What are the key differences between scabies and other similar skin conditions. How can you accurately identify scabies symptoms versus other rashes. Why is proper diagnosis crucial for effective treatment of skin issues.

Understanding Scabies: A Common Yet Misdiagnosed Skin Condition

Scabies is a widespread infectious skin disease that affects millions of people globally each year. The World Health Organization estimates that approximately 200 million individuals are impacted annually by this condition. While scabies is indeed prevalent, several other skin conditions can present similar symptoms, leading to potential misdiagnosis.

To better understand scabies and its mimics, it’s crucial to first grasp the nature of the condition itself.

What Causes Scabies?

Scabies is caused by microscopic mites called Sarcoptes scabiei. These eight-legged parasites infest human skin by burrowing into its upper layers. Female mites lay eggs within these burrows, and their presence, along with their eggs and feces, triggers an allergic reaction in the human body.

This allergic response manifests as intense itching, skin irritation, and a characteristic rash. While effective treatments exist to eliminate scabies mites, accurate diagnosis is crucial for proper management.

The Top 5 Skin Conditions Commonly Mistaken for Scabies

Given the similarities in symptoms, several skin conditions can be erroneously identified as scabies. Here are the top five conditions that often lead to confusion:

1. Contact Dermatitis

Contact dermatitis, including reactions to substances like poison ivy, occurs when the skin comes into direct contact with an irritant or allergen. This condition shares some similarities with scabies, such as itching and rash formation.

• Key differences:
  • Contact dermatitis is usually limited to the area of skin that touched the irritant
  • Symptoms typically subside once the irritant is removed
  • Unlike scabies, it is not contagious

2. Folliculitis

Folliculitis is an infection and inflammation of hair follicles in the skin. It can produce a pimple-like rash that may resemble scabies at first glance.

• Key differences:
  • Folliculitis lacks the intense itching characteristic of scabies
  • The rash is typically confined to areas with hair follicles
  • It often responds to topical antibiotics, unlike scabies

3. Insect Bites

Insect bites, particularly those from bed bugs, can cause itchy rashes that mimic scabies. The nocturnal nature of bed bug activity can further add to the confusion, as scabies also tends to cause increased itching at night.

• Key differences:
  • Bed bug bites often appear in a linear or clustered pattern
  • Unlike scabies, there are no visible burrows in the skin
  • Bed bug infestations can be identified by checking bedding and furniture

4. Eczema (Atopic Dermatitis)

Eczema is a chronic skin condition that causes itchy, inflamed, and thickened skin. Its symptoms can sometimes be mistaken for scabies, especially in severe cases.

• Key differences:
  • Eczema is not contagious and does not spread through skin-to-skin contact
  • It often has a chronic, recurring nature unlike scabies
  • Eczema typically responds to moisturizers and topical corticosteroids

5. Psoriasis

Psoriasis is an autoimmune condition characterized by the rapid growth of skin cells, resulting in scaly, itchy patches. In severe cases, it can resemble crusted scabies, also known as Norwegian scabies.

• Key differences:
  • Psoriasis is not contagious
  • It often affects larger areas of skin compared to typical scabies
  • Psoriasis plaques have a distinct silvery scale appearance

Debunking Common Myths About Scabies

Misconceptions about scabies can lead to stigma and delayed treatment. Let’s address some common myths:

Is scabies caused by poor hygiene?

No, scabies is not a result of poor personal hygiene. It is a parasitic infection that spreads through prolonged skin-to-skin contact with an infected person. Anyone can contract scabies, regardless of their cleanliness or socioeconomic status.

How easily does scabies spread?

While scabies is contagious, it typically requires direct and prolonged skin contact to spread. Brief interactions like handshakes or hugs usually do not transmit the mites. However, people in close living conditions or those sharing beds are at higher risk of transmission.

Identifying Scabies: Key Symptoms and Diagnostic Challenges

Recognizing the symptoms of scabies is crucial for timely diagnosis and treatment. However, the similarity to other skin conditions can make this challenging.

What are the five primary symptoms of scabies?

1. Intense itching, particularly at night
2. A pimple-like rash with tiny blisters and scales
3. Visible burrows or tunnels on the skin surface
4. Skin sores from persistent scratching
5. Common occurrence in skin folds and specific body areas

It’s important to note that these symptoms can vary in severity and presentation, which is why professional medical evaluation is essential for accurate diagnosis.

The Importance of Accurate Diagnosis: Scabies vs. Look-alike Conditions

Distinguishing scabies from other skin conditions is crucial for several reasons:

• Appropriate treatment: Scabies requires specific antiparasitic medications, while other conditions may need different approaches.
• Preventing spread: As a contagious condition, early identification of scabies can help prevent its transmission to others.
• Avoiding unnecessary treatments: Misdiagnosis can lead to the use of ineffective treatments, potentially exacerbating the actual condition.
• Addressing underlying causes: Some look-alike conditions may be symptoms of other health issues that require different interventions.

How do healthcare providers diagnose scabies?

