What are the main symptoms of scabies. How is scabies transmitted. What does a scabies rash look like. How is scabies diagnosed and treated. Can scabies be prevented. What are the complications of untreated scabies. How long does it take for scabies symptoms to appear.

Understanding Scabies: The Microscopic Mite Menace

Scabies is a highly contagious skin infestation caused by the Sarcoptes scabiei mite, a tiny parasite that burrows into the skin and causes intense itching. This common condition affects millions of people worldwide, regardless of age, gender, or socioeconomic status. To effectively combat scabies, it’s crucial to understand its causes, symptoms, and available treatments.

What Exactly Is Scabies?

Scabies is an infestation of the skin by the Sarcoptes scabiei mite. These microscopic creatures are so small that they’re invisible to the naked eye, measuring only 0.3-0.4 mm for females and 0.2-0.3 mm for males. The female mites burrow into the upper layer of the skin, where they lay eggs and deposit feces, triggering an allergic reaction that causes the characteristic symptoms of scabies.

The Life Cycle of Scabies Mites

Understanding the life cycle of scabies mites is essential for effective treatment and prevention:

1. Female mites burrow into the skin and lay 40-50 eggs during their lifetime.
2. Eggs hatch into larvae after 3-4 days.
3. Larvae develop into adult mites within 10-15 days.
4. The average number of mites on an infested person is about 12.

Recognizing the Signs and Symptoms of Scabies

Identifying scabies early is crucial for prompt treatment and preventing its spread. The primary symptoms of scabies include:

Intense Itching

The hallmark symptom of scabies is severe itching, which often intensifies at night or after a hot bath. This itching can be localized at first, typically starting on the hands, but may spread to other areas of the body, including the neck, abdomen, chest, groin, and buttocks.

Characteristic Rash

A scabies rash usually appears shortly after the itching begins. It typically presents as a blotchy, lumpy, red rash that can occur anywhere on the body. Common areas include:

• The inside of the thighs
• The abdomen and buttocks
• The armpits
• Around the nipples in women

Mite Burrows

One of the most distinctive signs of scabies is the presence of mite burrows. These appear as fine, dark, or silvery lines on the skin, typically 2-10 mm long. They’re most commonly found in the web spaces between fingers, on the inner surface of the wrists, and on the hands.

The Transmission and Spread of Scabies

Scabies is highly contagious and spreads through close skin-to-skin contact. Understanding how it’s transmitted is key to prevention and control.

How Is Scabies Spread?

Scabies is primarily transmitted through prolonged, direct skin-to-skin contact with an infected person. This often occurs through:

• Sexual contact
• Living in close quarters with an infected individual
• Sharing bedding or clothing with someone who has scabies

It’s important to note that casual contact, such as a handshake or hug, is unlikely to spread scabies. The mites can’t jump or fly, and they don’t survive long away from human skin.

Incubation Period and Contagiousness

The incubation period for scabies—the time between infection and the onset of symptoms—is typically 2-6 weeks for a first-time infection. However, individuals can still spread the mites during this time, even before they develop symptoms. For those who have had scabies before, symptoms may appear much more quickly, often within 1-4 days of exposure.

Diagnosing Scabies: Challenges and Techniques

Accurately diagnosing scabies is crucial for effective treatment and preventing its spread. However, diagnosis can be challenging due to the variety of ways scabies can present.

Clinical Examination

A healthcare provider will typically diagnose scabies based on the patient’s symptoms and a physical examination of the skin. They will look for:

• Characteristic burrows between the fingers and on the wrists
• The typical scabies rash on the body
• Intense itching, especially at night

Microscopic Confirmation

In some cases, a definitive diagnosis may require microscopic confirmation. This involves:

1. Scraping the skin to collect samples from suspected burrows
2. Examining the samples under a microscope to identify mites, eggs, or fecal matter

However, even if mites are not found, a clinical diagnosis may still be made based on symptoms and appearance.

Effective Treatment Strategies for Scabies

Once diagnosed, scabies requires prompt and thorough treatment to eliminate the infestation and prevent its spread to others.

Topical Treatments

The most common treatments for scabies are topical medications, including:

• Permethrin cream (5%): Usually considered the first-line treatment
• Ivermectin lotion (1%): An alternative for those who can’t use permethrin
• Crotamiton lotion or cream: Less commonly used due to lower efficacy

These medications are typically applied to the entire body from the neck down and left on for 8-14 hours before being washed off.

Oral Medications

In some cases, particularly for severe or widespread infestations, oral ivermectin may be prescribed. This medication is taken as a single dose and often repeated after one week.

Treatment of Close Contacts

To prevent reinfestation, it’s crucial that all household members and close physical contacts be treated simultaneously, even if they don’t show symptoms.

