SCABIES: Symptoms, Causes, Transmission, and Treatment.

SCABIES: SYMPTOMS, CAUSES, TRANSMISSION, AND TREATMENT.

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Photography by DermNet New Zealand

Mr Dagam fetched his 3 children from the Boarding School 6 weeks earlier for the long holidays. That was before he traveled for a work trip to another city. Everything was fine, or so he thought, before he left home.

Upon return from his trip he noticed some rashes on the hands of one of his children. He made nothing of it. Two days later, his wife complained of being unable to have a smooth sleep at night because she tended to have a lot of itchy skin at night. It all started since her husband traveled and she was somewhat embarrassed that a good amount of the itching was in her perineal region.

A further inquiry showed?that apart from his wife, his children were having the same experience. His wife had already tried home remedies but the effect was doubtful. The next logical thing to do was go to the hospital.

The doctor asked questions, examined the family members and concluded that the children most probably got Scabies infestation from the boarding house. Unfortunately, other the members of the family now have scabies also!

THE DISEASE

Scabies is a skin infestation caused by a mite known as the?Sarcoptes scabiei. Untreated, these microscopic mites can live on one’s skin for months. They reproduce on the surface of the skin and then burrow into it to lay eggs. This causes an itchy, red rash to form on the skin.

Although scabies?isn’t?a sexually transmitted disease, it can be transmitted through intimate contact, sharing clothing, or sharing bedding. Scabies is a very contagious disease and?affects about 200 million people globally?per time. Scabies is a worldwide problem but happens most often in tropical areas and in very crowded places.

The mites live in the folds and narrow cracks of the skin, especially in places like:-

• Skin folds in between the fingers and toes.
• Skin folds in the genital area and thigh as well as the region around the waist -the belt area.
• Buttocks.
• Soles of the feet and palms of the hand, scalp, face, neck (mainly in children)
• Bends at the wrists and knees.
• Under fingernails, rings, wristwatch bands and bracelets
• The region around the armpits, breasts,?and around the nipples.
• Inner elbows
• Shoulder blades

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Considering?that it is a contagious disease,?anyone can get scabies.?It’s not a disease caused by poor hygiene even though it is more endemic in poorer countries. However, some people are more likely to get the disease. For example:

• People who live in close, crowded conditions.
• Infants and children. (Children have a lot of close physical contact with their parents, friends, family members and classmates.)
• People who are elderly, especially those living in nursing homes.
• Healthcare workers who care for people who aren’t aware they have scabies.

Types:

Apart from the classical Scabies there are other types of scabies, namely:

• Crusted (Norwegian):?This type often happens in people with faulty immune systems. May not be itchy. Death may result from secondary bacterial infection in untreated cases.
• Nodular:?(This type is more common among children).
• Bullous
• Scalp

SYMPTOMS

The hallmark symptoms?of scabies include?a rash and intense itching that gets worse at night and could make it hard to sleep.?Continuous scratching of the infested area can create sores that become infected.?The rash spreads slowly over a period of weeks or months. In addition to the rash and itching, signs and symptoms of scabies include:

• Bumps that sometimes become infected as a result of scratching.
• A later rash that looks grayish or skin-colored lines on the skin..

Children with scabies may have a particularly difficult situation. Rash may become generalized and the children may become irritable and tired because of lack of sleep at night.

TRANSMISSION

Scabies is usually transmitted person-to-person through close skin contact (e.g. living in the same house) with an infested person. Transmission risk increases with the level of infestations, with highest risk due to contact with individuals with crusted scabies. Transmission due to contact with infested personal items (e.g. clothes and bed linens) is unlikely with common scabies but may be important for individuals with crusted scabies. Transmission may occur before the initially infested person even develops symptoms. As in my earlier blogs on?cholera,?typhoid fever, and?climate change,?genital?herpes, and even?Head lice, the environment plays a strong role in determination of disease. We also need a good?mindset?to overcome negative or unintended consequences. Today’s technological advances in?telemedicine?will, no doubt, help in no small way in deploying help.

TREATMENTPrimary management of affected individuals involves application of a topical?scabicide such as 5% permethrin, 0.5% malathion in aqueous base, 10–25% benzyl benzoate emulsion or 5–10% sulphur ointment. Benzyl benzoate is not to be applied on the face. Tetmosol soap is considered useful for bathing.

Oral ivermectin is also highly effective and is approved in several countries. Safety of ivermectin in pregnant women or children under 15 kg body weight has not been established, so ivermectin should not be used in these groups until more safety data are available. Itch commonly intensifies with effective treatment for 1-2 weeks, and treated individuals should to be informed about this.

Because people in the early stage of new infestation may be asymptomatic and because the treatments for scabies do not kill the parasite’s eggs, best results are obtained by treating the whole household at the same time and repeating treatment in the time frame appropriate for the chosen medication.

Non-pharmacological adjuncts to the treatment includes steaming all personal contact materials, under-wears and all items of clothing, as well as washing bed linens in hot water. Cushion covers should be similarly treated.

WHAT SHOULD WE DO?

The price of freedom is vigilance. For those that may have to be exposed to the environment or circumstances that may encourage the disease, it may be prudent to check again with your doctor if you are in any doubt.

We encourage?community protection and personalized care.