Healthcare professionals typically diagnose scabies through a combination of methods:

• Physical examination: Carefully inspecting the skin for characteristic signs and symptoms
• Patient history: Considering factors like recent exposures and the progression of symptoms
• Skin scraping: In some cases, a skin sample may be examined under a microscope to identify mites, eggs, or fecal matter
• Dermoscopy: Using a special magnifying tool to visualize burrows and mites on the skin surface

Treatment Approaches: Scabies vs. Look-alike Conditions

The treatment for scabies differs significantly from that of its mimics, underscoring the importance of accurate diagnosis.

How is scabies treated?

Scabies treatment typically involves:

• Prescription medications: Topical or oral antiparasitic drugs to kill the mites
• Thorough cleaning: Washing bedding, clothing, and other potentially infested items
• Treating close contacts: To prevent reinfestation, even asymptomatic close contacts are often treated

How do treatments differ for look-alike conditions?

In contrast, treatments for conditions that mimic scabies vary:

• Contact dermatitis: Avoiding the irritant and using topical corticosteroids
• Folliculitis: Topical or oral antibiotics, improved hygiene practices
• Insect bites: Antihistamines, topical anti-itch creams, and addressing the source of infestation
• Eczema: Moisturizers, topical corticosteroids, and sometimes immunomodulators
• Psoriasis: Topical treatments, phototherapy, or systemic medications depending on severity

Prevention Strategies: Scabies and Similar Skin Conditions

While prevention methods may differ, understanding how to avoid these skin conditions can significantly improve quality of life.

How can scabies be prevented?

Preventing scabies involves:

• Avoiding prolonged skin-to-skin contact with infected individuals
• Practicing good hygiene, especially in crowded living conditions
• Promptly washing and drying clothing and bedding at high temperatures after suspected exposure
• Seeking early treatment if symptoms appear to prevent spread to others

What about preventing look-alike conditions?

Prevention strategies for similar skin conditions include:

• Contact dermatitis: Identifying and avoiding known irritants or allergens
• Folliculitis: Maintaining good skin hygiene and avoiding tight clothing
• Insect bites: Using insect repellents and implementing pest control measures
• Eczema: Moisturizing regularly and avoiding known triggers
• Psoriasis: Managing stress, maintaining a healthy lifestyle, and avoiding skin injuries

When to Seek Professional Help: Navigating Skin Condition Diagnosis

Given the complexity of differentiating between scabies and similar skin conditions, knowing when to consult a healthcare provider is crucial.

What are the signs that professional evaluation is needed?

Consider seeking medical attention if you experience:

• Persistent, intense itching, especially if it worsens at night
• A spreading rash that doesn’t respond to over-the-counter treatments
• Signs of skin infection, such as increased redness, warmth, or pus
• Symptoms that affect large areas of the body or interfere with daily activities
• Recent close contact with someone diagnosed with scabies

Remember, early diagnosis and appropriate treatment can significantly improve outcomes and prevent the spread of contagious conditions like scabies.

Living with Skin Conditions: Coping Strategies and Support

Dealing with skin conditions, whether it’s scabies or one of its mimics, can be challenging both physically and emotionally. Implementing effective coping strategies and seeking support can make a significant difference in managing these conditions.

How can individuals cope with the psychological impact of skin conditions?

Living with visible skin conditions can affect self-esteem and social interactions. Here are some strategies to help cope:

• Educate yourself: Understanding your condition can help reduce anxiety and empower you to manage it effectively
• Join support groups: Connecting with others who have similar experiences can provide emotional support and practical advice
• Practice stress-reduction techniques: Stress can exacerbate many skin conditions, so techniques like meditation or yoga may be beneficial
• Seek professional help: If you’re struggling emotionally, consider talking to a mental health professional

What resources are available for those dealing with chronic skin conditions?

Various resources can provide support and information:

• Patient advocacy organizations: Many skin conditions have dedicated organizations that offer education and support
• Online communities: Forums and social media groups can connect you with others sharing similar experiences
• Dermatology clinics: Many offer patient education programs and support services
• Telemedicine platforms: These can provide access to dermatologists for ongoing management and advice

Remember, while dealing with skin conditions can be challenging, proper diagnosis, treatment, and support can significantly improve quality of life. If you’re unsure about your symptoms or struggling to manage a skin condition, don’t hesitate to seek professional help. With the right approach, most skin conditions, including scabies and its look-alikes, can be effectively managed or treated.

5 Skin Conditions Commonly Mistaken for Scabies

Scabies is a common infectious skin disease, affecting some 200 million people around the world every year, according to the World Health Organization (WHO). A scabies infestation can spread easily in crowded places, such as nursing homes, extended care facilities, prisons, and child care facilities where people are in close skin contact with one another. But while scabies is very common, other skin conditions can also cause similar signs and symptoms. Please keep reading to learn more about human scabies and some of the conditions a scabies rash can be confused with. 

What are scabies mites?

Scabies mites (Sarcoptes scabiei) are microscopic eight-legged parasites that infest the human body, specifically human skin. When someone gets a scabies infection, the tiny mites burrow into the skin. The female mites lay their eggs in the upper layer of skin and live there. The mites themselves, as well as mite eggs and mite feces (poop), cause an allergic reaction in the body. This leads to intense itching, skin irritation, and a skin rash. Effective treatment is available to kill scabies mites.

What can be mistaken for scabies?

Here are some of the skin conditions that can be mistaken for scabies.

