Scabies

What is scabies?

Scabies is a contagious, and very itchy disease that is caused by infestation with a microscopic mite called Sarcoptes scabiei, that lives only on humans. This mite burrows in the very superficial layer of the skin.

untreated it can last for years, which explains its other name – seven year itch.

How does scabies look and feel like?

Scabies usually causes very itchy, small, red, scaly and crusty bumps typically between fingers, on wrists, armpits, breasts, buttocks, genitalia and feet. In adults it usually does not involve face and scalp, while in infants it can involve the entire skin. Itching is worse at night, frequently waking you up, which is very typical of scabies. No over-the-counter medicines have ever helped any of our patients.

How did I get scabies?

You caught the scabies from some other person who has scabies. Just think if within the past 2-6 weeks you were in direct, skin-to-skin contact lasting for at least several minutes (not just a handshake or a hug) with someone who had been diagnosed with scabies, had complained of itching, or had been living in a nursing home or in a jail. Rarely, you can catch scabies from the clothes of someone with scabies. However, mites cannot live longer than 3 days off a person. After you catch scabies mite, it takes 2-6 weeks until you  start itching. Therefore you might have it without knowing it, and spread it around to other people.

Can animals spread scabies?

No, they cannot.

Can I treat scabies by myself?

No, you cannot. No over-the-counter medicine has ever helped any of our patients.

Ok, then I should see my health care provider, but how can my provider determine that I indeed have scabies?

Your health care provider will confirm the diagnosis of scabies by listening to your story (severe itching, worse at night, wakes you up at night, contact with someone else who is itchy etc.), and by examining your skin, sometimes by using a dermatoscope (a hand-held instrument typically used by a dermatologist) looking for burrows, or by scrapping the involved skin and looking the scrapings under the microscope (also typically done by a dermatologist) looking for mites and its eggs. If still uncertain about the diagnosis, your health care provider may refer you to a dermatologist. If you caught scabies during sex, then you should be checked for other sexually transmitted diseases as well.

What is the treatment for scabies?

Here are standard instructions we provide to our patients:

1. Treat all household members, roommates and close contacts even if they do not have itching.
2. Apply permethrin cream (brand name: Elimite) in ample amounts from the jaw-line (in babies treat head as well)  to the tips of toes as well as under fingernails and toenails. Leave it on overnight for 10 hours.
3. Shower in the morning.
4. In the morning wash everything that can be washed in hot water (e.g. bedding and all the clothing that you wore in the past 5 days).
5. Place everything that cannot be washed (shoes, wrist watches, belts etc.) in plastic bags and close tightly for 7 days.
6. Repeat steps 1 through 5 in 7 days.

You may continue to be itchy for about 6 weeks. This is normal since it is our immune reaction to mites that causes itching and not the mites themselves.

In more severe cases, or when creams are not feasible, we prescribe ivermectin pill (brand name: Stromectol) that is taken as a single dose on an empty stomach. If needed, the dose is repeated in 2 weeks.

I am still itchy after the treatment, what now?

We always examine patients a week or two after the last treatment. If there is no scabies mite present, and the patient is still itchy we prescribe a steroid ointment or cream to be used once or twice daily for the next 1-2 weeks.

When is safe to go back to work or school?

After one treatment you can go back to work, or school.

 

For more specific questions on scabies send us your question using our blog below.