What are the early signs of scabies. How does scabies spread. What does scabies look like on the skin. How is scabies diagnosed and treated. Can scabies be prevented. What complications can arise from untreated scabies. How long does scabies last after treatment.

Understanding Scabies: A Microscopic Mite Infestation

Scabies is a highly contagious skin condition caused by the Sarcoptes scabiei var. hominis mite, also known as the human itch mite. This microscopic parasite burrows into the upper layer of the skin, causing intense itching and a characteristic rash. Affecting approximately 200 million people worldwide at any given time, scabies can strike individuals of all ages, races, and socioeconomic backgrounds.

What makes scabies so pervasive? The mite’s life cycle and mode of transmission contribute to its widespread nature. After a female mite burrows into the skin, it lays eggs in the tunnel it creates. Once hatched, the larvae move to the skin’s surface and spread across the body or to another host through close physical contact.

Recognizing the Symptoms: The Telltale Signs of Scabies

Identifying scabies early is crucial for prompt treatment and preventing its spread. What are the primary symptoms of scabies?

• Intense itching, often worsening at night
• A rash that may resemble hives, bites, knots, pimples, or patches of scaly skin
• Visible burrow tracks or lines, typically in skin folds
• Sores from scratching, which can lead to secondary infections
• In severe cases, thick crusts on the skin (crusted scabies)

It’s important to note that symptoms may not appear immediately after infestation. For first-time exposure, it can take 4-8 weeks for symptoms to develop. In subsequent infestations, symptoms may appear within 1-4 days due to the body’s quicker immune response.

Common Infestation Sites

Where does scabies typically appear on the body? In adults and older children, common sites include:

• Between the fingers and around fingernails
• Armpits and waistline
• Inner wrists and elbows
• Soles of the feet
• Breasts, particularly around the nipples
• Male genitalia
• Buttocks and knees
• Shoulder blades

Infants and young children may experience infestations in different areas, including the scalp, face, neck, palms, and soles. In some cases, children may develop a widespread infestation covering much of their body.

The Contagious Nature of Scabies: Understanding Transmission

How does scabies spread so easily? The primary mode of transmission is through direct skin-to-skin contact. This close physical contact allows the mites to transfer from one person to another. Additionally, sharing infested items such as bedding, clothing, or furniture can also lead to transmission.

Why are certain environments more prone to scabies outbreaks? Close-contact settings like family homes, childcare centers, schools, and nursing homes provide ideal conditions for the rapid spread of scabies. In these environments, the frequent and prolonged physical contact between individuals facilitates mite transmission.

Scabies in Animals

Can humans get scabies from animals? While animals like dogs and cats can be affected by mites, they host different species than those that infest humans. Human contact with animal mites may cause a mild, transient skin reaction, but full-scale human infestation with animal mites is rare.

Diagnosing Scabies: Identifying the Infestation

How do healthcare professionals diagnose scabies? Diagnosis typically involves a combination of clinical examination and patient history. A doctor will look for characteristic signs such as burrow tracks and the distinctive rash pattern. In some cases, they may perform a skin scraping to examine under a microscope for mites, eggs, or fecal matter.

What can make diagnosing scabies challenging? The symptoms of scabies can mimic other skin conditions, leading to potential misdiagnosis. Additionally, the delayed onset of symptoms in first-time infestations can make it difficult to pinpoint the source of exposure.

Treatment Options: Eliminating the Mite Infestation

What are the primary treatments for scabies? The main approach to treating scabies involves the use of topical medications to kill the mites. Some common treatments include:

• Permethrin cream: A 5% cream applied to the entire body from the neck down
• Ivermectin: An oral medication sometimes used for severe cases or when topical treatments are ineffective
• Crotamiton: A topical medication that can help relieve itching
• Lindane: A prescription lotion or cream used in cases where other treatments have failed

How should scabies treatment be approached? It’s crucial that all individuals who have had close contact with an infested person be treated simultaneously, even if they don’t show symptoms. This comprehensive approach helps prevent reinfestation and breaks the cycle of transmission.

Managing Symptoms During Treatment

What can be done to alleviate the discomfort associated with scabies? While the medications work to eliminate the mites, the following measures can help manage symptoms:

• Antihistamines to reduce itching
• Cool compresses to soothe inflamed skin
• Keeping nails short to minimize skin damage from scratching
• Using calamine lotion or other anti-itch products

Post-Treatment Care: Ensuring Complete Eradication

What steps should be taken after scabies treatment? To prevent reinfestation, it’s essential to thoroughly clean and decontaminate the environment. This includes:

1. Washing all clothing, bedding, and towels used in the past 3 days in hot water and drying on high heat
2. Dry cleaning items that can’t be washed or sealing them in plastic bags for at least 72 hours
3. Vacuuming carpets and upholstered furniture thoroughly
4. Avoiding close contact with others until treatment is complete

How long does it take for scabies to clear after treatment? While the medication typically kills mites quickly, the itching and rash may persist for up to 4 weeks as the body clears the dead mites and eggs. If symptoms continue beyond this period, a second round of treatment may be necessary.