Preventing Scabies: Strategies for Individuals and Communities

While scabies can be effectively treated, prevention is always preferable. Understanding how to prevent scabies can help individuals and communities reduce the risk of infestation.

Personal Hygiene and Awareness

Maintaining good personal hygiene can help prevent scabies:

• Regularly wash hands and body with soap and water
• Avoid sharing personal items such as clothing, towels, or bedding
• Be cautious about close physical contact with individuals who have unexplained rashes or intense itching

Environmental Control

If someone in your household has been diagnosed with scabies:

1. Wash all bedding, clothing, and towels used in the past 3 days in hot water (at least 50°C or 122°F) and dry on high heat
2. Items that can’t be washed should be sealed in plastic bags for at least 72 hours
3. Vacuum carpets and upholstered furniture thoroughly

Community Measures

In institutional settings like nursing homes or schools, additional measures may be necessary:

• Implement regular skin checks for residents or students
• Educate staff about recognizing and reporting potential scabies cases
• Have protocols in place for rapid treatment and contact tracing when cases are identified

Complications and Long-Term Effects of Scabies

While scabies itself is not typically dangerous, it can lead to complications if left untreated or in certain populations.

Secondary Bacterial Infections

The intense itching associated with scabies can lead to excessive scratching, which may damage the skin. This damage can serve as an entry point for bacteria, potentially leading to secondary infections such as:

• Impetigo
• Cellulitis
• Folliculitis

These infections may require additional treatment with antibiotics.

Crusted (Norwegian) Scabies

In individuals with weakened immune systems, such as those with HIV/AIDS or the elderly, a severe form of scabies called crusted or Norwegian scabies can develop. This condition is characterized by:

• Thick, crusted areas of skin
• Infestation with thousands or millions of mites
• High contagiousness due to the large number of mites

Crusted scabies is more difficult to treat and may require multiple applications of topical medications or oral ivermectin.

Psychological Impact

The persistent itching and social stigma associated with scabies can have significant psychological effects, including:

• Sleep disturbances
• Anxiety
• Depression
• Social isolation

Addressing these psychological aspects is an important part of comprehensive scabies management.

Special Considerations: Scabies in Vulnerable Populations

While scabies can affect anyone, certain populations may be at higher risk or require special considerations in diagnosis and treatment.

Infants and Young Children

Scabies in infants and young children may present differently:

• The rash may appear on the head, neck, palms, and soles
• Burrows may be harder to identify due to scratching
• Treatment may need to be applied to the entire body, including the head and neck

Elderly and Immunocompromised Individuals

These populations are at higher risk for developing crusted scabies and may require:

• More aggressive treatment regimens
• Closer monitoring for complications
• Additional support for environmental control measures

Institutional Settings

Scabies outbreaks in institutions like nursing homes or prisons require coordinated efforts:

• Mass treatment of all residents and staff may be necessary
• Strict isolation protocols for affected individuals
• Thorough environmental decontamination

By understanding these special considerations, healthcare providers and caregivers can ensure appropriate management of scabies in vulnerable populations.

Scabies: Causes, Symptoms, and Treatment

In this series Skin Rashes Cellulitis Erythema Nodosum Erythema Toxicum Neonatorum (Baby Acne) Folliculitis Lichen Planus Perioral Dermatitis Pityriasis Versicolor (Tinea Versicolor) Rosacea Lupus Discoid Lupus Vitiligo

Scabies is a very itchy skin infestation caused by a tiny mite. It is spread by close contact, such as living with someone or sharing a bed.

What causes scabies?

Scabies is caused by a mite called Sarcoptes scabiei. A mite is like a tiny insect, and with scabies it’s a parasite, meaning it lives off the host (a human) with no benefit to the host. The mites burrow into your skin, often through your hands, and then spread around your body.

Scabies mites

Scabies mites are so tiny, you can’t see them with the naked eye. They have a cream-coloured body, bristles and spines on their back, and four pairs of legs. The female mite is bigger (about 0.4 mm x 0.3 mm) compared with the male (0.2 mm x 0.15 mm). With the naked eye you might be able to see them as a speck.

The female mites tunnel into the skin and lay eggs. About 40-50 mite eggs are laid in the lifetime of a mite. The eggs hatch into larvae after 3-4 days; these then grow into adults within 10-15 days.

Most of the symptoms of scabies are due to your immune system’s response to the mites, or to their saliva, their eggs or their poo (faeces). In other words, the rash and the itching are mostly caused by your body’s allergic-like reaction to the mites, rather than the mites themselves.

The average number of mites that can live on an infested person is 12.

What to do if you have an infected ingrown hair

Ingrown hairs occur when hair grows into the skin rather than outwards as it should. They often…

Scabies symptoms

Itching

This is the main symptom of scabies. This is often severe and tends to be in one place at first (often the hands), and then spreads to anywhere you tend to touch: your neck, your tummy (abdomen), your chest. It often focuses on your belly button or the tops of your legs (your groin). The itch is generally worse at night and after a hot bath. You can itch all over, even with only a few mites, and even in the areas where the mites are not present.

