SCABIES

CAUSE Scabies is an itchy, highly contagious skin disease caused by an infestation by the itch mite Sarcoptes scabiei. Mites are small eight-legged parasites (in contrast to insects, which have six legs). They are tiny, just 1/3 millimeter long, and burrow into the skin to produce intense itching, which tends to be worse at night. The mites that infest humans are female and are 0.3 mm-0.4 mm long; the males are about half this size. Scabies mites can be seen with a magnifying glass or microscope. The scabies mites crawl but are unable to fly or jump. They are immobile at temperatures below 20 C, although they may survive for prolonged periods at these temperatures. Scabies infestation occurs worldwide and is very common. It has been estimated that worldwide, about 300 million cases occur each year. Human scabies has been reported for over 2,500 years. Scabies has been reported to occur in epidemics in nursing homes, hospitals, long-term care facilities, and other institutions. In the U.S., it is seen frequently in the homeless population but occurs episodically in other populations of all socioeconomic groups as well. SIGNS AND SYMPTOMS The characteristic symptoms of a scabies infection include intense itching and superficial burrows.[4] The burrow tracks are often linear, to the point that a neat "line" of four or more closely placed and equally developed mosquito-like "bites" is almost diagnostic of the disease. Itching In the classic scenario, the itch is made worse by warmth and is usually experienced as being worse at night, possibly because there are fewer distractions.[4] As a symptom, it is less common in the elderly.[4] Rash The superficial burrows of scabies usually occur in the area of the hands, feet, wrists, elbows, back, buttocks, and external genitals.[4] Except in infants and the immunosuppressed, infection generally does not occur in the skin of the face or scalp. The burrows are created by excavation of the adult mite in the epidermis. Crusted scabies The elderly and people with an impaired immune system, such as HIV, cancer, or those on immunosuppressive medications, are susceptible to crusted scabies (formerly called Norwegian scabies).[4][7][8] On those with a weaker immune system, the host becomes a more fertile breeding ground for the mites, which spread over the host's body, except the face. Sufferers of crusted scabies exhibit scaly rashes, slight itching, and thick crusts of skin that contain thousands of mites.[9] Such areas make eradication of mites particularly difficult, as the crusts protect the mites from topical miticides, necessitating prolonged treatment of these areas. TREATMENT The following instructions apply to the use of a 5% permethrin cream. Success of permethrin cream, when properly applied, is 90-95% effective.

Take a bath or a shower before treatment; this is done in order to remove excess skin and oils from the body, so that the lotion penetrates more effectively.

Warm skin just out of a shower or bath has a lot of blood in it which can carry away the active ingredient in the scabicide; wait until skin cools before applying the cream. Discontinue the use of topical steroids (e.g. Cortisone cream), until after treatment is completed. Fingernail and toenails should be clipped Apply treatment, paying special attention to the belly button/navel. Massage into areas of thick skin, such as the soles of the feet and other calluses. Be, very thorough, making sure to apply between the toes, on the perineum and genitals, and on the back where it can be difficult to reach. Pay special attention to any skin folds, and make sure you apply cream under the nails (a soft brush, such as an old toothbrush can help with this). Do not stint on treatment - make sure that you are well covered with the treatment; remember, permethrin works by absorbing into the skin, not coating it. The usual adult dose is 30 grams. Reapply treatment to any area where it may have come off. For instance, if you wash your hands, reapply treatment to them. It's best to be relatively inactive during the treatment, this is why treating before sleep is ideal. Use clean bedding and clothing after the treatment is applied. Remove cream after 8-14 hours (follow instructions supplied with scabicide). Wear clean clothes after treatment is completed. Do not wear the same clothes that were worn while treating; likewise, change bedding and towels etc. used during treatment.

PREVENTION & CONTROL When a person is infested with scabies mites the first time, symptoms may not appear for up to two months after being infested. However, an infested person can transmit scabies, even if they do not have symptoms. Scabies usually is passed by direct, prolonged skin-to-skin contact with an infested person. However, a person with crusted (Norwegian) scabies can spread the infestation by brief skin-to-skin contact or by exposure to bedding, clothing, or even furniture that he/she has used. Scabies is prevented by avoiding direct skin-to-skin contact with an infested person or with items such as clothing or bedding used by an infested person. Scabies treatment usually is recommended for members of the same household, particularly for those who have had prolonged skin-to-skin contact. All household members and other potentially exposed persons should be treated at the same time as the infested person to prevent possible reexposure and reinfestation. Bedding and clothing worn or used next to the skin anytime during the 3 days before treatment should be machine washed and dried using the hot water and hot dryer cycles or be dry-cleaned. Items that cannot be dry-cleaned or laundered can be disinfested by storing in a closed plastic bag for several days to a week. Scabies mites generally do not survive more than 2 to 3 days away from human skin. Children and adults usually can return to child care, school, or work the day after treatment. Persons with crusted scabies and their close contacts, including household members, should be treated rapidly and aggressively to avoid outbreaks. Institutional outbreaks can be difficult to control and require a rapid, aggressive, and sustained response. Rooms used by a patient with crusted scabies should be thoroughly cleaned and vacuumed after use. Environmental disinfestation using pesticide sprays or fogs generally is unnecessary and is discouraged.