Preventing Scabies: Minimizing Risk of Infestation

Can scabies be prevented? While complete prevention may be challenging due to its highly contagious nature, certain measures can reduce the risk of infestation:

• Avoiding skin-to-skin contact with individuals known to have scabies
• Refraining from sharing personal items like clothing or bedding with others
• Practicing good hygiene, including regular hand washing
• In institutional settings, implementing screening protocols and prompt treatment of identified cases

What role does education play in scabies prevention? Raising awareness about the signs, symptoms, and transmission of scabies can help individuals identify and seek treatment early, reducing the risk of outbreaks in communities.

Complications of Untreated Scabies: Beyond the Itch

What can happen if scabies is left untreated? While scabies itself is not life-threatening, prolonged infestation can lead to several complications:

• Secondary bacterial infections: Persistent scratching can break the skin, allowing bacteria to enter and cause infections like impetigo
• Crusted scabies: A severe form of infestation where thousands of mites are present, often seen in immunocompromised individuals
• Sleep disturbances: The intense itching, particularly at night, can significantly impact sleep quality
• Psychological distress: The persistent symptoms and social stigma associated with scabies can lead to anxiety and depression

How does crusted scabies differ from typical scabies? Crusted scabies, also known as Norwegian scabies, is a more severe and highly contagious form of the infestation. It typically affects individuals with weakened immune systems and can be challenging to treat due to the high number of mites present.

Long-term Effects of Scabies

Are there any long-lasting effects of scabies after treatment? In most cases, once successfully treated, scabies does not cause long-term health problems. However, some individuals may experience prolonged skin sensitivity or post-scabies itch, which can persist for weeks or months after the mites have been eliminated.

Scabies in Special Populations: Unique Considerations

How does scabies affect different age groups and populations? While scabies can affect anyone, certain groups may require special attention:

• Infants and young children: May experience more widespread infestations and have difficulty communicating discomfort
• Elderly individuals: May be at higher risk in care facilities and may have atypical presentations
• Immunocompromised patients: At risk for developing crusted scabies, which is highly contagious and difficult to treat
• Pregnant women: Require careful consideration in treatment options to ensure safety for both mother and fetus

What precautions should healthcare workers take when dealing with scabies patients? Healthcare professionals should use appropriate personal protective equipment, including gloves and gowns, when in direct contact with infested individuals. They should also follow proper hand hygiene protocols to prevent transmission within healthcare settings.

Scabies Myths and Misconceptions: Separating Fact from Fiction

What are some common myths about scabies that need debunking?

• Myth: Scabies is a result of poor hygiene.
  Fact: Scabies can affect anyone, regardless of personal cleanliness.
• Myth: You can get scabies from animals.
  Fact: Human scabies is caused by a different mite species than those affecting animals.
• Myth: Scabies can be treated with over-the-counter remedies.
  Fact: Effective treatment typically requires prescription medications.
• Myth: Once treated, you’re immune to scabies.
  Fact: You can get scabies multiple times if re-exposed to the mites.

Why is it important to dispel these myths? Misconceptions about scabies can lead to stigmatization, delayed treatment, and ineffective prevention strategies. Accurate information is crucial for proper management and control of this common skin condition.

Global Impact of Scabies: A Public Health Perspective

How does scabies affect communities worldwide? Scabies is a significant public health issue, particularly in resource-limited settings. It can lead to:

• Economic burden due to treatment costs and lost productivity
• Strain on healthcare systems, especially during outbreaks
• Complications from secondary bacterial infections, which can be severe in areas with limited access to healthcare
• Social stigma and psychological distress for affected individuals

What efforts are being made to combat scabies on a global scale? The World Health Organization (WHO) has recognized scabies as a neglected tropical disease. Efforts are underway to improve surveillance, develop more effective treatments, and implement community-wide interventions in endemic areas.

Research and Future Directions

What are some areas of ongoing research in scabies management? Current research focuses on:

• Developing new, more effective treatments
• Improving diagnostic methods for faster and more accurate detection
• Understanding the genetic factors that may influence susceptibility to scabies
• Exploring mass drug administration strategies for population-level control in endemic areas

How might future advancements change the landscape of scabies management? Improved treatments and diagnostic tools could lead to more efficient control of outbreaks and reduced transmission rates. Additionally, a better understanding of the mite’s biology could pave the way for novel prevention strategies.

Living with Scabies: Coping Strategies and Support

How can individuals cope with the physical and emotional challenges of scabies? Dealing with scabies can be stressful, but there are several strategies that can help:

• Adhering strictly to treatment regimens and follow-up care
• Communicating openly with healthcare providers about concerns and symptoms
• Seeking support from friends, family, or support groups
• Practicing stress-reduction techniques to manage anxiety related to the condition
• Educating oneself about scabies to dispel fears and misconceptions

What resources are available for individuals affected by scabies? Many healthcare organizations and dermatology associations provide educational materials and support for those dealing with scabies. Online forums and support groups can also offer a platform for sharing experiences and coping strategies.

Returning to Normal Life After Scabies

When is it safe to resume normal activities after scabies treatment? Generally, individuals can return to work or school the day after completing their first treatment. However, it’s important to follow healthcare provider recommendations and avoid close contact until treatment is fully complete.

How can individuals rebuild confidence after a scabies infestation? Overcoming the psychological impact of scabies may take time. Focusing on self-care, maintaining open communication with loved ones, and gradually reintegrating into social activities can help restore a sense of normalcy and confidence.