Mite tunnels

These tunnels (burrows) may be seen on the skin as fine, dark, or silvery lines about 2-10 mm long. They most commonly occur in the loose skin between the fingers (the web spaces), the inner surface of the wrists, and the hands. However, they can occur on any part of the skin. You may not notice the burrows until a rash or itch develops.

Scabies rash

The rash usually appears soon after the itch starts. It is typically a blotchy, lumpy red rash that can appear anywhere on the body. The rash is often most obvious on the inside of the thighs, parts of the abdomen and buttocks, the armpits and around the nipples in women. The appearance of the rash is often typical. However, some people develop unusual rashes which may be confused with other skin conditions.

Scratching

Scratching due to intense itching can cause minor skin damage. In some cases the damaged skin becomes infected by other germs (bacteria). This is a secondary skin infection. If skin becomes infected with bacteria it becomes red, inflamed, hot, and tender.

Aggravation of pre-existing skin conditions

Scabies can worsen the symptoms of other skin conditions, particularly itchy skin problems such as eczema, or problems such as psoriasis. Scabies can be more difficult to diagnose in these situations too.

Note: the itch and rash of scabies are due to a reaction (allergy) to the mites (or their saliva, poo (faeces) or eggs). Scabies symptoms usually take 2-6 weeks to occur after you are first infected. The itch and rash can develop on any part of the skin, away from where the mites are actually burrowing. This means that you are infectious and can spread scabies before you even know you have scabies.

What does scabies look like?

The visible symptoms of scabies include blotchy red rashes that tend to form on the thighs, abdomen, and lower back, though they can form anywhere on the body. Additionally, thin grey lines between 2 mm and 10 mm long will typically be seen between the fingers and on the hands.

Scabies on hand and fingers

Gzzz (Own work), CC BY-SA 4.0, via Wikimedia Commons

By Gzzz (Own work), CC BY-SA 4.0, via Wikimedia Commons

Scabies on the arm

Steschke (Own work), CC BY-SA 3.0, via Wikimedia Commons

By Steschke (Own work), CC BY-SA 3.0, via Wikimedia Commons

Symptoms of recurring scabies

The itch and rash normally take 2-6 weeks to develop when you have a first scabies infection. However, if you have scabies and it is cleared with treatment, and then you catch it again, the symptoms may be slightly different.

In such instances the rash and itching develop much more quickly – often within a day or two. This is because the first scabies infestation has already sensitised your immune system. It then reacts much more quickly with this second bout of scabies.

How do you get scabies?

You need close skin-to-skin contact with an infected person to catch scabies. This is because the scabies mite cannot jump or fly. The hand is the most common site to be first affected. Close skin-to-skin contact when having sex is another common way of catching scabies.

You are unlikely to catch scabies from bedding and towels unless you use them immediately after being used by someone with scabies. However, just in case, it is best to treat bedding and towels by hot washing (described later).

Sometimes outbreaks of scabies occur in places such as nurseries and residential homes, where people are in regular close physical contact.

Crusted scabies (Norwegian scabies)

Crusted scabies – also called Norwegian scabies, is unusual, and most people who develop scabies do not get this type of scabies.

It is a more severe form of scabies with a hyperinfestation of lots of scabies mites. This means that there are thousands or millions of the mites, causing excessive scaling and flaking of the skin. Because there are so many mites, and because the skin is flaking off, scabies can be spread to others extremely easily. The rash is crusting (and looks a bit like psoriasis). It can be very extensive and can, if severe, lead to serious secondary bacterial skin infections.

Crusted scabies mainly occurs in people who have a poor immune system (are immunocompromised). The types of people who might get crusted scabies include:

• People with HIV/AIDS.
• People having chemotherapy.
• Frail people who are elderly or ill due to other conditions.
• Those who are poorly fed (malnourished).
• Those with learning difficulties (because they cannot comprehend or respond to the itch).
• People who have nerve-related problems (because they cannot feel the itch).

What causes crusted scabies?

Crusted scabies is more easily transmitted through contact with towels, bedding and upholstery. In crusted scabies, the mites can survive for a few days away from their host. Even minimally exposed people, such as cleaners and laundry personnel, are at risk from crusted scabies and need insecticide treatment if they are working in an institution with an outbreak.

An outbreak in an institution with many vulnerable people, such as a nursing home, can be extremely challenging. It is likely that all residents and all staff would require treatment.

A healthy person and young children with a normal immune system would develop ‘normal’ scabies if infested with the scabies mite following contact with someone who had crusted scabies.

Crusted scabies may be impossible to eradicate in people with HIV infection, and recurrences are common.

