What is scabies?

Scabies is quite a common itchy skin condition caused by a tiny mite called Sarcoptes scabiei that burrows in the surface of the skin, especially around the hands, feet and male genitalia. It does not usually affect the neck and head.

Itching is a response to an allergic reaction to the tiny mites and a rash of red, raised spots may develop.

How is scabies contracted?

The mite may be passed to someone else by close physical contact, such as holding hands.

Typical patients with scabies include young adults who are in close contact with someone else itching, the elderly in a home or hospital, parents or grandparents recently visited by scratching children and several members of a school class who are itching.

Scabies is not due to uncleanliness.

What are the symptoms of scabies?

An itchy rash with tiny lumps and blisters will develop on parts of the skin, including between the fingers, around the wrists, around the armpit folds, on the buttocks, on the penis, on the insteps of the feet, and the backs of the heels. It rarely affects the face and head. Small itchy lumps on the penis, buttocks and around the armpits may indicate scabies.

The itch is worse at night and may affect more than one family member.

How is scabies diagnosed?

Scabies is diagnosed by the history which typically is that of an intensely itchy rash, which is worse at night and is gradually spreading to involve a greater area. It can be present for up to 12 weeks before an itch or rash develops. During this time, scabies can be passed on to others.

Diagnosis is often made clearer because more than one family member has an itchy rash.

Burrows can sometimes be seen near the wrists and the diagnosis can be confirmed by microscopic examination of its contents.

How is scabies treated?

There are three main types of treatment currently in use for scabies. All are applied to the whole body except the head and neck and the whole family should be treated at the same time.

  • Permethrin is considered safe, easy to apply and tends not to irritate the skin. It should be left on the skin for at least eight hours and may be used on the head and necks of children under two years.
  • Benzyl benzoate emulsion is washed off after twenty-four hours and repeated two or three times. Dilute it in two or three times as much water for use in infants or young children.
  • Malathion is washed off after twenty-four hours.

What is the outlook?

These treatments kill the mites but their bodies are still in the skin. The allergic itch will persist until our natural defence systems break down and get rid of what is left of the mites.

This process can take about two weeks, so expect the itch to continue for that time and don’t feel disheartened.

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