What is scabies? Images, symptoms, and treatment

Scabies is a skin condition that can cause itching and a rash. It is caused by a microscopic mite. It can occur at any age and spreads through physical contact. Topical medications, such as permethrin cream, can treat it.

Scabies is contagious and can spread very easily from person to person through close physical contact. This makes outbreaks likely in close settings, such as the family home, a childcare group, a school class, or a nursing home.

However, it can affect people of all ages, whatever their living situation and socioeconomic status. If an individual has scabies, they and anyone they have close contact with should all receive treatment at the same time.

In this article, learn about what scabies looks like, its symptoms, its causes, and some of its treatment options.

Scabies affects around 200 million people worldwide at any one time. These are people of all races, ages, and socioeconomic statuses.

Scabies is highly contagious, spreading easily through close physical contact and by sharing bedding, clothing, and furniture items infested with mites.

Scabies most often occurs in children and young adults, with outbreaks common in childcare facilities and schools.

Share on PinterestScabies infestation on the hands.
Photography by DermNet New ZealandShare on PinterestScabies is classically known to cause intense itching and a rash in the spaces between the fingers.
Photography courtesy of Gzzz/Wikimedia

The onset of scabies symptoms varies depending on whether or not a person has previously had exposure to mites. The first time a person has exposure to the scabies mite, it can take 4–8 weeks for symptoms to develop.

This timeframe is significantly shorter in subsequent infestations, as the body’s immune system is quicker to react. This is typically within 1–4 days.

Some symptoms of scabies include:

• Itching: This is often worse at night, and it can be severe and intense. Itching is one of the most common scabies symptoms.
• Rash: When the mite burrows into the skin, it forms burrow tracks, or lines, which are most commonly present in skin folds. The rash may look like hives, bites, knots, pimples, or patches of scaly skin. Blisters may also be present.
• Sores: These occur in infested areas where a person has scratched the skin. Open sores can lead to impetigo, which is commonly caused by a secondary infection with Staphylococcus aureus.
• Thick crusts: Crusted scabies is a form of severe scabies in which hundreds to thousands of mites and mite eggs are present within skin crusts. This causes severe skin symptoms.

Most often, people with crusted scabies exhibit widespread gray, thick, and crumbling crusts. Mites living in the detached crusts can live for more than a week without needing human contact due to the food provided by the crusts themselves.

The most common sites of infestation in adults and older children include:

• between the fingers
• around the fingernails
• the armpits
• the waistline
• the inner parts of the wrists
• the inner elbow
• the soles of the feet
• the breasts, particularly the areas around the nipples
• the male genitalia
• the buttocks
• the knees
• the shoulder blades

Infants and young children tend to experience infestations in other areas of the body, including the:

• scalp
• face
• neck
• palms of the hands
• soles of the feet

At times, children can present with a widespread infestation that covers the majority of the body.

Infants with scabies tend to exhibit symptoms of irritability as well as sleeping and eating difficulties.

How long does scabies last?

Scabies mites can live for 1–2 months on children and adults. When they are not on people, mites only survive for up to 72 hours.

Treatment with prescribed medications generally kills mites quickly. The itching and rash that scabies causes may initially become worse, but the skin should heal within 4 weeks.

If the symptoms persist beyond 4 weeks, scabies mites may still be present. To get rid of the mites thoroughly, some people may need to receive treatment two or three times.

Scabies is an infestation with the Sarcoptes scabiei var. hominis mite, which is also known as the human itch mite.

After burrowing under the skin, the female mite lays its eggs in the tunnel it has created. Once hatched, the larvae move to the surface of the skin and spread across the body or to another host through close physical contact.

Humans are not the only species that mites affect. Mites can also affect dogs and cats. However, each species hosts a different species of mite, and while humans may experience a mild, transient skin reaction to contact with animal mites, a full-scale human infection with animal mites is rare.

Scabies is highly contagious and spreads through direct skin-to-skin contact or by using a towel, piece of bedding, or furniture item infested with the mites. Because of this, some of the most likely people to experience an infestation include:

• children attending daycare or school
• parents or caregivers of young children
• sexually active young adults
• people with multiple sexual partners
• residents of extended care facilities
• older adults
• people with weakened immune systems, including those with HIV, transplant recipients, and others taking immunosuppressant medications

Scabies is highly contagious, so anyone living with someone who has the condition will most likely need to receive treatment for scabies even if they do not have any symptoms. This includes anyone with whom the person has had recent intimate contact.

Doctors generally treat scabies with topical medications such as 5% permethrin cream, crotamiton cream, or lindane lotion. In some cases, a 25% benzyl benzoate lotion or 10% sulfur ointment may be necessary.

For most topical preparations, people should apply them at night, leave them on during sleep, wash them off in the morning.

In the meantime, if they can, the person should wash all sheets, towels, and clothing they have recently used. If it is impossible to wash a particular item, the person should put it in a sealed bag and leave it out for 3–5 days.

Ivermectin, which is an oral medication, may be a good option for people with weakened immune systems, those with crusted scabies, or those who do not respond to topical therapy.

People should not use ivermectin during pregnancy or while breastfeeding. Children weighing under 33 pounds (15 kilograms) should also avoid this medication.

A doctor might prescribe other medications — including antihistamines, anti-itching lotions such as pramoxine lotion, antibiotics, and steroid creams — to offer relief from symptoms.