Contact Dermatitis or Poison Ivy

A contact dermatitis such as poison ivy occurs due to direct skin contact with a harsh or irritating substance, causing an allergic reaction. Symptoms of contact dermatitis include temporary itching, rash, and fluid-filled blisters, which can be mistaken for symptoms of scabies. However, contact dermatitis symptoms are usually limited to the area where the irritant or poison ivy came in contact with human skin.

Folliculitis

This is an infection and inflammation of the hair follicles in the skin. It causes a pimple-like rash that may resemble a scabies rash. However, the intense itch that is a characteristic of scabies is not present in folliculitis. 

Insect Bites

Insect bites, especially bed bug bites, can cause an itchy rash and intense itching at night. This can be mistaken for scabies. Additionally, bed bug bites appear in a zigzag pattern that can resemble scabies burrows. Before suspecting or treating scabies, it’s important to rule out a bed bug infestation. A doctor can look at your rash and tell you whether it is from the scabies mite or bed bug bites.

Eczema or Atopic Dermatitis

Atopic dermatitis or eczema causes the skin to become itchy, irritated, inflamed, and thickened. This skin condition can be mistaken for scabies. However, eczema is not contagious and does not spread through skin-to-skin contact. 

Psoriasis

This is an autoimmune condition in which new skin cells develop at a faster rate than normal, causing them to pile up on the skin surface in scaly patches. Psoriasis plaques can be itchy and can resemble crusted scabies or Norwegian scabies. However, unlike scabies, psoriasis does not spread from person to person with skin-to-skin contact.

Scabies: Frequently Asked Questions

Is scabies caused by poor hygiene?

No, scabies is not caused by poor hygiene. Scabies is a parasitic infection that spreads from person to person through skin contact. 

It requires direct and prolonged skin-to-skin contact with an infected person to spread human scabies. Short hugs or quick handshakes do not usually spread typical scabies. However, sleeping in the same bed can lead to scabies transmission. As a result, scabies frequently spreads among sexual partners and members of the same household. 

A severe form of scabies called Norwegian scabies or crusted scabies can occur in people with weakened immune systems. In this condition, highly contagious and thick crusts develop on the skin. Crusted scabies can spread through shared personal items like towels, bedding, and clothing.

Anyone can get scabies. However, scabies outbreaks are common in places where people live in crowded conditions.

What are the 5 symptoms of scabies? 

The 5 most common symptoms of typical scabies are:

• Pruritus (severe itching), which is usually worse at night.
• A papular (pimple-like) skin rash with tiny blisters and scales. 
• Tiny, raised, and wavy/crooked burrows or tunnels (grayish-white or skin-colored lines) on the skin surface.
• Skin sores and bacterial infection from constant scratching of the rash.
• Common sites for a scabies rash in an infested person include skin folds such as the webbing between the fingers, wrists, elbows, knees, armpits, nipples, breasts, waist, buttocks, and penis. In infants and very young children, the head, neck, palms, and soles can be involved.

How do you know if you have scabies?

A doctor can make a diagnosis based on the signs and symptoms of scabies. If there is any confusion, they may send a skin scraping to the lab to look for scabies mites and eggs under the microscope.

People who have had scabies before usually develop symptoms soon after exposure to scabies mites, usually within 1-4 days. However, people who have not had scabies before may not have symptoms for 4-8 weeks after exposure. Remember, even if you don’t have symptoms yet, once you’re infected, you can spread scabies to others.

What kills scabies instantly? 

Permethrin Cream

A medicine called permethrin is a very effective scabies treatment. This topical treatment (cream) is available with a doctor’s prescription. It needs to be applied to the entire body below the head, including the palms, soles, and webbing between the toes and fingers. In children, the cream should be applied to the scalp as well. 

Permethrin cream must be left on the skin for 8-14 hours before it is washed off. Your doctor will probably advise you to apply it before bed and wash it off in the morning. 

You will also need to wash your clothes and bed linen on a hot cycle in the washing machine and dry them on a hot dryer setting. 

When your scabies treatment begins, your doctor may advise every close contact in your household to undergo treatment simultaneously. 

Ivermectin

An oral antiparasitic medication called ivermectin is another treatment option for scabies. This medicine is given as a single dose, followed by another 1-2 weeks later. However, ivermectin is unsuitable for pregnant or lactating women or children weighing under 15 kg (35 pounds).

Other Medications for Treating Scabies

Your healthcare provider may recommend antihistamines (topical or oral) to relieve itching caused by scabies. They may prescribe antibiotics if you have a secondary bacterial infection.

When does itching go away after you treat scabies?

A single treatment with permethrin cream kills the scabies mites. Most people do not need to repeat the treatment. However, it can take two to six weeks for the itching to go away after the initial treatment. 
 

References:

1. https://www.cdc.gov/parasites/scabies/gen_info/faqs.html
2. https://www.mayoclinic.org/diseases-conditions/scabies/symptoms-causes/syc-20377378

Rashes that look like scabies: Causes, symptoms, and treatment

People may mistake skin conditions such as psoriasis, eczema, or contact dermatitis for scabies. Unlike these conditions, though, scabies occurs due to a mite known as Sarcoptes scabiei.

In this article, we look at what a scabies rash looks like. We also look at other rashes that are similar in appearance and their treatment options.