Scabies diagnosis

To diagnose scabies, a pharmacist will usually just look at the rash, and by the story of itchy spots spreading around your body. A doctor will often be able to recognise the typical appearance of the scabies rash, although in the early stages it can resemble eczema.

Often, a doctor will find one or more mite tunnels (burrows) on the skin to confirm the diagnosis. Sometimes the doctor will rub some ink on the skin and then wipe it off. If there are burrows in that area of skin, the ink will move along the burrow under the skin in those diagnosed with scabies. It will be visible as a line after the rest of the ink has been wiped away.

Could it be something other than scabies?

It is sometimes difficult to tell the difference between the rash caused by scabies and the rashes of some other skin conditions. For example, sometimes the itchiness on the hands and wrists is quite similar to eczema. Sometimes doctors will treat the itching with steroid creams, which work well in eczema but will not help scabies at all.

If itching and a rash develop in several people who live in the same home at about the same time then scabies is a likely cause.

Do I need to see a doctor for scabies?

If you are confident that you have scabies – you may have seen the tunnels (burrows) on your skin, or perhaps you have had it before – then you don’t need to see your doctor. Treatments for scabies are available to buy from a pharmacy.

Who should be treated for scabies?

Scabies can stay in your skin for ever if not treated. Treatment is needed for:

• Anybody who has scabies; and
  
• All household members, close contacts, and sleeping/sexual partners of the affected person – even if they have no symptoms. This is because it can take up to six weeks to develop symptoms after you become infected. Close contacts may be infected, but have no symptoms, and may pass on the mite.

Note: everyone who is treated should be treated at the same time – that is, on the same day.

Scabies treatment

Scabies is curable. The usual way to treat scabies is with permethrin cream. Permethrin is an insecticide that kills the mites. This is known to be the treatment that works the best. If permethrin cannot be used, an alternative is to use a lotion called malathion liquid. (For example, some people may be allergic to permethrin.)

You can buy both of these products from pharmacies. You can also get them on prescription from a doctor. They are easy to apply and normally work well if used properly.

Re-apply the same treatment seven days after the first application. This helps to make sure that all the mites are killed.

Note: daily baths or a scrubbing with soap and hot water will NOT cure a scabies infestation. Insecticide MUST be used.

Self-help tips

• Read the leaflet that comes with the product, for exact instructions as to where to apply. Usually treatment is applied to your whole body, including the scalp and face, whilst other treatments are to be applied just from the neck down. Remember to include awkward places such as the back, soles of the feet, between fingers and toes, under fingernails, and the genitals. Pay special attention to the areas where mite tunnels (burrows) most commonly occur. That is, in between the fingers, the front of the wrists and elbows, beneath the breasts, the armpits and around the nipples in women.
• An adult needs at least 30 g of cream or 100 ml of lotion to cover the whole body. So, for two applications you will need at least 60 g of cream or 200 ml of lotion per adult.
• Apply cream or lotion to cool dry skin (not after a hot bath).
• The cream or lotion should be left on for the full recommended time. Permethrin cream should be left on for 8-12 hours. Malathion lotion should be left on for 24 hours.
• Children should stay off school until the first application of treatment has been completed.
• If you wash your hands or any other part of your body during the treatment period, you should re-apply the cream or lotion to the washed areas.
• Breastfeeding mothers should wash off the lotion or cream from the nipples before breastfeeding, and re-apply treatment after the feed.
• Permethrin cream is not usually used for babies under the age of 2 months, and malathion is not usually used under the age of 6 months.
• Put mittens on babies to stop them licking the cream or lotion off their hands.
• Clothes, bedding, and towels should be machine-washed at 50°C or above after the first application of treatment. This kills the scabies mites. Keep any items of clothing that cannot be washed, in plastic bags for at least 72 hours to contain the mites until they die. Alternative options to kill the mites on clothes, towels and linen are to iron the item with a hot iron, dry cleaning, or putting items in a dryer on the hot cycle for 10-30 minutes. It is not necessary to fumigate living areas or furniture, or to treat pets.
• Some people who develop a secondary skin infection may also need antibiotics. If you suspect this is the case, you should consult a doctor.

When to see a doctor for scabies

See a doctor if the itch persists longer than 2-3 weeks after treatment. Sometimes the first treatment does not work, and a different one is then needed. The most common reasons why treatment fails, and scabies returns, are:

• The cream or lotion is not applied correctly for the recommended time.
• A close contact is not treated at the same time and the infection is passed back.

Note: you will still be itchy for a while after successful treatment.

How long does it take for scabies to go?

It is normal to take up to 2-3 weeks (and sometimes up to six weeks) for the itch to go completely after the mites have been killed by treatment. This is because your skin reacts to the mites and takes a while to settle down, even once the mites have been killed.