Tests and diagnosis

A person can sometimes mistake scabies for dermatitis or eczema, as these skin conditions also cause itching and bumps on the skin. Anyone who is unsure about the cause of a skin condition should contact a doctor, as over-the-counter remedies cannot eradicate scabies.

A doctor can diagnose scabies by examining the skin or looking at skin scrapings under a microscope.

Sarcoptes scabiei var. hominis most commonly affects humans. The sections below look at some different mite species and some types of scabies infestations.

Species of mites

The scabies mite that affects humans belongs to the Sarcoptidae family, which contains three subfamilies: Sarcoptinae, Teinocoptinae, and Diabolicoptinae.

Altogether, the entire scabies mite family includes 118 species, and these affect the skin of different mammals. When scabies affects animals, the condition is known as sarcoptic mange.

Types of scabies infestations

The human scabies mite can affect people in different ways, as follows:

• Typical scabies: The most common type, this infestation causes itchiness on the hands, wrists, and other areas, but not on the face or scalp.
• Nodular scabies: This causes itchy, raised bumps that usually develop in the armpits or around the genital area.
• Crusted scabies: People with typical scabies who have weakened immune systems may develop this type. It produces thick, gray crusts of skin that contain thousands of scabies mites. It is extremely contagious.

If a person scratches or rubs their skin to relieve the intense itching of a scabies infestation, it may create skin sores.

Should these open sores become infected with bacteria on the skin, such as S. aureus, it could lead to serious conditions, such as heart disease, kidney disease, or blood poisoning.

People can prevent scabies infestations by limiting contact with the skin of someone who already has one and items such as their bedding or clothing.

However, this may be difficult when it comes to members of the same household or people who are in close proximity to someone with an infestation, as that person can sometimes be symptom-free for as long as 4–8 weeks.

To prevent subsequent infestations and spreading, a person should wash or dry-clean all clothes, towels, and linens. When doing so, they should use hot, soapy water and dry on a high heat. People should place any items that they cannot wash into a sealed plastic bag for at least 3 days to starve the mites.

People should also vacuum the entire home — including carpets, rugs, and upholstery — on the day that treatment is initiated and either discard the bag or thoroughly clean the vacuum’s canister.

If a person has any concerns that they may have or may be at risk of experiencing scabies, they should speak with a doctor.

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Scabies | Cause, Symptoms, & Treatment

scabies-causing itch mite Sarcoptes scabiei, variety hominis

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scabies, also called sarcoptic itch, skin inflammation accompanied by severe itching, particularly at night, caused by the itch mite (Sarcoptes scabiei, variety hominis). The mite passes from person to person by close contact. While scabies occurs worldwide, it is most common in areas that are affected by overcrowding and poverty, particularly in countries with tropical climates. The disease also afflicts many schoolchildren and residents of nursing homes and assisted-living facilities, with periodic epidemics occurring even among persons with strict habits of hygiene and adequate living conditions.

Sarcoptes scabiei attains a length of about 0.35 mm (0.014 inch) and is barely visible to the unaided eye. Despite its small size, it has quite formidable mouthparts and eight very powerful legs. With its hind legs, the female of the species hitches itself to the skin and, with its mouthparts thus closely applied to the skin, cuts its way down into the outer epithelial layer. The mite then tunnels horizontally and gouges out an easily recognizable burrow up to several inches long and usually not very straight. These burrows sometimes are visible as dark wavy lines. The female mite prefers the skin between the fingers and toes, on the wrists and elbows, in the armpits, below the breasts, and on the male genitals. It does most of its moving at night. Sometimes it is visible at the far end of one of its burrows. The female mite lays eggs that hatch into larvae. The larvae emerge from the skin and molt several times through a nymph stage before they become adults and mate. The development from egg to laying adult frequently takes about three weeks.

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The initial lesion produced by the burrowing mite becomes intensely itchy after a few days to about a month, and the scratching usually leads to secondary skin lesions consisting of papules (solid elevations), pustules, and crusted skin areas. In addition, a rash breaks out on parts of the body where there are no burrows—on the buttocks, over the shoulder blades, and on the abdomen. The rash is the result of an allergic reaction to mite proteins, feces, and eggs. It is intensely irritating and interferes with sleep.

Transmission of the mite is by skin-to-skin contact and by contamination of clothing or bedding. Transmission can be prevented by wearing clean underclothes and by frequently changing one’s clothes and washing—conditions not always possible in overcrowded or resource-poor communities. Effective treatment consists of covering the affected person from neck to feet with medicinal lotion that kills the mite. Several medications are available. One percent lindane lotion (gamma-benzene hexachloride) is effective but can be toxic. Permethrin, a synthetic drug based on chemicals derived from the chrysanthemum, is effective and quite safe, even in pregnant women and in very young children. Crotamiton, a prescription anti-itch medication, is another scabicidal lotion that can be applied to the entire body. Sulfur-containing ointments may also work, but they are not well accepted for cosmetic reasons. Ivermectin, taken orally, may be prescribed for individuals who do not respond to lotions or creams or for patients who suffer from crusted scabies. It is desirable to treat an entire family or a group of people living together, for often the early burrowing stage of the disease causes no irritation, and a person can be infested without knowing it.

