Scabies Treatment

Scabies - an age-old, highly transmissible skin infestation - is characterized by burrows, pruritus, and excoriations with secondary infections. It occurs world­wide, is associated with overcrowding and poor hygiene, and can be endemic. The mites that cause this disorder can live their entire life cycles in human skin, causing chronic infection. The female mite burrows into the skin to lay eggs, from which larvae emerge to copulate and then reburrow under the skin.

Causes

Infestation with Sarcoptes scabiei var.hominis (itch mite) causes scabies.

Transmission of scabies occurs through skin contact or venereally. Schoolchildren, family members, and intimate contacts of those with scabies are at greatest risk for spreading the infection. The adult mite can live for 2 to 3 days without a human host; therefore, inanimate objects can't be ruled out as a means of transmission.

Signs and Symptoms

The most common symptom of scabies is severe itching, which may be worse at night or after a hot bath. A scabies infection begins as small, itchy bumps, blisters, or pus-filled bumps that break when you scratch them. Itchy skin may become thick, scaly, scabbed, and crisscrossed with scratch marks.

The areas of the body most commonly affected by scabies are the hands and feet (especially the webs of skin between the fingers and toes), the inner part of the wrists, and the folds under the arms. It may also affect other areas of the body, particularly the elbows and the areas around the breasts, genitals, navel, and buttocks.

Diagnostic tests

In diagnosing scabies, the skin and skin crevices are examined by your child's physician. A sample of skin, obtained by scraping the skin, may be examined under a microscope to confirm the presence of mites.

Treatment

Scabies treatment consists of bathing with soap and water, followed by application of a pediculicide. Permethrin cream (Elimite) or lindane lotion should be applied in a thin layer over the entire skin surface, left on for 8 to 12 hours, and then thoroughly washed off. Because this cream is not ovicidal, application must be repeated in 1 week. Another pediculicide, crotamiton cream, may be applied for 5 consecutive nights but isn't as effective.

Because about 10% of a pediculicide is absorbed systemically, a less toxic 6% to 10% sulfur solutiop may be applied for 3 consecutive days as an alternative therapy for infants and pregnant women. Secondary bacterial infections may require systemic antibiotics. An antipruritic emollient can reduce itching. Topical steroids, which may potentiate the infection, shouldn't be used.

Prevention

To prevent re-infestation and to prevent the mites from spreading to other people, take these steps:

• Clean all clothes and linen. Use hot, soap water to wash all clothing, towels and bedding you used before treatment. Dry with high heat. Dry-clean items you can't wash at home.
• Starve the mites. Consider placing items you can't wash in a sealed plastic bag and leaving it in an out-of-the-way place, such as in your garage, for a couple of weeks. Mites die if they don't eat for a week.

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