Also, even after successful treatment, in a small number of cases there remain some itchy brownish-red lumps (nodules) up to 2 cm in diameter. If these remain, they most commonly occur on the genitals and armpits. These lumps are neither infectious, nor mean that the mite is still present. They occur in some cases as a prolonged skin reaction to the scabies mite. If they occur, they usually go within three months but occasionally last up to one year.

How to relieve scabies itch

Itching can be a distressing symptom. It can be eased either with topical treatments that you apply to the skin (such as creams or lotions), or with medication taken by mouth. Your GP or pharmacist can usually give advice regarding suitable products. Even cold moisturisers (emollients), especially if they contain menthol, can provide temporary relief. Avoid applying strong steroid creams, especially if the diagnosis of scabies is uncertain.

• Crotamiton cream or lotion has soothing qualities and may help to relieve itch. Apply crotamiton 2-3 times a day (but only once a day for children less than 3 years old).
• Hydrocortisone cream. This is a mild steroid cream that may ease any inflammation and help to ease itch. It can be bought from the chemist, or obtained by prescription. It can be applied once or twice per day, for up to a week.
• An antihistamine medicine that makes you drowsy, such as chlorphenamine. This does not ease the itch directly, but can help you to sleep if itching is a problem at night (particularly for children). It is not licensed for this use but can be safely used under the direction of a doctor.

Scabies – Better Health Channel

Summary

Read the full fact sheet

• Scabies is a skin infestation caused by organisms called mites.
• Scabies leads to red bumps or blisters on the skin which are very itchy.
• You and your sexual partners and all members of your household will need treatment if you have scabies.

About scabies

Scabies is a skin infestation caused by very small mites called Sarcoptes scabiei. The mites burrow into the skin to lay their eggs. New insects hatch from the eggs and can be spread to other parts of the skin by scratching. Scabies is spread by direct, prolonged physical contact including sexual activity. Scabies mites can survive away from humans for about 24 to 36 hours, so it’s possible to get scabies from infected articles such as bed linen and clothing, although this is much less common. Scabies is common around the world and can affect anyone. Pets do not cause human scabies infections.

Symptoms of scabies

The main symptoms of scabies are:

• intense itching of the skin, typically worse at night and after a hot bath or shower
• visible burrows on the skin between the fingers and in skin creases such as armpits and genitals
• a bumpy or pimple-like rash, which is often difficult to see
• small, clear, fluid-filled spots or lesions
• very itchy bumps on the scrotum or labia.

Usually, the rash doesn’t show very much because the mites bury into the skin. In elderly people, the rash may appear more widespread. In children, areas such as the face, scalp, palms and soles of the feet are often affected.

The itch may last for two to three weeks

The itch may persist for two to three weeks after treatment, even if the scabies has been effectively treated. This is because the itch is caused by the body’s immune system responding to the mites and may take time to settle down.

If symptoms persist for longer than two to three weeks, see your doctor for a review.

Scabies infection times may vary

Symptoms usually develop two to four weeks after infection. However, people who have previously been exposed may develop symptoms within 24 to 48 hours, because the immune system takes less time to respond.

Generally, a person is no longer infectious 24 hours after treatment.

Diagnosis of scabies

Diagnosis is based on observing the signs and symptoms or identifying the burrows on the top of the skin. Sometimes, scabies is confirmed by taking a skin scraping and identifying the mites and eggs under a microscope.

Treatment for scabies

Treatment involves applying a cream or lotion specifically used for treating scabies. This is available from a pharmacist.

To effectively treat scabies:

• Apply creams after a shower and towel drying for better absorption.
• Apply a thin layer of the treatment to your entire body surface, from the chin down. Avoid your eyes, nose and mouth and pay particular attention to the areas between your fingers, under your nails, the soles of your feet and between your buttocks. A pastry brush may make it easier to apply.
• Do not wash your hands after applying the treatment.
• Leave the treatment on for 12 to 24 hours and then wash thoroughly. One way to achieve this is to apply the cream in the evening and leave it on overnight.
• If you need to wash any part of your body within the 12 to 24 hour treatment period, re-apply cream to that area after washing.
• If possible, ask someone else to apply the cream for you. This will make sure your entire body surface is covered with cream.
• Repeat the treatment after seven days to kill recently hatched mites.

If the pimples or spots become infected, antibiotics may be necessary.

Treatment for scabies may vary

Treatment is different for some groups of people, including:

• babies and children under two years of age
• pregnant women
• people with sensitive skin
• elderly people.

Check with your GP or pharmacist about what kind of treatment is recommended for people in these groups.

Treat clothing and bedding

Any clothing, bedding or towels used in the last two days should be washed on a hot cycle and dried in the sun, tumble-dried or dry-cleaned. Items that cannot be washed should be sealed in a plastic bag for 72 hours.

Treat sexual partners and household members for scabies

If you have scabies, your sexual partners and all members of your household will also need to be treated.