The Editors of Encyclopaedia BritannicaThis article was most recently revised and updated by Kara Rogers.

Scabies (clinic and diagnostics before and after HIV/AIDS infection)

Scabies (lat. scabies , from scabo – scale) is the most common parasitic skin disease. It affects people of all ages – from infants to centenarians inclusive. Scabies has not been established predisposition of any ethnic or socio-economic groups of the population. The causative agent of scabies is the mite Sarcoptes scabiei . Ticks reproduce sexually. Both females and males are ovoid in shape. Females are larger than males. The largest size of the female, her length, is approximately ¹ / ₃ mm with tolerances on both sides. Males die after fertilization. They do not play a significant role in the development of scabies. The female at the tip of a sterile needle appears to the eye, not armed with optics, as a tiny spherical formation of a whitish color. Under the microscope, its morphological features are clearly distinguishable. The main clinical symptoms are associated with the activity of females – moves and itching.

Usually scabies is contracted through close bodily contact with the patient – a direct route of infection. Most often, it is realized during a joint stay in bed at night – the period of maximum activity of ticks [1-6]. An indirect route of infection through bedding, clothing, and various household items (for example, a toilet seat) is also possible: live ticks may remain on them for some time. The role of the indirect route of scabies infection is limited. The transmitters of scabies (invasive stages) are fertilized females and tick larvae [7, 8].

The incubation period of scabies has not yet received a generally accepted definition. According to the traditional view, the most common, it covers from 3 to 6 weeks [9]. Its end is considered the moment of itching.

Infection with scabies is usually caused by fertilized females, which, together with the larvae, fall on the skin of the infected person. Females, as a rule, immediately begin to make passages and lay eggs.

Infection with mite larvae is rare. At the same time, the larvae, having entered the human skin, are introduced into the hair follicles, where they undergo metamorphosis, as a result of which adult individuals are formed – females and males. After mating, the males die, and the fertilized females make passages that mark the onset of scabies. Thus, there is a time interval of about 2 weeks between the ingestion of larvae on human skin and the onset of scabies [7, 8]. During the two week interval, the larvae undergo the complex biological processes described above. The end of these processes is the appearance of fertilized females capable of parasitizing. Infection with larvae is clinically manifested by single follicular papules on the skin of the trunk and single so-called non-inflammatory vesicles on the skin of the hands, most often in the interdigital folds and on the skin of the lateral surfaces of the fingers. These rashes can be detected during an active examination of persons shortly after their close contact with a patient with scabies.

In the dermatological literature, such cases are referred to as scabies without burrows. In our opinion, single follicular papules and non-inflammatory vesicles are precursors of scabies, and the two-week interval in which they appear should be considered as a prodromal period in its evolution.

Scabies is a pathognomonic sign of scabies, allowing it to be distinguished from other pruritic dermatoses. Females make passages in the form of a tunnel in the stratum corneum of the epidermis. Nail plates are not affected.

According to the dominant view, these “tunnels” are laid by females with a complex gnawing organ. Along with this, in recent years it has been established that female ticks make passages, producing proteolytic enzymes that dissolve the stratum corneum of the epidermis [9].

On examination, the burrows appear as slightly raised, twisted and straight scratches or narrow stripes. Scratches appear passages, the “roof” of which is destroyed and the “tunnels” have turned into “trench”. Narrow stripes show passages, the integrity of which is preserved. The color of scabies is white or dark gray, the usual length is 5-7 mm, in rare cases it reaches 1.5-2 cm.

Scabies are found on the skin of the hands, mainly on the skin of the interdigital folds and lateral surfaces of the fingers; often on the skin of the palms and palmar surface of the fingers, on the flexor surface of the wrist joints, on the genitals, especially on the skin of the penis, on the feet, usually in the interdigital folds, on the arch; in the medial malleolus and Achilles tendon; in the axillary depressions; on the buttocks; in women on the mammary glands, especially in the areola area.

Papules appear on the skin of the trunk, and vesicles without signs of inflammation near the burrows, mainly on the hands, appear [7]. The number of papules and less often vesicles gradually increases. Follicular papules are caused by larvae that have invaded the hair follicles. Papules outside the hair follicles are the result of sensitization [7, 8].

Indispensable, with rare exceptions, a symptom of scabies is itching, worse in the evening and at night, often occurring in several family members. The intensity of itching varies from patient to patient. Scratching often injures blood vessels, which leads to the formation of hemorrhagic crusts. Excoriations can be complicated by staphylococcal infection, leading to ostiofolliculitis and folliculitis, less often to boils and ecthymas.

In immunocompetent individuals, scabies foci can be extensive and widespread, covering various areas of the skin, but in adults, as a rule, the neck, interscapular region and head remain unaffected. It has been convincingly shown that with scabies in immunocompetent individuals, the number of mites is limited, within 2 dozen. According to the generalized data of various authors, scabies mites survive outside a person at room temperature for no more than 1 week.

In addition to burrows, papules and vesicles, the appearance of which is associated with the activity of ticks, the patient may have excoriations, serous and hemorrhagic crusts resulting from scratching, as well as various kinds of pyoderma, which are the result of a staphylococcal infection. With a long course of scabies, eczematous changes are not uncommon.