Scabies is a common condition that occurs as the result of an infestation of a microscopic skin mite called Sarcoptes scabiei. The mites burrow under the skin, causing intense itching and a rash.

The Centers for Disease Control and Prevention (CDC) describes the rash as pimple-like. On darker skin, the rash may be more difficult to see, but a person should be able to feel it.

According to DermNet, a scabies rash is varied in appearance, and may appear as:

• pimple-like on the limbs and trunk
• widespread or coin-shaped
• small blisters
• scales
• lesions in the armpits, groin, navel, areolas, scrotum, buttocks, and along the penile shaft

The American Academy of Dermatology Association notes that the rash may cause small bumps that form a line.

The rash can affect many parts of the body, including the:

• wrists
• elbows
• armpits
• spaces between the fingers and toes
• nipples
• penis
• waist
• buttocks

A scabies rash causes intense itching that is normally worse at night.

The itchiness normally starts within 1–4 days in people who have had scabies before, but can take 2–6 weeks to appear in those that have not had scabies in the past.

Some people have a variant of scabies known as crusted scabies.

This occurs when thousands or even millions of mites infest the skin surface. People with crusted scabies have a scaly rash and the itchiness may not be present, or may be minimal. This type of scabies often occurs in people who are immunocompromised.

Other skin conditions may present similarly to scabies, some of which are discussed below.

Psoriasis is an autoimmune skin condition where the body makes new skin cells at a fast rate. This causes the cells to pile up on the skin surface, which results in scaly patches. Unlike scabies, psoriasis is not contagious.

In about 80–90% of people with psoriasis, plaques develop. This is called plaque psoriasis.

When this occurs, often there are raised patches that will have scales coated on top. Because of this, psoriasis can sometimes appear similar to crusted scabies.

The symptoms of plaque psoriasis include:

• thick skin patches normally found on the elbows, scalp, knees, lower back, face, palms, and soles of the feet
• silvery scales on the patches
• plaques of different sizes

On lighter skin, psoriasis will be red or pink. On browner skin, psoriasis appears salmon-colored and the scales are silvery-white.

On dark skin, psoriasis patches are violet in color and the scales will appear gray.

Treatment

A variety of treatment options are available for psoriasis depending on the type of psoriasis present and its severity.

Topical treatments are the first line of treatment for mild psoriasis. A 2020 study found that topical treatments remain effective in treating mild psoriasis.

Topical treatments include:

• Emollients: These include moisturizers and anti-itch creams.
• Coal tar: Coal tar can help reduce the itchiness and flakiness of psoriasis as well as reduce the redness and swelling, and slow the growing skin cells.
• Topical corticosteroids: This includes creams such as hydrocortisone. These help decrease the itchiness and inflammation.
• Salicylic acid: Salicylic acid can help soften the scales and reduce swelling.
• Topical retinoids: This is a synthetic form of vitamin A. The retinoid that can treat psoriasis is called tazarotene.

For moderate to severe psoriasis, a person may require phototherapy, systemic therapy, and biologics.

Eczema, or atopic dermatitis, describes a group of conditions that cause the skin to be itchy, inflamed, and irritated.

Atopic dermatitis is an inflammatory skin condition that is not contagious. It is more common in children, although it can affect people of all ages.

The symptoms of atopic dermatitis include:

• itchiness, which can be severe
• dry patches of skin that are red to dark brown in color
• hardened or thickened skin
• itching that can disrupt sleep

Treatment

Treatment of atopic dermatitis includes medications, skin care, and phototherapy.

A 2019 study found that NB-UVB phototherapy treatment was effective in treating atopic dermatitis.

Medication that may be prescribed includes:

• steroids to reduce swelling and clear the rash
• antibiotics to help prevent infections
• antihistamines to reduce irritation

A dermatologist may recommend that a person:

• avoids scratching the skin
• uses a moisturizer
• uses soap that is fragrance-free
• applies lubricating ointments and moisturizers to damp skin after washing

A person can also try bleach baths. The National Eczema Association advises that a person uses regular, unconcentrated household bleach, which contains 5.25% sodium hypochlorite.

People should always consult a healthcare professional before trying a bleach bath.

Additionally, people should:

• avoid using excessively cold or hot water
• avoid adding any other ingredients to the bath
• avoid soaking for longer than 15 minutes
• avoid submerging the head and face

Learn how to use bleach baths safely here.

Contact dermatitis occurs when a substance comes into contact with the skin and causes irritation or an allergic reaction.

Irritant contact dermatitis can occur due to detergents, solvents, acids, and more.

When the substance causes an allergic reaction, this is called allergic contact dermatitis.

Symptoms of contact dermatitis include:

• itchiness, which can be intense
• rash
• swelling
• tender skin
• dry and cracking skin
• fluid-filled blisters
• blisters that ooze, crust, and scale

Allergic contact dermatitis can also cause hives to appear.

Treatment

The treatment of contact dermatitis involves avoiding the trigger. A healthcare professional may also prescribe certain topical and oral medications, including:

• strong corticosteroid cream to reduce inflammation
• prednisone to suppress the immune reaction
• antihistamines to control the itchiness

This is a reaction to insect bites. According to DermNet, the symptoms include itchy clusters of bumps.

