Scabies – Causes, Picture, Symptoms and Treatment

Skin is the clothing of the body and everyone wants to keep it good and be comfortable with it. Scabies is one disease which could play spoilsport with the skin. It gives not only a bad and ugly skin but also severe itching which could be a big problem in the society. Hence to know about scabies and keep good and glowing skin keep reading.

Scabies is common with the human from the ancient times. The Bible and Aristotle have mentioned scabies in the form of lice and mites. But only the Roman Encyclopedist Aulus Cornelius Celsus at the time of turnaround from BC to AD coined the name Scabies.

The name Scabies is from the Latin word Scabere which means scratching. The disease was also called flesh worms of the human body in the 16th century.

Scabies, when coupled with secondary bacterial infection, can cause sores. This development of sores can lead to serious ailments including septicemia, heart disease, and kidney failure.

Scabies even today affects 300 million people around the world annually. A survey reports that 1 – 10 % of the world population is affected by scabies and the percentage could be more between 50 – 80 % in certain demographical locations. Hence the WHO has brought Scabies under the neglected tropical diseases list.

Scabies is a contagious skin disease caused by the infestation of the itch mite Sarcoptes Scabiei. It is highly transmittable by just skin to skin contact. This disease can affect anyone and of all ages. This is the third most common skin disease among children who are the most affected because of transmission.

Scabies causes red, itching bumps and blisters on the skin. The itching could be very severe and intolerable if untreated. Scabies form pimple like rashes, creases, blisters on the skin in all parts of the body and for some only in certain parts of the body.

Scabies is not an indication of poor hygiene and is also not transmitted from animals because the mites from animals cannot breed on humans.

Scabies is also considered to be one of STD or Sexually transmitted disease. But it is also not true. Only because of the close contact of the bodies during intercourse the scabies is transmitted from one partner to the other through the creases of the blistered skin or of the infected sexual organs.

There were recent outbreak or scabies in the western world. In Texas and Charlotte N.C. there was a scabies outbreak in 2015. In 2017 there was an outbreak of Scabies in Dayton, Ohio.

Sarcoptes scabiei:

Sarcoptes scabiei is the parasitic mite which causes Scabies. This eight-legged mite is only 0.2 mm to 0.4 mm length and cannot be seen easily by naked eye. Only through a magnifying glass, these mites can be observed on the skin.

Scabies mites can only crawl on the skin and cannot jump or fly. Their movement is not much felt because of their size but ‘S’ shaped burrows on the skin could indicate the movement of the mites. They are immobile or cannot move below 20 degree Celsius.

These parasitic mites are found in all parts of the world and affect all kinds of mammals including humans. The female mites infest the stratum corneum human skin and deposits eggs in the burrow. They lay 3 to 5 eggs per day and the larvae hatch between 3 to 10 days and move about the skin.

Female mites after one mating with the male can produce eggs for more than a month and burrow in under the skin.

The eggs are .01 to .15 mm in length and they form larvae which are six-legged. These six-legged larvae migrate to the skin surface and molt to become eight-legged parasitic Sarcoptes scabiei mite.

Within a month which is the period of no symptom of scabies they root well in the bottom of the skin and start spreading all over the body. The old and the weak immune people are more affected.

The thread-like tunnels of about 10 mm long may be visible as grey lines on the skin. Scabies on the genitals forms as small itchy lumps.

Infestation period is 2 – 6 weeks for first-time infected persons. It rapidly spreads for persons who are affected for more than once. The infestation period is only 1 – 5 days for these previously affected people.

Even without any visible infection rashes or itches, scabies could be transmitted in the infestation period. This is a real danger of outbreaks as persons come into contact with each other because of no symptoms. Even the clothing, bedspreads, bed sheets, towels and other clothing related to the infected person could transmit scabies.

Norwegian Scabies:

From October 1998 to February 1999 there was an outbreak of Scabies in a nursing home in Norwegia. Nearly 14 persons were affected.

Crusted scabies is called as Norwegian Scabies. And the incident in the nursing home of fast infestation for several patients only got crusted scabies the name of Norwegian scabies.

Crusted scabies is a condition when hundreds of thousands of mites and eggs are formed on the elderly, weakened immune system people, HIV patients, Lymphoma and other diseases which causes severe damage due to scabies. The disease becomes highly contagious because of thick bristle crusts which form on the skin with the worms and eggs.

Causes of Scabies:

The only cause of scabies is the parasitic mite Sarcoptes Scabiei. Scabies is an itchy contagious skin disease. The mites get into the contact of the human skin and form the disease. Direct contact of skin to skin is the main way of transmission of scabies.