The following symptoms are diagnostically significant in scabies [7]: Ardi — pustules and purulent crusts on the skin of the elbow joints and in their circumference; Gorchakov – in the same place hemorrhagic crusts; Michaelis – hemorrhagic and purulent crusts, ostiofolliculitis and folliculitis in the intergluteal fold and on the skin of the sacrum; Cesari – determination of the elevation of scabies during their palpation.

The duration of scabies without treatment and its outcome has not been established. N.S. Potekaev observed a patient whose scabies 20 years ago acquired the character of subtotal erythroderma. The general condition of the patient was quite satisfactory, there was a slight itching, which intensified in the evening and was stopped by hydrogen sulfide baths, scabies were single, found with great difficulty. Treatment with tar ointment in an increasing concentration of tar from 5 to 20% against the background of systemic glucocorticosteroid drugs ended in complete recovery.

Norwegian scabies is a rare, peculiar and severe variant of the scabies described above, which various authors consider as classic, common or typical. The most common term is typical scabies.

Norwegian scabies was first identified in Norway by D.K. Danielssen (D.C. Danielssen) in 1844 in a patient with anesthetic leprosy and studied together with K.V. Beck (C. W. Boeck). In 1848 they published the results of their research. The term “Norwegian scabies” was later proposed by F. Gebra. Norwegian scabies was detected in syringomyelia, dorsal tabes, senile dementia, Down’s disease, dementia and other diseases.

It has been established that Norwegian scabies is caused by the same mites as typical scabies, and that people infected from Norwegian scabies develop typical scabies. It was believed that the basis of the pathogenesis of Norwegian scabies is the reduced sensitivity of the skin to the introduction of mites.

According to Russian dermatologist P.S. Grigorieva (1879-1940) [1], Norwegian scabies initially and for a long time manifests itself as a typical scabies, but even then a decrease in the intensity of itching can be determined in patients. The formed Norwegian scabies is characterized by horny deposits, penetrated in all directions by a huge number of scabies, located on several floors and crowded with mites. These deposits, as a rule, are accompanied by peeling, bran-like scales and, like a shell, cover the affected areas of the skin. They are especially pronounced on the skin of the hands, feet, elbow and ankle joints, as well as on the neck, face and scalp. On the skin of the palms and soles, these hyperkeratotic deposits may appear as massive calluses. Itching is absent. The nail plates are sharply deformed. On the skin, free from lesions, typical scabies are found. Perennial erythroderma is a common outcome of Norwegian scabies.

Norwegian (crustal, crustose, hyperkeratotic) scabies, according to traditional concepts, has the following features that distinguish it from typical scabies: high contagiousness, an abundance of mites, numbering in the thousands and millions, minimal itching and even its complete absence, the formation of hyperkeratotic plaques and massive crusts , damage to the interscapular region, neck and head, as well as nail plates.

It is now generally accepted that Norwegian scabies occurs against the background of immunosuppression and immunodeficiency, which may be due to advanced age, aggressive treatment, including long-term use of glucocorticosteroid drugs and / or cytostatics [9—11], as well as various diseases of a wide spectrum. Thus, Norwegian scabies should be considered as a disease, for the manifestation of which a necessary condition is the morphofunctional suppression of the immune system. In our time, during the pandemic of the human immunodeficiency virus, Norwegian scabies occurs most often with HIV / AIDS infection. For the first time, it manifests itself in HIV-infected people against the background of the formation of immunodeficiency, as it deepens, the spectrum of its clinical manifestations expands, reaching maximum severity in AIDS patients. The basis of the appearance of Norwegian scabies and its progression is the uncontrolled reproduction of mites in the stratum corneum of the epidermis.

The clinical manifestations of Norwegian scabies are varied: erythematous patches, including extensive erythema, numerous papules, as well as massive crusts, hyperkeratotic plaques without itching, and other rashes. Of this diversity, the most reliable evidence of Norwegian scabies is considered to be massive crusts and especially hyperkeratotic plaques without itching, hence its synonyms: crusting, crustose and hyperkeratotic scabies.

The observation of A.B. Perna, K. Bell, T. Rosen [11]. In a 45-year-old AIDS patient, numerous pruritic papules were observed on the skin of the abdomen and anterior thighs and a single small hyperkeratotic plaque without itching on the skin of the penis, which served as the basis for the clinical diagnosis of Norwegian scabies; Numerous eggs and fragments of tick feces were found in the stratum corneum of the plaque, which confirmed the clinical diagnosis. The wife and adult daughter who lived with the patient suffered from itching without lesions of the skin.

Representation, in other words, a set of clinical manifestations of Norwegian scabies, their prevalence, severity and combination with each other are closely related to the increasing suppression of the immune system. Initially, large erythematous patches appear predominantly on the skin of the upper and lower extremities, including the palms and soles. Then the spots transform into scaly hyperkeratotic plaques, which spread in increasing numbers over the limbs and trunk, including the interscapular region, and also affect the neck, face and scalp, where they become covered with crusts, sometimes massive. The skin of the palms and soles is totally affected, the nail plates become thinner, their pronounced dystrophy is noted. In most cases, hyperkeratotic plaques are not accompanied by itching, only a few patients complain of mild itching.