Fleas and mites that live on pets are typically responsible.

The bumps commonly form on the legs, forearms, and face.

Treatment

Treatment will likely include:

• topical steroid cream
• antihistamines
• antiseptic cream

This is a skin infection that develops in the hair follicles. It looks similar to acne.

It occurs when the hair follicles become damaged, and germs such as Staph aureus cause an infection.

Unlike with scabies, itching is not always present with folliculitis.

Treatment

Mild folliculitis should resolve itself without medical attention. A person can apply a warm compress to affected areas three to four times a day. Widespread folliculitis will often require treatment with a topical or oral antibiotic.

There are other conditions that also present similarly to scabies.

These include, but are not limited to:

• Dermatitis herpetiformis: This is a rare, chronic condition that causes severely itchy blisters and raised lesions. They commonly appear on the scalp, lower back, buttocks, elbows, and knees. This skin condition occurs alongside celiac disease.
• Prurigo nodularis: This is a skin condition that causes firm, itchy bumps. They typically begin on the lower arms and legs. They may occur as the result of scratching or picking.
• Insect bites: Bites from mosquitoes, fleas, bed bugs, chiggers, and other mites, can look similar to scabies.

A person should seek medical advice if they notice any skin changes that persist.

People should also seek medical advice if they experience pain with the skin changes or any changes to the color or texture of the skin.

Scabies is a skin condition that occurs due to a mite infestation in the skin. The resulting rash and itchiness may be similar to rashes seen in:

• atopic dermatitis
• psoriasis
• contact dermatitis
• folliculitis
• papular urticaria

Unlike scabies, the above skin conditions are not contagious.

Although treatment options are available, a person should seek the advice of a dermatologist or other healthcare professional.

Treatment options include medications, topical creams, and phototherapy. The treatment option will depend on the severity of each condition.

what it looks like, symptoms, signs and treatment

Scabies: a definition of the disease

Scabies (or, scientifically, scabies) is a common contagious skin disease.

In the last decade in Russia, the incidence of scabies has been officially kept at the level of 18-45 cases per 100 thousand people. But it can be much higher, since people do not go to the doctor: they try to cope with the disease on their own or are ashamed of their symptoms.

Scabies agent

The cause of the disease is the scabies mite Sarcoptes scabiei, which feeds on flakes of dead skin. It spends most of its life in the skin, and appears on the surface only for mating.

The size of an adult tick is approximately 0.1 mm. The parasite has a powerful jaw, with the help of which it gnaws tunnels in the skin

As a rule, mating of ticks occurs in the evening. After it, the males die, and the females gnaw through human skin and make scabies in it, in which they lay 2-4 eggs. The hatched larvae come to the surface of the skin and penetrate into the hair follicles and flakes of the epidermis (upper layer of the skin). After a couple of days, they molt and become nymphs, and then they become adults, ready to mate.

Features of the scabies mite Sarcoptes scabiei:

• the tick quickly dies in the external environment: it is unable to absorb water from the air, therefore it dies from moisture deficiency;
• for the parasite, temperatures above 55 degrees are detrimental;
• adult females can penetrate the skin only in the most sensitive areas, and larvae – in any, due to their small size;
• is usually infected by females and larvae at the same time.

Ways of transmission of scabies

There are two ways of transmission of scabies – direct and indirect.

Direct infection with scabies occurs during close bodily contact. There are known cases of tick transmission from an infected person to a healthy person even during a strong handshake.

Indirect infection with scabies occurs without direct contact with an infected person. This can happen in a bathhouse, a hotel, an entrance and in other places where many people touch the same objects on which ticks are located.

Usually scabies is infected in orphanages, boarding schools, hostels, barracks, prisons – wherever people live in a large group.

The risk of contracting scabies is higher in places where people work and live in small groups

Incubation period for scabies

The incubation period for scabies depends on whether infection has occurred with adult scabies mite or its larvae.

When infested with larvae, the first symptoms may appear after 10-14 days – this is how long it takes for the mites to mature. And when infected by already fertilized females, there may not be an incubation period at all: the females will immediately begin to dig scabies and lay eggs in them in order to breed as soon as possible.

Types of scabies

Typical scabies – the most common, accompanied by excruciating itching, itching, nodules and blisters on the skin. The characteristic symptom of the disease – itching – usually appears 10-14 days after infection. Itching intensifies in the evening and at night, it is at this time that scabies mites are active.

For the treatment of typical scabies, scabicides are prescribed – drugs that destroy mites and their larvae. The illness usually resolves within 2-3 weeks.

Clean scabies mostly occurs in people who shower or bathe in the evening. They have almost no nodules and blisters on their skin, strong scratching and bloody crusts.

Treatment for clean scabies is the same as for typical scabies. With the right choice of drugs and compliance with all the doctor’s recommendations, recovery occurs in 2-3 weeks.

Norwegian (crustal) scabies is a rare and highly contagious form of the disease. It was first identified by Norwegian doctors in 1848 in patients with leprosy (leprosy).

As a rule, Norwegian scabies occurs in immunocompromised people, in patients with Down’s syndrome, HIV, dementia, oncological diseases, as well as in patients taking hormonal and cytotoxic drugs for a long time.