Where to get help

• Your doctor / GP
• Sexual Health Victoria (SHV)External Link. To book an appointment call SHV Melbourne CBD Clinic: (03) 9660 4700 or call SHV Box Hill Clinic: (03) 9257 0100 or (free call): 1800 013 952. These services are youth friendly.
• Melbourne Sexual Health CentreExternal Link Tel. (03) 9341 6200 or 1800 032 017 or TTY (for the hearing impaired) (03) 9347 8619
• Thorne Harbour HealthExternal Link (formerly Victorian AIDS Council) Tel. (03) 9865 6700 or 1800 134 840
• Ballarat Community Health Sexual Health ClinicExternal Link Tel. (03) 5338 4500
• Bendigo Community Health Sexual Health ClinicExternal Link Tel. (03) 5434 4300 Or (03) 5448 1600
• Gateway Health Clinic 35External Link, Wodonga Tel. (02) 6022 8888 or 1800657 573
• Sunraysia Community Health ServicesExternal Link Tel. (03) 5022 5444
• Barwon Health Sexual Health ClinicExternal Link Tel. (03) 5226 7489
• 1800MyOptionsExternal Link Tel:1800 696784 is a statewide phone service for information about sexual health as well as contraception and pregnancy options

• Sexual health factsheetsExternal Link, Melbourne Sexual Health Centre
• Australian STI Management GuidelinesExternal Link
• Sexually Transmissible InfectionsExternal Link, Royal Australian College of General Practitioners (RACGP)
• Family Planning VictoriaExternal Link
• Department of HealthExternal Link, Australian Government

This page has been produced in consultation with and approved
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Scabies – symptoms, causes and treatment

This disease is treated by a Dermatologist

• What is it?
• About disease
• Species and varieties of scabies
• Symptoms of scabies
• Causes of scabies
• Diagnostics
• Expert opinion
• Treatment of human scabies
• Prevention
• Q&A

About disease

What does scabies mean? The disease has been described since ancient times. The first description is over 4000 years old, and it was made by Chinese healers. But only in 1834 the causative agent was identified – the scabies mite. This was done by the French scientist Rinucci.

The main route of transmission of the disease is contact (implemented by direct contact with the skin of an infected person or through household items). If earlier the disease was common among people with low social status, now scabies of clean people is becoming more common. The likelihood of contracting scabies mites is increased in crowded places: school groups, kindergartens, army barracks, additional education sections, etc.

Symptoms of the disease are directly related to the vital activity of female ticks, which are localized in the epidermal layers. After mating, females drill new passages in the surface layers of the skin (scabies passages) and lay eggs as they move. After about 3-4 days, the eggs transform into larvae that are capable of active movement. Female scabies mites are almost twice as large as males.

Scabies mites mate with each other on the surface of the skin. After fertilization, only females survive – males soon die. Female ticks live for about 1.5-2 months; during the life cycle, one individual lays about fifty eggs. The scabies mite is always located at the anterior end of the scabies passage, then the eggs follow, then the larvae, and even further the skins left after the molting of the larvae. The development of a tick from an egg to a mature individual takes about 4 days. After maturation, the larva leaves the course, enters the surface of the skin, and then re-embeds inside the epithelium. Pimples and small bubbles form at the injection sites.

The intraepidermal movement of mites causes intense itching, which can sometimes become unbearable. Due to itching, scratching appears on the skin.

The advancement of scabies mites under the layer of the epidermis causes intense, sometimes unbearable itching. Scratching itchy areas of the skin leads to scratching of the skin. These epithelial lesions are often infected with secondary pyogenic flora, which significantly aggravates the course of the disease (pyogenic complications).

Dermoscopy allows to detect objective signs of the disease. Microscopic examination is aimed at identifying scabies mites in the biomaterial.

Therapy of the disease is carried out with the help of anti-scabious drugs. After the treatment course, a thorough washing of the body and a complete change of underwear and bed linen are recommended. This helps to prevent re-infection with mites remaining on clothing.

Types and varieties of scabies

The following clinical varieties of scabies are distinguished:

• classical form;
• scabies without burrows;
• clean scabies;
• scabies erythroderma;
• Norwegian scabies;
• pseudosarcoptic mange;
• scabious lymphoplasia.

Each of these types of scabies has its own distinctive features, which can make differential diagnosis difficult.

