Scabies

Overview

Scabies is a highly contagious skin condition caused by a tiny burrowing mite called Sarcoptes scabiei. It leads to an itchy skin rash, with intense itching typically occurring in the areas where the mite burrows. The need to scratch is often more severe at night. Scabies can spread quickly through close person-to-person contact, and it's recommended to treat the entire family or any close contacts when it occurs. Symptoms include severe itching, thin, wavy tunnels on the skin composed of tiny blisters or bumps, and the presence of mites mainly in skin folds. However, scabies can appear on various parts of the body. While pets don't spread scabies to humans, coming in contact with animals having scabies can cause temporary itching.

Understanding the disease

Symptoms

The symptoms of scabies include intense itching, usually worse at night, and thin, wavy tunnels made up of tiny blisters or bumps on the skin. Itching may not stop for many weeks after treatment. Scabies can appear on many parts of the body, including the fingers, face, scalp, palms, soles of the feet, and around the waist, genitals, and nipples. Symptoms may take up to six weeks to appear in individuals who have never had scabies before. If you experience any of these symptoms, it's recommended to talk to your healthcare provider for the right treatment.

Risk Factors

Risk factors for developing scabies include:

1. Close person-to-person contact: Scabies can spread quickly through close person-to-person contact in families, child care groups, schools, nursing homes, or prisons.
2. Poor hygiene: Living in crowded conditions, lack of access to proper hygiene facilities, and poor hygiene practices increase the risk of contracting scabies.
3. Weakened immune system: People with weakened immune systems, such as those with HIV or lymphoma, or those who have had organ transplants, are more susceptible to scabies.
4. Age: Young children and older adults are more likely to develop scabies, especially those living in crowded conditions or with limited access to healthcare. It's important to note that while scabies can spread through close contact, pets don't spread scabies to humans, and the mites that affect animals don't survive or reproduce on people.

Development

Scabies develops due to the presence of a tiny burrowing mite called Sarcoptes scabiei. The mite burrows under the skin, causing intense itching and the formation of thin, wavy tunnels made up of tiny blisters or bumps on the skin. The symptoms of scabies include itching, often severe and usually worse at night, and the presence of these skin burrows. Crusted scabies is a more severe form of scabies that affects certain individuals, including young children, people with developmental disabilities, those with weakened immune systems, and older people in nursing facilities. Crusted scabies causes the skin to become crusty and scaly, and affects large areas of the body. It is highly contagious and can be difficult to treat, often requiring a combination of prescription pills and skin creams. The risk of complications from scabies arises from scratching the skin too much, leading to skin infections like impetigo. It is essential to seek medical attention if you experience any symptoms of scabies or have concerns about your skin condition.

Assessment and Diagnosis

Triage

You should see a doctor if you have any symptoms of scabies, which include intense itching, especially at night, and thin, wavy tunnels on the skin made up of tiny blisters or bumps. It's important to consult a healthcare provider for proper diagnosis and treatment to avoid further spreading of the condition.

Diagnosis

To diagnose scabies, a healthcare provider typically examines the skin for symptoms of mites, such as rashes and bumps, and may also take a sample of the skin to examine under a microscope. This allows the provider to determine if any mites or eggs are present. A patch test or skin exam may also be performed to help identify the cause of the rash.

Management and Treatment

Complications

One potential complication of scabies is scratching too much, which can break the skin and cause an infection, such as impetigo. Impetigo is an infection on the skin's surface that is usually caused by staph bacteria (staphylococci) or sometimes by strep bacteria (streptococci). Another potential complication is crusted scabies, which makes the skin crusty and scaly, affects large areas of the body, and is very contagious. Crusted scabies may affect certain people, including young children, people with developmental disabilities, people with weakened immune systems, and older people in nursing facilities.

Prevention

Scabies can be prevented through proper hygiene and cleanliness. To prevent scabies from coming back and to keep the mites from spreading to other people, you should take the following steps:

1. Wash all clothes and linen: Use hot, soapy water to wash all clothing, towels, and bedding used in the last three days before beginning treatment. Dry with high heat or have them dry-cleaned if you can't wash them at home.
2. Starve the mites: Place items you can't wash in sealed plastic bags and leave them in an out-of-the-way place, such as your garage, for a week. Mites die after a few days without food.
3. Clean and vacuum: Vacuum furniture, carpets, and floors to remove scales and crusts that may have scabies mites.
4. Avoid close contact: Scabies spreads through close person-to-person contact, so avoid sharing clothing, bedding, or towels with someone who has scabies.
5. Use medicated treatments: Apply prescription-strength creams or pills to kill the mites and their eggs as recommended by your healthcare provider. By following these prevention measures, you can help reduce the risk of scabies outbreaks and prevent the spread of the mites to others.

Treatment

The treatments for scabies are medicated skin creams or pills that kill the mites and their eggs. The itching may persist for several weeks after treatment. It is also important to take preventive measures, such as washing all clothes and linen in hot, soapy water, placing untreated items in sealed plastic bags for a week, and vacuuming furniture, carpets, and floors to remove scales and crusts that may contain scabies mites.

Preparing for medical consultation

To prepare for an appointment for scabies, you should:

1. List your symptoms: Note down the time of onset, location, severity, and any other relevant information about the rash and itching.
2. Review your medical history: Make a list of any other health conditions you have, as well as any medications, vitamins, or supplements you are currently taking.
3. Prepare a list of questions: Compile a list of questions to ask your healthcare provider during the appointment. Some relevant questions for scabies might include:
   • What is likely causing my symptoms?
   • Are tests needed to confirm the diagnosis?
   • What is the best course of action?
   • How can I manage other health problems alongside the scabies treatment?
   • What are the alternatives to the primary approach you're suggesting?
   • Do I need prescription medication, or can I use nonprescription products to treat the condition?
   • What results can I expect?
   • Can I wait to see if the condition goes away without treatment?
4. Follow pre-appointment restrictions: When you schedule the appointment, ask if there are any specific instructions or restrictions you should follow in the days leading up to the appointment, such as isolation to prevent spreading the infection.
5. Gather your medication information: Bring a list of all the medications, vitamins, or supplements you are taking, along with the dosages and directions. If possible, bring the original bottles as well. By being well-prepared for your appointment, you can ensure that you get the most out of your visit and receive the appropriate treatment for your scabies.