With Norwegian scabies, vesicles, nodules, cracks form on the skin, and then – rough crusts – gray-yellow or brown-black. Such crusts can, like a shell, cover large areas of the skin and prevent a person from moving normally. In the lower layers of the crusts, sinuous depressions are visible – scabies. When removing the crusts, extensive weeping erosions are exposed. Between the layers of crusts, a huge number of mites are found – up to 200 individuals in one square centimeter (for comparison: with typical scabies, there are usually no more than 10-15 of them).

Norwegian scabies can cause a microepidemic – when all family members, health workers and patients who are in the same room are infected with the disease.

Treatment of Norwegian scabies is long and takes place in two stages. First, the doctor removes the crusts from the patient’s skin (sometimes local anesthesia is required), then prescribes anti-scabies, which will need to be used for a long time.

Scabies without burrows is less common than typical and is usually found in people who have been in contact with people with scabies. With such scabies, infection with scabies mite larvae occurs. Symptoms of the disease: single nodules and inflammatory vesicles on the skin.

Scabies without burrows usually resolves in 2 weeks, is treated in the same way as typical scabies – with anti-scabies drugs.

Scabious lymphoplasia – manifested by intensely itchy flat rounded bluish-purple nodules, which are most often localized on the trunk (buttocks, abdomen, in the axillary region), as well as on the elbows and genitals in men, mammary glands in women. The basis of the disease is the reaction of the body to the waste products of the tick. This happens in people who suffer from scabies for a long time.

After full therapy, rashes may disappear in 2 weeks – 6 months.

Scabious erythroderma occurs in people who have been treated for a long time (up to 3 months) with typical scabies with corticosteroid ointments, antipruritic and soothing drugs. The disease is manifested by many itch moves that occur even in atypical places (between the shoulder blades, on the head, on the face). At the same time, itching is mild, and patients do not comb the skin, but rub it with their palms.

The treatment of scabious erythroderma is quite long – up to 6 weeks may be required until complete recovery.

Pseudosarcoptic mange is a type of scabies that affects dogs, pigs, horses, rabbits, wolves, foxes and other animals. Pseudosarcoptic mange can only be contracted from animals. It is not transmitted from person to person.

The incubation period is several hours. There are no scabies, since the mites do not breed on an unusual host and only partially burrow into the skin, causing itching. The rashes are concentrated on open areas of the skin and look like blisters, blisters, bloody crusts and scratches.

Pseudosarcoptic mange often resolves on its own after contact with the affected animal is stopped. If the symptoms recur or persist for several days, you should consult a doctor to make an accurate diagnosis.

Symptoms of scabies

The main symptom of scabies is unbearable itching, which intensifies in the evening and at night.

Itching runs along the burrows. They look like straight or curved lines that rise above the skin. The color of the lines can be dirty gray or whitish gray. Length – 5-7 mm.

Most often, itch moves are found on the wrists, feet, male genital organs, in the interdigital spaces.

The skin of a person infected with scabies usually has blisters and nodules. In about a third of cases, young males and females of the parasite are found in them. You can see them with the naked eye: ticks look like white or yellowish dots the size of a poppy seed.

Nodules with mites are located in the area of ​​hair follicles. Bubbles are more often between the fingers, on the wrists.

The main symptom of scabies is excruciating itching

Complications of scabies

Complications of scabies in the form of dermatitis and secondary pyoderma occur in approximately 50% of patients.

Dermatitis is an inflammation of the skin, which is manifested by redness, burning, tingling, itching, swelling of the affected area. Secondary pyoderma is a purulent-inflammatory skin disease caused by bacteria.

Less commonly, scabies develops microbial eczema – inflammation of the skin of an allergic nature caused by microbes.

Skin changes in scabies complicated by the addition of a secondary infection:

• staphylococcal impetigo – inflammation of the hair follicle caused by staphylococcus aureus;
• deep folliculitis – damage to the deep sections of the hair follicle, which leads to purulent inflammation;
• furunculosis – acute purulent-necrotic inflammation of the hair follicle, sebaceous gland and surrounding tissues;
• impetigo – vesicular-pustular rash;
• paronychia – inflammation of the periungual fold.

Scabies in children

As a rule, children become infected with scabies in a direct way – through prolonged contact with the skin of an infected person. This happens when sleeping in the same bed, contact games, using shared toys. In addition, children can catch scabies in crowded groups – in orphanages, camps, hospitals, sports clubs, swimming pools. Teenagers are infected with scabies during sexual intercourse.

The course of scabies in children is usually more pronounced than in adults. Complications develop more often – microbial eczema, pyoderma (purulent-inflammatory skin lesions), impetigo (vesicle-pustular rashes), paronychia (inflammation of the periungual roller).

Symptoms of scabies in children:

• severe itching that worsens in the evening and at night;
• rash;
• scabies;
• nodules and vesicles on the skin.

Symptoms of scabies in children are usually worse than in adults

In infants and young children, rashes can be located on any area of ​​the skin – including the face, scalp, palms and soles. The rash in babies often begins to get wet, there are multiple grouped vesicles in the lesions, scabious lymphoplasia of the skin.

In school-age children and adolescents, scabies affects the hands, feet, elbows, buttocks, genitals, intergluteal folds.