Even though poor hygiene is not the reason for the cause of scabies it rapidly spreads among homeless people, highly populated demographical locations where the skin contact is more common. Mother to babies and children are the most common form of transmission within families.

Unlike other skin diseases which are mainly caused by allergies, genetics, and viruses, scabies is only by the parasitic mite scabiei.

The common causes of scabies are as follows :

Sexual contact :

Body contact during intercourse is the main reason for the transmission of scabies from one human to another. The close proximity of the skin of the two persons makes it easily possible for the parasitic mites to be infested into the person from an affected person.

This is more possible during the initial infested period when the rashes or other symptoms are not visible in the affected person’s skin.

Though it could spread even from the reproductive organs because of infection it is not considered as one of the STD disease or the sexually transmitted disease.

Dresses and bed sheets :

The dresses and mainly the undergarments of the infected person when comes into contact with other clothes transmit infection. This is because the mites have a lifetime of approximately around 48 hours of survival even without a human host.

The bed sheets, bedspreads, towels, and other related things when people share for a living cause the transmission of scabies.

The handshake and holding hands:

A person affected with scabies on shaking hands or holding hands of an unaffected person could transmit scabies. This is the reason for the outbreak of scabies in most community centers, clinics, schools, prisons, and hospitals.

Symptoms for Scabies:

Symptoms are the saviors of scabies. Once the symptom surfaces on the skin and other forms, immediate care and caution should be taken. This is not only to save the affected person from many sufferings and ailments but also to prevent transmission.

Since the life cycle of Scabiei for the first time an infected person takes nearly 2 to 5 weeks, it is complicated to identify the symptoms of the infected person.

Some common symptoms for scabies:

Itching:

This is the most common symptom of scabies. The scabies mites present on the skin and in the epidermis layer cause this itching on the skin.

This appears in the form of grey lines on the skin and causes severe itching. This could be in any part of the body. The more it gets severe without treatment the more is the itching.

The itching mainly increases in the night due to the decrease in temperature which makes the mites more active.

Burrows:

The burrows are caused by the mite on various parts of the body of all age groups. They are about 10 mm in length “S’ grey lines on the skin showing the movement of the mite. This appears mostly on the folding parts of the human body.

Some of the parts of the human body where burrows are formed:

• Inner elbows
• Armpits
• Around the waist
• On the soles of the feet
• Between the fingers
• Around the breasts
• Genital parts
• Buttocks
• On the knees
• Inside the wrists
• For babies and children, they are mainly found in the following parts
• Scalp
• On the palms
• Soles of the feet
• Under the finger and toenails

Nodules :

This is common with children who are unable to scratch the itching because of the bite of the mite. Bigger nodules of 2 to 20 mm length could appear in infants.

Crusts :

Thick crusts on the skin indicate the severity of the infection and could be the cause of Crust scabies or Norwegian scabies. These thick crusts contain tens of thousands of eggs, larvae, and mites.

They are common with the elderly, immune deficient people and should be treated immediately.

The other common symptoms of scabies are the lesions caused by the mite bite which are in the form of the following indications:

• Bumps
• Blisters
• Redness of skin
• Rashes
• Hives
• Red pimples
• Tunnels
• Vesicles

Diagnosis of Scabies:

Scabies can be easily self-diagnosed by the red rashes or blisters on the skin. It is to be properly diagnosed to not to get confused with other insect bites and various other skin diseases. Hence once the itching is severe and the rashes become more prominent on the skin it is time to consult a doctor.

The doctor after a clinical examination of the blisters and rashes try to extract a mite from the affected places. If that is not possible the doctor scraps a part of the affected and skin and sends it for microscopic examination which clearly diagnoses the reason for the infection.

Other types of diagnosis of scabies:

PCR Test :

PCR Test Polymerase Chain Reaction test is done to identify the genetic material of the scabies mites. This is done in cases where the microscopic test fails due to the less presence of eggs, larvae, and mites in the affected skin portion.

Biopsy:

Biopsy of the affected part’s scraped skin is also done to confirm the mites in the skin. Skin biopsies are done to identify scabies from other skin diseases like eczema. Biopsy also will establish the severity of the mites in the skin. This is done mainly in the crusted scabies.

BIT:

BIT or Burrow Ink Test is very common in the African countries and could be tested at home itself. Ink from the fountain pen is gently applied on the infected site of the skin. Excess ink is wiped off with an alcohol swab. The burrow is visible as a wavy ink filled line in the stratum corneum where the mite has tunneled and laid eggs.

Dermatoscope Diagnoses:

This recently developed diagnosis involves identifying the mite with an epiluminescence microscopy or Dermatoscope. This confirms the triangular structure of the mite and could view the anterior part with the first two legs. This gives the clear confirmation of the diagnoses of Scabiei mites for the skin disease.