• Scabies without burrows. The development of this form of the disease is due to the fact that infection occurs not by mature forms, but by larvae. First, single pimples and vesicles appear, which exist for 10-15 days after infection. Then the classical form of scabies develops with intraepidermal passages, which is associated with the development of adult sexually mature individuals.
• Clean scabies. This variant of the disease is most often observed in people who carry out hygiene procedures too often. Symptoms are identical to the classical form, but the severity of manifestations is minimal.
• Postparasitic lymphoplasia. After the treatment, rashes in the form of postparasitic lymphoplasia may form. This condition is nodules around the remnants of the scabies mite, formed by lymphocytic cells. This form is characterized by very severe itching, which lasts from a crescent to six months after a full treatment.
• Norwegian scabies. This is a very contagious form that occurs with prolonged use of corticosteroids, cytostatics, as well as a disorder of peripheral sensory innervation, etc. This neglected form is characterized by reddening of the skin, on which large pityriasis crusts of gray-yellow or black-brown color appear. The thickness of the crust can reach from a few millimeters to 2–3 cm. Such a massive layer makes movements in the affected area painful. A large population of mites is found in the intercortical and subcortical layers. From patients with the Norwegian form of the disease comes an unpleasant smell of fermented dough. This form has an unusual feature, which is that itching may be absent altogether or exist constantly. However, the symptoms are dominated by pain on movement.
• Pseudosarcoptic mange. This type of scabies is associated with the fact that a person becomes infected with mites that parasitize animals. The disease can be transmitted from cats, dogs, rabbits, etc. The incubation period is quite short – only 2-3 days. These mites do not multiply on the surface, and only penetrate into the epidermis for a short distance, so there are no true scabies. Pinpoint pimples, dried blood crusts and traces of scratching appear in the injection zone. The disease resolves on its own after the natural death of ticks. Person-to-person transmission is not possible.

Symptoms of scabies

The main symptoms of scabies are:

• intense itching that becomes especially pronounced at night;
• skin rashes that may affect different anatomical regions (with some exceptions).

The disease usually develops after a close skin, incl. sexual contact. The average incubation period is 1-2 weeks, but can vary widely (1-6 weeks).

An objective examination of the skin reveals pathognomonic rashes – scabies in places where the skin is thin and dry. In these areas, the female tick can easily gnaw through the epidermis and realize its reproductive function. Scabies most often come to light in the following places:

• skin in spaces between fingers;
• lateral and medial fingertips;
• inner wrist;
• external genitalia;
• areola on the mammary glands;
• lateral sections of the trunk;
• buttocks.

The passages of the female scabies, as a rule, are not found in those areas where there are especially many sebaceous glands. This is due to the fact that sebum clogs the openings of the passages and thereby blocks the oxygen necessary for the life of the tick. Therefore, typical scabies elements are not found on the face, neck, head (in the hairline) and between the shoulder blades.

The intense itching that accompanies this disease leads to skin scratching. Therefore, during an objective examination, purulent crusts are also determined, bloody crusts often form on the elbows.

Causes of scabies

The direct cause of scabies is the scabies mite Sarcoptes scabiei. This parasite lives inside the epidermis, causing the appearance of typical moves.

Transmission of the pathogen occurs through direct contact between an infected and a healthy person, for example, by shaking hands, by holding contaminated handrails in public transport. The tick is also transmitted through bedding. Scabies is also considered a sexual infection, because. during intimacy, ticks can move to the body of the sexual partner and intrude into the epidermis.

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If you experience these symptoms, we recommend that you make an appointment with your doctor. Timely consultation will prevent negative consequences for your health.

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Diagnosis

An important differential diagnostic sign of the disease is a nocturnal increase in skin itching. It is believed that it is at night that ticks are most active and secrete substances that irritate nerve receptors. Scabies itching is not stopped by antihistamines and corticosteroids. Its elimination is possible only after the death of the pathogen.

An absolute diagnostic sign is the identification of a causative agent in rashes (scabies). For analysis, the pathogen is usually removed from the blind end of the passage formed by the tick with a thin needle and this material is subjected to microscopic examination. Sometimes the material is obtained by scraping to blood dew (after preliminary softening of the epidermis with a solution of lactic acid).

However, at present, according to modern medical recommendations, the diagnosis of scabies is established on the basis of the results of a dermatoscopy examination. With the help of a special device, it is possible to obtain an enlarged image of the skin and visualize characteristic passages. This method is non-invasive and painless, yet informative, quick and simple.

Expert opinion

Intense itching that accompanies typical forms of the disease causes a lot of discomfort for a person. Therefore, patients are interested in when it will pass. Usually, after the end of treatment, this symptom persists for 5–7 days, which is associated with irritation of the pain receptors of the epidermis, which are responsible for the development of a sensation of itching of the skin. Therefore, even after the end of antiparasitic therapy, it may be necessary to use local distractions and local anesthetics, etc.

Dimant Larisa Evgenievna

Dermatovenereologist, Ph.D.

Treatment of scabies in humans

Treatment of scabies in humans is carried out with anti-scabiosis drugs applied by rubbing into the skin. They allow you to destroy the causative agent of the disease, located intradermally. If there are no signs of purulent inflammation of the scratches, then before starting treatment it is recommended to rub the skin well with a washcloth under hot water. This will help to hit the superficial layer of the epithelium, and thereby facilitate the delivery of antiparasitic agents to the lesion.

