Scabies

=Scabies=

What it is
Scabies is caused by a tiny mite called //Sarcoptes scabiei.// It is about half a millimetre in size and burrows under the skin and lays eggs. The fecal pellets left in the burrow cause of local hypersensitivity reaction and is assumed to cause the release of the inflammatory mediators that trigger an allergic reaction invoking intense itching. The eggs hatch and mature in 14 days, after which the cycle can begin again.

The scabies mite is spread from person to person by direct physical contact, such as holding hands, and sexual contact. Contact must be prolonged – a quick handshake or hug will not spread it. It is thought that about 20 minutes of touching is required. Although the mite does not survive for more than 36-48 hours away from the human body, it can be spread by contact with clothes or linen, although this is much less common. Scabies cannot be transmitted by animals.
 * Causes:**

Symptoms
//symptoms appear two to four weeks after first exposure// //and one to four days after subsequent infestations// - Severe itching all over the body, except for the head, which is usually worse at night. - A red lumpy rash appears, commonly around the buttocks, wrist and ankles, and between the fingers and toes. It also occurs in the folds of the skin around the armpits, elbows, breasts and genitals. - In babies and young children the rash may also occur on the face and scalp, palms of hands and soles of feet. - Sometimes little burrow lines that look like a greyish-coloured fine line or curve around 5-10mm in length will be visible, although this is not required for diagnosis.

Scratching of the affected area can cause a secondary bacterial infection (Staphlycoccus and Streptococcus). If this occurs antibiotic treatment may be required.

How to Treat
//All members of the patient’s family and close contacts should also be treated, even if they do not have symptoms.//

The person who is infected should first have a shower or bath to soften the skin. A clean washer and towel should be used and the skin should be allowed to dry well before the application of the treatment. The lotion should be applied to //all the skin surfaces// thoroughly with a brush such as a shaving brush or paintbrush. It is important that the soles of the feet are treated.

Permethrin 5% cream (Lyclear) is the treatment of choice. It should be applied from the neck down to clean, cool, dry skin and left on for eight to 14 hours (usually overnight). In babies and young children it should also be applied to the scalp, neck, face and ears (avoiding the mouth, eyes and nostrils). It should then be washed off with warm, soapy water. The treatment should be repeated after seven days.

Benzyl benzoate 25% lotion (Ascabiol, Benzemul) is effective if used correctly, but it is more irritating than permethrin. It must be diluted for children (child <2 years: dilute with 3 parts of water; child 2 to 12 years and sensitive adult: dilute with equal parts of water). It should be left on for 24 hours and re-applied to the hands if they are washed.

For babies less than 2 months old: Crotamiton [|hand cream] (Eurax)

Other advice
- If a school child has scabies, the school should be notified, but treatment of all the children at the school is not required. Infested children may return to school when they have had two treatments one week apart. - Fingernails and toenails should be trimmed to remove mites present under the nails due to scratching. - Clothes, bedding, towels and soft toys should be washed in hot water; items that cannot be washed should be stored in tightly sealed plastic bags for one to two weeks. - The itch may persist for two to three weeks after treatment, even if the scabies have 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. Antihistamines and topical or oral corticosteroids can be given when the itch is severe.

Crusted (Norwegian) scabies is severe form of scabies in which thousands to millions of mites infest an individual (most scabies cases involve only 10 to 20 mites). People affected by crusted scabies often have a poor or compromised immune system or have been misdiagnosed leading to a delay in treatment. Crusted scabies results in intense crusting and scaling of the skin, although the itch generally associated with scabies may be mild or absent.

Additional Resources
[|Self-care Card - Scabies] [|Facts behind the Fact Card - Headlice and Scabies] [|Health NT - Scabies] [|Health SA - Scabies] [|Health First - Scabies] [|Better Health - Scabies]