Papular rashes are among the early frequent and main manifestations of Norwegian scabies along with hyperkeratotic plaques. Usually papules occur on an erythematous background, forming papuloerythematous foci; less often they occur on apparently healthy skin. Papuloerythematous foci appear discretely throughout the skin, initially and predominantly on the extremities and scalp. Sometimes they are combined in different proportions with hyperkeratotic plaques and erythema.

Papuloerythematous foci are covered with massive yellow crusts, which are the outcome of serous exudation of the affected areas of the epidermis. Similar crusts, but not as massive, are found on erythematous patches and healthy-looking skin. Sometimes crusts may dominate the clinical picture of Norwegian scabies. Unusual for Norwegian scabies is the intense itching that occurs with its papular manifestations. In debilitated and malnourished patients, papuloerythematous rashes progress rapidly, covering almost the entire skin [12]. However, persistent erythroderma, noted in due time by P.S. Grigoriev.

In violation of the integrity of the epidermis, Norwegian scabies is complicated by erysipelas, cellulitis, septicemia and sepsis. The abundance of mites in the stratum corneum of the epidermis and on its surface, as well as their dispersion in the patient’s things and objects, determine the high contagiousness of Norwegian scabies. Even short-term contact with the patient’s skin can lead to infection. Those who become infected develop typical scabies. A patient with Norwegian scabies is the source of a nosocomial outbreak of typical scabies [12-14]. At the dawn of studying the clinical manifestations of HIV/AIDS infection in 1989, in one of the US hospitals in the department for patients with AIDS, an outbreak of typical scabies was observed 10 weeks after the stay of two subsequently deceased patients with Norwegian scabies. 20 patients who were in the department, 5 doctors and a nurse, as well as some relatives who cared for the patients fell ill with typical scabies.

Modern methods of treatment of Norwegian scabies, including the use of oral and intravenous drugs, provide a positive result. Consequently, Norwegian scabies in modern times is only the cause of typical scabies when it has not been recognized and HIV-infected and AIDS patients suffering from it have not received adequate anti-scabiosis treatment.

However, typical scabies may also occur with HIV/AIDS infection. Clinical manifestations of scabies and its course are determined mainly by the state of the patient’s immune system. Infection with scabies occurs either before infection with HIV, or at different stages in the evolution of HIV/AIDS infection.

Histopathology. Histological examination of typical scabies did not reveal signs that are characteristic, and even more so pathognomonic for it. In the epidermis, acanthosis, parakeratosis and vesicles with serous contents are noted; the stratum corneum, which is a reservoir of mites, without significant changes; there is a small cell infiltrate in the dermis [4–6, 15].

In Norwegian scabies [14, 6 17], the epidermis is enlarged, its processes are hypertrophied, and the papillae of the dermis are elongated in accordance with their changes. The stratum corneum is thickened due to hyperkeratosis and parakeratosis, numerous itch passages are found in it, communicating with each other; the passages are full of ticks. In the dermis, an extensive inflammatory infiltrate is determined.

Typical scabies is usually not difficult to recognize. The history and physical examination findings are sufficient for a clinical diagnosis. For the final diagnosis, laboratory tests are used to identify ticks or larvae, as well as eggs and their shells.

The recognition of Norwegian scabies is often associated with significant difficulties. Therefore, laboratory studies with it are of particular importance. Manifestations of Norwegian scabies may acquire a certain similarity with psoriasis, Darier’s disease, ringworm and other skin lesions, especially in the absence of itching. In such atypical situations, lesions are subject to examination for the detection of ticks, even without scratching. Sometimes only histological examination, detection of mites in biopsy specimens or their absence solve the diagnostic problem.

In conclusion, L.J. Roberts, S.E. Huffam, S.F. Walton, B.J. Currie in 2005 substantiated the point of view on the genetic condition of Norwegian scabies [14]. After 7 years, it was confirmed in the observation of a group of Brazilian authors J.B. Costa, V.L. Rocha de Sousa, P.B. da Trindade Neto and others [18]. Almighty time will tell if this is true or not.

The authors declare no conflict of interest.

The authors declare no conflict of interest .

Podolsky KVD | Official website of the Podolsky Dermatovenerological Dispensary

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GAUZ MO “PKVD”

