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 Scabies:

The 7 Year Itch!

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What is Scabies?

Scabei sarcopteiScabies is  a highly contagious, severely itchy skin disease caused by an itch mite known as Sarcoptes scabei var hominis, belonging to the arachnoid family and genus Acarus.

It has an ovoid body, the adult female is about 0.4 X 0.3 mm and male is 0.2 X 0.15mm in size and can only be visualized microscopically.

The life cycle of Scabies Mite

The scabies mite lives and dies  in the burrows. Copulation occurs in the burrow excavated by the female, and as is the nature's rule, the male dies  soon after copulation. The female lays 2-3 eggs daily, which are thatched in one week. The female mite lives around one month.

What are the signs and symptoms of Scabies?

Usually scabies is a disease seen among overcrowded families living in narrow congested rooms. It can also be contracted from pet animals, when it is known as animal scabies.scabies burrow

  • The itching starts about 5-30 days after the mite infestation.

  • The itching is particularly severe during night.

  • The diagnostic lesion in scabies is the Burrow, it is a wavy, thread like greyish line, a few millimeters to a centimeter in length. The open end is usually seen as a papule or vesicle

  • In severe cases, nodules(deep seated swellings) may be seen

  • Secondary lesions due to itching are excoriations, erosions and crusting of the skin

  • As scabies itch mite gets transferred from person to person very fast, there is a typical history of more than one family member suffering from "itching during night'.

  • Infestation can also spread through the clothes, bed sheets, sofas etc that are used by the patient.

Which are the characteristic sites of involvement of scabies in the body?

  • Finger webs, flexor aspect of wrist, inner area of elbows, anterior fold of axilla, below the breasts, in and around umbilicus, genitalia and thighs are the most favoured sites.

  • Scalp, face, neck, palms and soles etc are involved in infants

Are there different types of scabies?

Yes. besides the classical scabies described above, following are the variants of scabies:

  1. Clean Man's Scabies: In those who bath daily and keep themselves clean,  the lesions are scarce and barely visible. Itching is minimal.

  2. Scabies incognito: If strong steroids are mistakenly applied, the lesions are suppressed and change morphology.

  3. Infant scabies: Palms and soles, head neck, face and the whole body is involved in babies. There may be circular scaly patches, vesicles and pustules present in abundance. Often misdiagnosed and mistreated.

  4. Norwegian scabies: Very severe crusted scabies in the immune deficient and mentally retarded with lesions teeming with hundreds of thousands of mites!

  5. Animal scabies: If you have a cat or dog which has scabies, your household, especially children can get animal scabies. The lesions are seen only in areas which are in direct contact with the pet. Burroughs are conspicuous in animal scabies by their absence.

  6. Nodular Scabies: The mites burrow deeper in certain areas, especially the male genitalia and inguinal folds, forming brownish itchy deep seated nodules. These are resistant to normal modes of treatment.

  7. Sexually Transmitted Scabies: Scabies can get transmitted following a sexual contact and can co exist with other STDs like HIV, syphilis, gonorrhoea, chancroid,pubic louse etc.

  8. Scabies bullosa: Vesicular and bullous eruptions are seen in infants afflicted with scabies

  9. Scabies ide and pompholyx: In severe scabies, the skin develops an allergic response to the mite and its excretory product which manifest as vesicular eruption along the sides of the fingers and toes.

How is Scabies managed?

Treatment of scabies involves:

  1. Patient Education:

    1. All persons in the household, whether itching or non itching should be treated.

    2. Even after effective treatment the itching may persist for upto two weeks

    3. The clothes should be disinfected.

    4. Woolen blankets etc should be  kept locked inside the cupboard, as the mites die off if they do not come in contact with humans for 3-5 days

    5. The applications should be repeated on weekly base to prevent the eggs developing into adults.

  2. Medical Therapy

    1. Specific:

      1. The Drug of Choice is Permethrin 5% cream or lotion:

        1. Apply full body, wash off after 8-10 hours

        2. Usually single application enough, but in severe cases, I advise a second application after one week

        3. Can be used in infant above the age of 2 months.

        4. Use in pregnancy controversial, so not advised.

      2. Lindane(1% Gamma Benzene Hexa Chloride):

        1. 12 hours single application, repeat SOS after one week

        2. Avoided in children above 6 years, pregnancy and patients with a history of seizures and neurological disorders

      3. 25% Benzyl Benzoate emulsion:

        1. Should be kept on the body for 3 days

        2. Repeat after 1 week

        3. Over enthusiastic applications may cause irritant dermatitis

        4. Not advised in pregnancy and children below 3 years

        5. May be diluted with half amount of water in children 3-10 years

        6. May have a stinging sensation

      4. Sulfur: 6% precipitated sulfur in petrolatum  for 3 nightly applications. Can be used in infants even below 2 months and in pregnancy and lactation.

      5. Crotamiton

        1. Not very effective

        2. An alternative in children and lactating

      6. Nodular Scabies: Topical or intra lesional steroids followed by the above therapy

    2. Non Specific symptomatic treatment

      1. Systemic antibiotics: If secondary  infection present

      2. Antihistamines: To relieve itching

    3. Systemic Therapy

      1. Ivermectin is a new drug indicated in treating severe types of scabies. Only to be used under medical supervision.

Conclusion: Scabies is a very common disease, but still misdiagnosed and mistreated because of varied presentations. If not treated properly, the course of scabies can run into months. No wonder then, that in the pre, anti-scabicidal  medication era, it was also known as the Seven Year Itch!

Aside: Know any other Seven Year Itch?  Marital life is also known as the Seven Year Itch. Wonder Why?!:-)

 

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Dr.Hanish Babu, MD is a non resident Indian Dermatologist & Venereologist  practicing in Ajman, UAE. He is the  author of the well known Stress Management package  10 Days to Stress Free Life and a net-entrepreneur. He is also a certified hypnotist, stress management trainer and personality development trainer. He is the web editor of half a dozen web sites on the above subjects.

 

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Disclaimer

Information on this site is provided for informational purposes and is not meant to substitute for the advice provided by your own dermatologist or other medical professional. You should not use the information contained herein for diagnosing or treating a health problem or disease, or prescribing any medication. Many skin diseases have similar morphology and may resemble one another. But their treatment varies. Hence, self diagnosis and treatment are not advised. In case of doubt always be on the safer side and consult your dermatologist. Your online dermatologist will give you special tips to deal with specific skin and cosmetic problems.

Information about each product is taken from the labels of the products or from the manufacturer's advertising material. Skin Care Tips From Dermatologist.com or Dr.Hanish Babu are not responsible for any statements or claims that various manufacturers make about their products. We cannot be held responsible for typographical errors or product formulation changes. You should read carefully all product packaging. If you have or suspect that you have a medical problem, promptly contact your health care provider. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease. 

Copyright © 2006 Dr.Hanish Babu, MD. All rights reserved