Once the scabies mite infection is confirmed the doctor treatment should be given immediately.

Scabies Treatment

Some general ways of scabies treatment:

• Since scabies are caused by parasitic mites any home remedy is first ruled out.
• Over the counter medicines are also proved not effective and have not produced any significant remedies.
• Scabies is first treated by an emergency doctor who is usually a general medical practitioner or a Pediatrician. Depending on the severity of the disease the dermatologist should be consulted for treatment.
• The general treatment is applying cream or lotions of various combination of medicines.
• The dermatologist will also recommend the full family to undergo this treatment of applying lotions and creams.
• The lotions and creams should be applied not only to the affected area but also of the full body from head to toe for infants and in adults from neck to toe and in some cases even in the face. The cream applied should be left on the skin for a minimum of 10 hours.
• Even after applying the creams some eggs and mites may be left alive on the burrows. Hence a second time of applying is still required until the formation of fresh lesions on the skin is stopped.
• The itching could still continue even after curing. This should not be confused with the second time of infestation until the fresh lesions are found on the skin.
• Scabies treatment for the full family is totally necessary since for second-time infestation of scabies mites are fast and very severe.

Medical treatments for scabies:

Elimite or Permethrin Cream:

This is the universal medicine to kill the scabies mites and cure scabies. This can be applied from infants 2 months old to people of any age.

This is safe for a pregnant woman also. The 5 % permethrin chemical in the cream kills the mites fast for the first time infested people.

This cream should be left overnight or for more than ten hours on the skin and then washed off.

This should be continued for a minimum of 7 days. This is to kill not only the mites but also the larvae and eggs burrowed in the skin.

Lindane treatment:

Lindane treatment is given to patients only when they are not cured with other treatments like Permethrin cream. Lindane treatment is only applied to the secondary level of infected people.It is only used in rare conditions because of its side effects. When lindane comes into contact with skin it causes seizures to several people. This is more common when applied to the wet skin or after bath. Lindane treatment should be avoided by pregnant women, children below 10 years, nursing women, elderly people, people who have sores, and for those who weigh less 50 kgs or 110 pounds. Lindane lotions to an extent of one ounce of 1 % lindane lotion or 30 grams of lindane should only be applied to neck to toe.

Eurax treatment:

Euratex or crotamiton treatment is also used in some rare cases. It can cure within an application as a cream or lotion of one or two days. Since also because of safety reasons it is not highly recommended.

Antihistamine or Steroids :

For patients with the possibility of persistent itching antihistamine or steroid may be used as an adjunct to help pruritus or severe itching.

Antibiotics :

Scabies coupled with secondary bacterial infections could cause serious medical ailments septicemia, heart disease, and kidney failure. They along with the regular scabies treatment could be treated with topical or oral antibiotics depending on the severity.

Ivermectin treatment:

Ivermectin or Stromectol treatment is prescribed by doctors for Crusted Scabies depending on their severity. This is also given to people with altered immune systems like HIV patients. This is not recommended for pregnant women and children.

Sulfur treatment:

When other normal treatments fail 8 to 10 % of sulfur precipitated in petroleum jelly is recommended for patients. But due to its odor and messy application, it is not widely preferred. This is again not safe with kids and pregnant women.

Prevention of Scabies:

Scabies is caused by the parasitic mite found all over the world. Since its symptoms also occur only after more than a month of the infested person it is very difficult to predict the prevention of scabies. But once a community or a family is infested with the mites and formed of the disease the following preventive measures could help its spread and reduce the suffering of the disease by others.

• Treat all the symptomatic and asymptomatic members and those in close contact with them of any one of the scabies treatments.
• In the case of community centers, hospitals, and other highly located communities an oral dose of ivermectin could be used to prevent any outbreak of scabies.
• There should not be any time gap of treating the family members. All should be treated at the same time and with the same duration of treatment.
• All bed linens like pillowcases, blankets, sheets, towels, and all clothes worn mainly the underwear, shirts, pants, and socks should be laundered using a hot cycle wash and hot drying cycle.
• If hot water is not available put all the infested clothing in a safe and secluded place for more than 8 days to kill all the mites which cannot survive so long without the human host.
• Children who were infected with scabies mites should return to school only after the full treatment and curing of the disease.
• Improving living conditions, building local expertise in indigenous communities can reduce the spread of scabies.

Scabies is only a skin disease and could be cured with scabicide medications. Rare treatment failures could lead to severe sores and coupled with secondary bacterial infections lead to severe medical ailments.

Living a proper lifestyle and being aware of the body conditions all the time is a sure way to safety from not only scabies but all kinds of ailments.
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