All populations are susceptible, regardless of gender, race, or age, although children younger than 15 years are most frequently afflicted. People with multiple sex partners, those who are immunocompromised, and clinicians in direct patient contact are also at high risk for contracting the disease.
The female insect burrows into the skin, most commonly on the fingers, hands, wrists, heels, elbows, armpits, inner thighs, and waist. The intense pruritic that accompanies scabies is an allergic reaction to the mites, their eggs, or their feces.
Patients and their families are often disgusted and frightened by the prospect of having “bugs,” and as word spreads among their circle of friends, a ripple effect is felt by the entire local medical community, with phones ringing off the wall. Infection requires to be prolonged skin-to-skin contact, so a person cannot easily acquire the mites by shaking hands or from touching inanimate objects.
Scabies is often transmitted sexually but usually only in cases where skin-to-skin contact is lengthy (e.g., sleeping together all night), not from brief encounters. Additional insects commonly found in the United States include fleas, chiggers, and bedbugs, but they do not reside or multiply on humans.
There are a number of human ectoparasites that can be acquired in foreign countries, such as sand fleas and bot flies, so it is important to ask patients about recent travel. Knowing that scabies mites are the only “bugs” that reside and multiply on the human body and cause widespread itching makes it easier to diagnose an infestation.
Canine scabies is known as “mange.” These mites can crawl on humans, producing itching, but they will be unable to multiply and will soon die. And while human S. scabies presumably can infest dogs and other pets, the mites cannot survive for extended periods or carry out their life cycle.
A recent example was a young girl who developed an itchy rash on her chest and arms after clutching a pet rabbit. Reality: Often, patients will present with an extremely pruritic bumpy rash, which increases in intensity at bedtime.
However, there are certain signs for which clinicians should remain alert: persistent constant itching despite application of numerous medications; suboptimal patient hygiene; patient age and history of sexual activity; vesicular rash on the hands, especially between the fingers or on the solar wrists, their/hypothenar skin, and suprapubic skin; edematous red pa pules on the scrotum and/or penis; and additional family members similarly affected. The presence of burrows (thin, dark, wavy lines created by the female mites as they tunnel under the skin) is extremely helpful when making a diagnosis, but such obvious signs often are not seen.
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Scabies is an infestation of the skin by the human itch mite (Scopes scabies var. The microscopic scabies mite burrows into the upper layer of the skin where it lives and lays its eggs.
The most common symptoms of scabies are intense itching and a pimple-like skin rash. Scabies is found worldwide and affects people of all races and social classes.
Scabies can spread rapidly under crowded conditions where close body and skin contact is frequent. Institutions such as nursing homes, extended-care facilities, and prisons are often sites of scabies outbreaks.
It is important to remember that an infested person can spread scabies during this time, even if he/she does not have symptoms yet. In a person who has had scabies before, symptoms usually appear much sooner (1-4 days) after exposure.
The most common signs and symptoms of scabies are intense itching (pruritic), especially at night, and a pimple-like (popular) itchy rash. The itching and rash each may affect much of the body or be limited to common sites such as the wrist, elbow, armpit, webbing between the fingers, nipple, penis, waist, belt-line, and buttocks.
These burrows appear as tiny raised and crooked (vertiginous) grayish-white or skin-colored lines on the skin surface. They are found most often in the webbing between the fingers, in the skin folds on the wrist, elbow, or knee, and on the penis, breast, or shoulder blades.
Contact generally must be prolonged; a quick handshake or hug usually will not spread scabies. Scabies is spread easily to sexual partners and household members.
Scabies is sometimes spread indirectly by sharing articles such as clothing, towels, or bedding used by an infested person; however, such indirect spread can occur much more easily when the infested person has crusted scabies. Diagnosis of a scabies infestation is usually made based on the customary appearance and distribution of the rash and the presence of burrows.
It is important to remember that a person can still be infested even if mites, eggs, or fecal matter cannot be found; typically fewer than 10-15 mites can be present on the entire body of an infested person who is otherwise healthy. However, persons with crusted scabies can be infested with thousands of mites and should be considered highly contagious.
Products used to treat scabies are called herbicides because they kill scabies mites; some also kill eggs. Always follow carefully the instructions provided by the doctor and pharmacist, as well as those contained in the box or printed on the label.
When treating adults and older children, suicide cream or lotion is applied to all areas of the body from the neck down to the feet and toes; when treating infants and young children, the cream or lotion also is applied to the head and neck. If itching continues more than 2-4 weeks after initial treatment or if new burrows or rash continue to appear (if initial treatment includes more than one application or dose, then the 2-4 time period begins after the last application or dose), pretreatment with suicide may be necessary; seek the advice of a physician.
Pets can become infested with a different kind of scabies mite that does not survive or reproduce on humans but causes “mange” in animals. However, the animal mite cannot reproduce on a person and will die on its own in a couple of days.
Items that cannot be washed or dry-cleaned can be decontaminated by removing from anybody contact for at least 72 hours. Items that cannot be washed or dry-cleaned can be decontaminated by removing from anybody contact for at least 72 hours.
Many drug reactions can mimic the symptoms of scabies and cause a skin rash and itching; the diagnosis of scabies should be confirmed by a skin scraping that includes observing the mite, eggs, or mite feces (Scala) under a microscope. Reinfestation with scabies from a family member or other infested person if all patients and their contacts are not treated at the same time; infested persons and their contacts must be treated at the same time to prevent reinfestation.
Treatment failure caused by resistance to medication, by faulty application of topical herbicides, or by failure to do a second application when necessary; no new burrows should appear 24-48 hours after effective treatment. Reinfestation from items (famines) such as clothing, bedding, or towels that were not appropriately washed or dry-cleaned (this is mainly of concern for items used by persons with crusted scabies); potentially contaminated items (famines) should be machined washed in hot water and dried using the hot temperature cycle, dry-cleaned, or removed from skin contact for at least 72 hours.
The doctor can examine the person, confirm the diagnosis of scabies, and prescribe an appropriate treatment. Sleeping with or having sex with any scabies infested person presents a high risk for transmission.
The longer a person has skin-to-skin exposure, the greater is the likelihood for transmission to occur. Although briefly shaking hands with a person who has non-crusted scabies could be considered as presenting a relatively low risk, holding the hand of a person with scabies for 5-10 minutes could be considered to present a relatively high risk of transmission.
The type of scabies (i.e. non-crusted vs crusted) to which a person has been exposed; the degree and duration of skin exposure that a person has had to the infested patient; whether the exposure occurred before or after the patient was treated for scabies ; and, whether the exposed person works in an environment where he/she would be likely to expose other people during the asymptomatic incubation period.