treated. The entire community at risk must be treated to stop an epidemic of scabies.

In a family, all members should be treated at the same time, as well as others who are in close contact, such as close friends, and sometimes day care or school classmates. Scabies in institutions can be kept to manageable levels by routinely examining patients and conducting thorough skin exams of all new residents. The most successful, cost-effective approach is to treat all patients and health care personnel at the same time. Bedding and clothing must be washed or dry-cleaned.

Successful eradication of this infestation requires the following:

· See a dermatologist as soon as possible to begin treatment. Remember, although you may be disturbed at the thought of bugs, scabies is no reflection on your personal cleanliness.

· Treat all exposed individuals whether obviously infested or not. Incubation time is 6-8 weeks so symptoms may not show up for a while. If you do not treat everyone, it is as if you were never treated.

· Apply treatment to all skin from neck to toes. If you wash your hands after application, you need to reapply the medication to your hands again.

· Wash all personal items. The mite is attracted to scent. Any clean clothes hanging in the closet or folded in the drawers are ok. Do all the laundry.

· Items you do not wish to wash may be placed in the dryer on the hot cycle for 30 minutes.

· Items may be dry-cleaned.

· Rid or R&C spray may be used on items not laundered such as belts, shoes, purses, etc.

· Pets do not need to be treated.

· Carpets or upholstery do not need to be treated, though, some people will spray heavily on traffic areas.

· Itching may persist for two or more weeks after successful eradication of the mite.
· Items may also be placed in plastic bag and placed in the garage for two weeks. If the mites do not get a meal within one week, they die.

· Vacuum the entire house and discard the bag, just to be on the safe side.

What Not to Do

· Don’t attempt to treat scabies with home remedies. Scrubbing with laundry detergent or hard soaps, or applying kerosene will only make the condition much worse.

· Don’t use steroids or any other creams unless prescribed by a dermatologist.

· Don’t repeat the treatment more than twice unless specifically instructed by a dermatologist.