Full name	Position	Skill category	Certificate	Education
Eltsova Natalya Vladimirovna	Chief Physician dermatovenereologist	Higher Dermatovenereology	Dermatovenereology 04/12/2019 0550270015119	Higher, 1998 Nizhny Novgorod State Medical Academy
Khamitsaeva Irina Romanovna	Head of department Dermatovenereologist	Higher Dermatovenereology	Dermatovenereology 12/21/2020 0550270022291	Higher, Moscow State University of Medicine and Dentistry, 2000
Borisova Tatyana Timofeevna	Laboratory Manager Clinical Laboratory Diagnostic Physician	Higher Clinical lab. diagnostics	Clinical laboratory diagnostics 04/27/2022 7722 012316247	Higher, 1998 Moscow Medical Academy named after I.M. Sechenov
Kozlova Evgenia Yurievna	Dermatovenereologist	Higher Dermatovenereology	Dermatovenereology 02/16/2018 0550270010045	Higher, 1997 Moscow Medical Dental Institute
Kirillova Natalya Ivanovna	Dermatovenereologist	Higher Dermatovenereology	Dermatovenereology 28.02.2022 7722 012438671	Higher, 1983 2nd Moscow State Medical Institute. N.I. Pirogov
Klimontova Tatyana Vladimirovna	Medical laboratory assistant	Higher Clinical lab. diagnostics	Clinical laboratory diagnostics 12/16/2019 1178270024845	Higher, 1994 Kemerovo State University
Lyamina Elena Vladimirovna	Dermatovenereologist, candidate of medical sciences	Higher Dermatovenereology	Dermatovenereology 10/16/2020 0550270021262	Higher, 1996 Tver State Medical Academy
Samokhvalova Elena Viktorovna (maternity leave)	Dermatovenereologist	b/c	Dermatovenereology 01. 09.2017 0550270008008	Higher, SBEI HPE “Russian National Research Medical University. N.I. Pirogov” Ministry of Health of the Russian Federation, 2015.
Sityukov Yury Pavlovich	Dermatovenereologist	Higher Dermatovenereology	Dermatovenereology 10/16/2020 0550270021267	Higher, 1st Moscow Medical Institute named after I.M. Sechenov, 1989
Silakova Tatyana Alexandrovna	Dermatovenereologist	Second category Dermatovenereology	Dermatovenerology 03/27/2017 0146040012791	Higher, 2011 SBEI HPE “Kursk State Medical University” Ministry of Health and Social Development of the Russian Federation
Tsareva Ekaterina Dmitrievna	Dermatovenereologist	Higher Dermatovenereology	Dermatovenereology 12/28/2021 7721 012532219	Higher education, 2004 GOU VPO Russian State Medical University
Muratova Ekaterina Aleksandrovna	Dermatovenereologist	b/c	Dermatovenereology 07/12/2021 772300188328	Higher, 2019 Federal State Budgetary Educational Institution of Higher Education “Russian National Research Medical University named after N. N. N.I. Pirogov” Ministry of Health of the Russian Federation 2019.
Skotareva Oksana Sergeevna	Dermatovenereologist	b/c	Dermatovenereology 27.04.2019 0177180856529	Higher, 2012 Federal State Budgetary Educational Institution of Higher Professional Education “Oryol State Medical University
Bobrova Lyubov Lvovna	Dermatovenereologist	Higher dermatovenereology	Dermatovenereology 10/18/2019 0550270017369	Higher, 1987 Kalinin State Medical Institute
Schmidt Svetlana Andreevna	Dermatovenereologist	b/c	Dermatovenereology 15.08.2022 7722 007674811	Higher 2020 Moscow State University of Medicine and Dentistry named after A.I. Evdokimov” of the Ministry of Health of the Russian Federation
Filatenkova Victoria Petrovna	Medical laboratory assistant	Graduate Clinical Laboratory Diagnostics	Clinical laboratory diagnostics 15. 03.2019 0177241849270	Higher, Siberian Order of the Red Banner of Labor Medical University, 1993
Pokotilova Olga Vladimirovna	Biologist	First Clinical laboratory diagnostics	Clinical laboratory diagnostics 12/15/2017 1178270005081	Higher, 2003 GOU VPO “Voronezh State University”
Kiseleva Anna Vladimirovna	dermatovenereologist	Highest qualification category 06/30/2021	1154242364138 from 04/02/2020	higher – GOU VPO “Oryol State University” 2004

Information about medical workers

GAUZ MO “PKVD” providing paid medical services.

full name	Position	Skill category	Certificate	Education
Bobrova Lyubov Lvovna	Dermatovenereologist	Higher dermatovenereology	Dermatovenereology 10/18/2019 0550270017369	Higher, 1987 Kalinin State Medical Institute
Eltsova Natalya Vladimirovna	Chief Physician dermatovenereologist	Higher Dermatovenereology	Dermatovenereology 04/12/2019 0550270015119	Higher, 1998 Nizhny Novgorod State Medical Academy
Kozlova Evgenia Yurievna	Dermatovenereologist	Higher Dermatovenereology	Dermatovenereology 02/16/2018 0550270010045	Higher, 1997 Moscow Medical Dental Institute
Kirillova Natalya Ivanovna	Dermatovenereologist	Higher Dermatovenereology	Dermatovenereology 28. 02.2022 7722 012438671	Higher, 1983 2nd Moscow State Medical Institute. N.I. Pirogova
Lyamina Elena Vladimirovna	Dermatovenereologist, candidate of medical sciences	Higher Dermatovenereology	Dermatovenereology 10/16/2020 0550270021262	Higher, 1996 Tver State Medical Academy
Muratova Ekaterina Aleksandrovna	Dermatovenereologist	b/c	Dermatovenereology 07/12/2021 772300188328	Higher, 2019FSBEI HE Russian National Research Medical University. N.I. Pirogov” Ministry of Health of the Russian Federation 2019.
Skotareva Oksana Sergeevna	Dermatovenereologist	b/c	Dermatovenereology 27.04.2019 0177180856529	Higher, 2012 Federal State Budgetary Educational Institution of Higher Professional Education “Oryol State Medical University
Sityukov Yury Pavlovich	Dermatovenereologist	Higher Dermatovenereology	Dermatovenereology 10/16/2020 0550270021267	Higher, 1st Moscow Medical Institute named after I. Leave a Reply Cancel reply Your email address will not be published. Required fields are marked * Comment * Name * Email * Website