Diagnosis of scabies

The diagnosis of scabies is made by a doctor – a dermatologist, therapist or infectious disease specialist – on the basis of an examination and complaints of the patient.

A clear sign of the disease is pruritus, which becomes unbearable in the evening and at night. Other symptoms that make it possible to suspect the disease are characteristic linear scratches and nodules on the skin.

Skin scrapings can confirm the diagnosis of scabies. However, it should be borne in mind that there may not be ticks in the biomaterial if the person has washed himself thoroughly before visiting the doctor.

Another way to detect a mite in a laboratory or clinic is to apply a drop of 40% lactic acid to the suspected itch, nodule, vesicle. Lactic acid loosens the epidermis well, and after a few minutes it can be carefully scraped off, placed on a glass slide and examined under a microscope.

The tick extraction method is also used. In this case, the doctor opens the blind end of the itch with a needle. The female is attached to the needle. Then the doctor takes the needle out of the itch along with the female and immerses it in a drop of water or 40% lactic acid. Then microscopy is performed.

Treatment of scabies

There are three ways to treat scabies: specific, prophylactic and trial.

Specific treatment is given to patients with symptoms of the disease and a clinically confirmed diagnosis. Scabicides are used – drugs that destroy the scabies mite and its larvae.

Preventive treatment is performed according to epidemiological indications – in scabies. However, people may not have symptoms.

Such treatment is indicated for everyone who has been in contact with an infected person: family members, sexual partners, nannies and nurses, members of close groups in orphanages, boarding schools, hostels, prisons, barracks.

Trial treatment is performed only in cases where the patient has symptoms of scabies, but the causative agent – scabies mite – is not detected. If after the use of anti-scabies drugs a positive effect occurs, then the diagnosis of “scabies” is considered confirmed.

Anti-scabies preparations

Ointments, emulsions, aerosols are used to kill scabies mites.

Basic scabicides – scabicides:

• preparations containing esdepalletrin, a neurotoxic insect poison. Contraindicated in pregnant women, as well as in patients with bronchial asthma and obstructive bronchitis;
• benzyl benzoate (ointment, emulsion): 20% for adults and 10% for children from 3 to 7 years;
• sulfuric ointment 33%. The drug is contraindicated in children under 3 years of age. Has an unpleasant smell, stains clothes. Possible skin irritation, longer treatment;
• permethrin 5% (emulsion). The drug is not recommended for use in children under 1 year old, patients with liver and kidney diseases, lactating women;
• crotamiton 10% (cream, lotion). Pregnant women can use the medicine only according to strict indications. In addition, the drug is contraindicated in children under 12 years of age.

The doctor prescribes the drug regimen. Self-medication can be hazardous to health.

General rules for the use of anti-scabies:

• apply drugs in the evening, with bare hands, not with a tissue or swab;
• carefully rub the preparations into the palms and soles;
• change underwear and bed linen after completion of the course;
• simultaneously treat everyone who is in the focus of infection.

The doctor may prescribe antihistamines or topical corticosteroids to relieve itching. Both of them are usually used in a short course.

If itching does not resolve within a week, it may be necessary to re-treat the skin with scabicide preparations after thoroughly washing the patient with soap and a washcloth.

Prognosis and prevention

With proper and timely treatment, the prognosis of scabies is favorable. The disease is cured in an average of 4-7 days, after which the doctor monitors the condition for 2-3 weeks. Residual itching may persist for another 10-14 days.

Basic measures to prevent scabies:

• treatment and dispensary observation of all people with scabies;
• elimination of scabies foci: disinfection of bed and underwear;
• regular preventive examinations of children and adults in hospitals, nursing homes, colonies, orphanages, etc.

Sources

1. Albanova VI Experience in the treatment of patients with scabies // Bulletin of dermatology and venereology. 1999. No. 2. S. 39–42.
2. Malyarchuk A.P. Optimization of diagnosis, treatment and prevention of scabies: abstract of the dissertation of a candidate of medical sciences. M., 2010.
3. Malyarchuk A. P., Sokolova T. V., Lopatina Yu. V., Kiseleva A. V. Anti-scabies drugs: selection criteria // Clinical Dermatology. 2011. No. 9(2). pp. 53–59.

how I take care of my scalp with seborrhea

Cosmetic bag

02.12.22

A reader talks about skin care and an expert helps improve it

This text was written by a reader in the Community. Carefully edited and formatted according to editorial standards.

I am 43 years old. About six years ago, I noticed severe peeling on my head.

Alexander

struggles with seborrhea

Author profile

At first I did not attach any importance to this, I decided that it was nothing more than dandruff. But later, the peeling developed into red itchy spots, which became larger both in size and in quantity. Even later, pimples appeared on the head – although it would probably be more accurate to say pustules.

I’ll tell you how I let the situation take its course for several years and finally began to deal with the problem with the doctor.

See a doctor

The article contains expert advice written with love for evidence-based medicine. We refer to authoritative sources, but remember: the responsibility for the health of your skin lies with you. We don’t write prescriptions, we make recommendations. Relying on our point of view or not is up to you.