According to the clinical guidelines for scabies, anti-scabiosis therapy is carried out intermittently. Breaks fall on the 2nd and 3rd day. Their presence is explained by the fact that on the first day of treatment, mature females and males die, and on the fourth, the death of newly hatched larvae is achieved. Scabious eggs are resistant to pharmacological drugs, so there is no need to carry out anti-scabious therapy at the stage of eggs. If the itch moves are infected with pyogenic flora. Then a break on the 2-3rd day is an excellent opportunity to carry out antibacterial treatment.

Therapy of scabies during pregnancy involves the use of drugs that are not absorbed into the bloodstream and do not have a toxic effect on the fetus.

Prevention

Treatment of scabies cannot be complete without anti-epidemic measures. Careful processing of clothes, mattresses, blankets and other things where ticks can accumulate is recommended – boiling, airing, hot steam treatment, ironing with a hot iron are effective.

For a complete “victory” over the invasion, it is important to conduct a cure test. The examination is carried out 3 days after the end of therapy, and then within a month and a half with a frequency of 1 time in 10 days.

Question-answer

A dermatologist deals with the diagnosis and treatment of this pathology.

These associated conditions are treated in stages. At the first stage, anti-inflammatory therapy of the chronic form of dermatitis is indicated (corticosteroids of local action are usually prescribed). After the symptoms of atopic dermatitis have become less pronounced, anti-scabious treatment is prescribed. It is important that these drugs should not be rubbed intensively, but applied by light lubrication.

The use of topical acaricides often leads to dryness and irritation of the skin. Therefore, to restore the normal state of the epithelium after eradication of ticks, external therapy is carried out using soothing and moisturizing agents.

In contrast to adults, infants may have lesions on the face, scalp, palms, and soles.

Malarchuk A.P. Optimization of the diagnosis, treatment and prevention of scabies based on the study of the incidence and monitoring of the fundamental documents of the health authorities of the Russian Federation: dis. … Dr. med. Sciences. M., 2016.

Malyarchuk A.P., Sokolova T.V. The choice of tactics for the treatment of patients with complicated scabies // Clinical dermatology and venereology. 2016. V. 15, No. 6. S. 74–84.

Syrneva T.A., Koryukina E.B. Norwegian scabies: modern clinical features, methods of therapy and prevention // Clinical dermatology and venereology. 2012. No. 2. P. 124–127.

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reasons and how to get rid of it? ✓ Author’s articles of the Clinic of Podology Poljot in Moscow

Itching between the toes may indicate the development of various diseases: fungus, eczema, psoriasis, dermatitis, allergies to materials that make up shoes or socks. When this symptom appears, you should not resort to self-medication and traditional medicine, but it is better to immediately contact an experienced dermatologist until the disease has passed a chronic or acute form.

Diagnosis and treatment

During the appointment, the dermatologist conducts a visual examination of the skin of the legs, finds out the time when the discomfort began, and collects data on the patient’s lifestyle. To exclude other pathologies and accurately determine the diagnosis, a number of clinical tests are prescribed:

• scraping from the nail plates and skin of the toes;
• blood chemistry;
• analysis of feces for the presence of helminths;
• analysis for immunoglobulins, thyroid hormones;
• application tests.

If necessary, the patient is referred for a consultation with a gastroenterologist to rule out eczema.

The main cause of itching between the toes is a fungal infection. With mycosis, discomfort is felt more strongly after water procedures. If scraping from the nails and skin of the legs showed the presence of fungal spores, then complex antimycotic therapy is prescribed, taking into account the age and condition of the patient. In the absence of timely treatment, the fungus captures the nails, causing a change in their color, delamination and increased fragility. In severe cases, mycosis leads to flaking of the nail plates, which is accompanied by severe pain during walking and can be complicated by infection of the soft tissues of the toes.

Prevention

To avoid itching of the skin between the toes, you should follow the rules of personal hygiene:

• do pedicure regularly;
• wash your feet daily with antibacterial soap;
• when visiting swimming pools, baths, water parks, use individual hygiene products, personal shoes and a towel;

• wear comfortable shoes in size, excluding rubbing of the skin of the legs;
• use cotton socks.

With increased sweating of the feet, it is recommended to use antifungal powders, protective varnishes and gels for nails.

If you suffer from severe itching between your toes, do not self-medicate! Contact the dermatologists of the Podology Clinic and get rid of discomfort in the legs before complications appear.

The author of the article: Poletskaya Maria Nikolaevna

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This article appears in sections

Psoriasis

Treatment of hyperhidrosis

PACT therapy

Foot fungus (foot fungus)

Interdigital cracks

Mycosis of the skin

Atopic dermatitis

Microscopic studies

Eczema

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