How I tried to manage my symptoms

I used the most common shampoos from the mass market. My head became oily very quickly, I washed it twice a day and liked to stand under a hot shower. Fatness didn’t bother me, I thought it was normal for a man. But I did not like the appearance of peeling.

Since I thought that my problem was simple dandruff, I decided to replace the shampoo with the most obvious one – Head & Shoulders. I took the most vigorous one, with menthol.

A little better after a few uses. Firstly, oily scalp became much fresher. Although I did not seek to solve the problem of fat content, I liked this effect. Secondly, the peeling has decreased, even the itching, which at the very beginning was still insignificant, has completely disappeared. Then, of course, I was delighted, although now I understand that it could just be a coincidence.

My cosmetic bag: how I take care of my skin with seborrheic dermatitis

I continued to use Head & Shoulders shampoo, but at some point the skin condition began to worsen: red spots appeared, they became more and more, peeling and itching intensified. It was very unpleasant, but apparently not so bad that I went to the doctor. I decided that this was not the biggest problem, and let go of the situation. He lived and itched, sometimes stronger, sometimes it became easier by itself, then it became aggravated again. Later, “pimples” appeared on my head, I combed them, they bled.

As consulted by a trichologist

At one point, I had free time and I undertook to solve all health problems. The scalp is on the to-do list. I decided to go to a trichologist, because I heard that these specialists work with hair and scalp. He asked his wife to help with finding a normal doctor. We both read T⁠—⁠F and we know that we need an evidence-based doctor.

It was difficult to find, there are few specialists in our city, so they chose, as they say, from what was available, and I made an appointment. The chosen clinic was trustworthy: it was completely devoted to the topic of trichology, all doctors specialized in this topic, several had their own blogs on social networks, and we did not notice any nonsense there. “For sure, all the evidence will help me,” I decided. But I was wrong.

Arrived. The doctor asked me about the problem, examined the scalp on some apparatus, took an enlarged photo of the skin, on which the affected areas were clearly visible. Everything was going well, and then she began to write appointments, which included droppers and a chemical analysis of the hair.

“Usually hair thins due to genetics and age”: 11 important questions for trichologist Yulia Romanova

Yes, there were shampoos that might have been really needed. But after unnecessary appointments, my trust vanished. I realized that the doctor was frankly cheating on money: droppers had to be made from them, each for 1000 R, and the course was prescribed for ten, the shampoo was also prescribed with the caveat: “You can buy only in specialized clinics.” That is, they have. I remember I also thought: “What kind of medicine is this that you can’t buy in a pharmacy.” He smiled, left and did not come to them again.

As consulted by a dermatologist

We started looking for a doctor again. My wife stumbled upon a dermatologist who on his blog said sensible things about acne and skin care in general. We decided to write to her and ask if she was dealing with seborrhea. The doctor clarified whether the hair was falling out. Having received a negative answer, she said that I could come to her.

I already understood that literacy in a blog does not mean that they will not try to swindle me for money, like the previous time. But this could only be verified at the reception.

Came. The doctor examined me and immediately said: this is seborrhea, a chronic disease, it cannot be cured, but you can go into remission. She also said that purulent pimples are an attached infection. Apparently, I carried it in my arms when I was combing my head. She prescribed treatment and said to come back in two months for correction. No drips, nothing.

What I use now

I am currently continuing treatment. I’ll tell you what I use.

Keto Plus Shampoo. This is a therapeutic shampoo. The dermatologist recommended washing their hair every other time, alternating with their usual shampoo. Unlike “super specialized, you can only buy from us” products, this shampoo is sold in pharmacies. I appointed him for two months, then, based on the results, as I think, he will change the scheme.

Kerasys scalp treatment shampoo. I was not prescribed it, I bought it myself as the main one. I alternate with “Keto-plus”.

Antibiotics. The doctor explained that they are needed to cure an attached infection. You need to take a month according to a certain scheme. I will not write the scheme and the name, so that someone does not decide to be treated on their own. Although I am not a fan of going to hospitals, I am still categorically against self-treatment.

How to cure seborrheic dermatitis and how much it costs

Laktofiltrum. At the time of taking antibiotics to support digestion.

That’s it. No droppers and unnecessary tests. I would like to wish everyone who faced the same problem not to repeat my mistakes. Firstly, do not let the disease take its course, it will not go away on its own, but will only get worse. Secondly, do not do suspicious and expensive tests and procedures. Either search the Internet for information yourself, or consult another specialist.

My care products

How much money I spend on care

Treatment shampoo costs quite a budget — about 600 R per 60 ml. At first I thought that it was expensive for such a volume, but it turned out that it is used very economically, although it does not foam well. Kerasys on Ozone costs about 450 R per half liter and is also consumed slowly.

I have been on treatment for three weeks now, and my head itchs less, pimples are gone, only redness and traces of pimples remain. It’s like everything is alive. Fat content also decreased, there was no need to wash your hair in the morning. I’m watching what happens next.

Expert advice: how to understand that you have not just dandruff, but seborrheic dermatitis

Asya Popova

science journalist

Author profile and chose the right treatment. I will tell you in more detail how seborrheic dermatitis differs from dandruff and what remedies can help in these cases.

Dandruff – peeling of the scalp. It can occur in both dry and oily skin types. Shampoos help to cope with it, which cleanse and exfoliate the skin well.