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Scabies

Scabies is a transmissible ectoparasite skin infection characterized by superficial burrows, intense pruritus (itching) and secondary infection. The word 'scabies' is Latin for 'itch'. more...

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Etiology

Caused by the mite Sarcoptes scabiei, variety hominis, it produces intense, itchy skin rashes when the impregnated female tunnels into the stratum corneum of the skin and deposits eggs in the burrow. The larvae, which hatch in 3-10 days, move about on the skin, molt into a "nymphal" stage, and then mature into adult mites. The adult mites live 3-4 weeks in the host's skin.

The motion of the mite in and on the skin produces an intense itch which may resemble an allergic reaction in appearance. The presence of the eggs produces a massive allergic response which, in turn, produces more itching.

Scabies is transmitted readily, often throughout an entire household, by prolonged skin-to-skin contact with an infected person (e.g. bed partners), and thus is sometimes classed as a sexually transmitted disease. Spread by clothing, bedding or towels is a less significant risk, though possible.

Signs, Symptoms, and Diagnosis

A delayed hypersensitivity (allergic) response resulting in a papular eruption (red, elevated area on skin) often occurs 30-40 days after there may be hundreds of papules, less than 10 burrows are typically found. The burrow appears as a fine, wavy and slightly scaly line a few millimeters to one centimeter long. A tiny mite (0.3 to 0.4 mm) may sometimes be seen at the end of the burrow. Most burrows occur in the webs of fingers, flexing surfaces of the wrists, around elbows and armpits, the areolae of the breasts in females and on genitals of males, along the belt line, and on the lower buttocks. The face usually does not become involved in adults.

The rash may become secondarily infected; scratching the rash may break the skin and make secondary infection more likely. In persons with severely reduced immunity, such as those with HIV infection, or people being treated with immunosuppressive drugs like steroids, a widespread rash with thick scaling may result. This variety of scabies is called Norwegian scabies.

Scabies is frequently misdiagnosed as intense pruritis (itching of healthy skin) before papular eruptions form. Upon initial pruritus the burrows appear as small, barely noticeable bumps on the hands and may be slightly shiny and dark in color rather than red. Initially the itching may not exactly correlate to the location of these bumps. As the infestation progresses, these bumps become more red in color.

Generally diagnosis is made by finding burrows, which often may be difficult because they are scarce, because they are obscured by scratch marks, or by secondary dermatitis (unrelated skin irritation). If burrows are not found in the primary areas known to be affected, the entire skin surface of the body should be examined.

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Scabies
From Gale Encyclopedia of Alternative Medicine, 4/6/01 by Kathleen D. Wright

Definition

Scabies, also known as Sarcoptic acariasis, is a contagious, parasitic skin infection caused by a tiny mite (Sarcoptes scabiei).

Description

Scabies is caused by a tiny, 0.3 mm-long, parasitic insect called a mite. When a human comes into contact with the female mite, the mite burrows under the skin, laying eggs along the lines of its burrow. These eggs hatch, and the resulting offspring rise to the surface of the skin, mate, and repeat the cycle either within the skin of the original host, or within the skin of its next victim, causing red lesions.

The intense itching almost always caused by scabies is due to a reaction within the skin to the feces of the mite. The first time someone is infected with scabies, he or she may not notice any itching for four to six weeks. With subsequent infections, the itchiness will begin within hours of picking up the first mite.

Causes & symptoms

Scabies is most common among people who live in overcrowded conditions, and whose ability to practice good hygiene is limited. Scabies can be passed between people by close skin contact. Although the mites can only live away from human skin for about three days, sharing clothing or bedclothes can pass scabies among family members or close contacts.

Mite burrows within the skin are seen as winding, slightly raised gray lines along a person's skin. The female mite may be found at one end of the burrow, as a tiny pearl-like bump underneath the skin. Because of the intense itching, burrows may be obscured by scratch marks left by the patient. The most common locations for burrows include the sides of the fingers, between the fingers, the top of the wrists, around the elbows and armpits, around the nipples of the breasts in women, in the genitalia of men, around the waist (beltline), and on the lower part of the buttocks. Babies may have burrows on the soles of their feet, palms of their hands, and faces. The itching from scabies becomes worse after a hot shower and at night. Scratching, however, seems to serve some purpose in scabies, as the mites are apparently often inadvertently removed. Most infestations with scabies are caused by no more than 15 mites altogether.

Infestation with huge numbers of mites (on the order of thousands to millions) occurs when an individual does not scratch, or when an individual has a weakened immune system. These patients include those who live in institutions; are mentally retarded, or physically infirm; have other diseases which affect the amount of sensation they have in their skin (leprosy or syringomyelia); have leukemia or diabetes; are taking medications which lower their immune response (cancer chemotherapy, drugs given after organ transplantation); or have other diseases which lower their immune response (such as acquired immunodeficiency syndrome or AIDS). This form of scabies, with its major infestation, is referred to as crusted scabies or Norwegian scabies. Infected patients have thickened, crusty areas all over their bodies, including over the scalp. Their skin appears scaly, and their fingernails may be thickened and horny.

Diagnosis

Diagnosis can be made simply by observing the characteristic burrows of the mites causing scabies. A sterilized needle can be used to explore the pearly bump at the end of a burrow, remove its contents, and place it on a slide to be examined. The mite itself may then be identified under a microscope.

Occasionally, a type of mite carried on dogs may infect humans. These mites cannot survive for very long on humans, and so the infection is less severe.

Treatment

A paste made from two herbs, neem (Azadirachta indica) and turmeric (Curcuma lona,) applied to the affected area daily for 15 days has been found to be effective in treating scabies.

Allopathic treatment

Several types of lotions (1% lindane or 5% permethrin) can be applied to the body, and left on for 12-24 hours. This is usually sufficient, although it may be reapplied after a week if mites remain. Preparations containing lindane should not be used to treat pregnant women and infants. Itching can be lessened by the use of calamine lotion or antihistamine medications.

Expected results

The prognosis for complete recovery from scabies infestation is excellent. In patients with weak immune systems, the biggest danger is that the areas of skin involved with scabies will become secondarily infected with bacteria.

Prevention

Good hygiene is essential in the prevention of scabies. When a member of a household is diagnosed with scabies, all that person's recently worn clothing and bedding should be washed in very hot water.

Further Reading

For Your Information

Books

  • Darmstadt, Gary L., and Al Lane. "Arthropod Bites and Infestations." In Nelson Textbook of Pediatrics, edited by Richard Behrman. Philadelphia: W.B. Saunders Co., 1996.
  • Maguire, James H. "Ectoparasite Infestations and Arthropod Bites and Stings." In Harrison's Principles of Internal Medicine, edited by Anthony S. Fauci, et al. New York: McGraw-Hill, 1998.
  • Stoffman, Phyllis. The Family Guide to Preventing and Treating 100 Infectious Diseases. New York: John Wiley and Sons, Inc., 1995.

Periodicals

  • Apgar, Barbara. "Comparison of Lindane and Permethrin for Scabies." American Family Physician 54, no. 7 (November 15, 1996): 2293+.
  • Forsman, Karen E. "Pediculosis and Scabies: What to Look For In Patients Who Are Crawling With Clues." Postgraduate Medicine 98, no. 6 (December 1995): 89+.
  • Moore, Adrienne V. "Stopping the Spread of Scabies." American Journal of Nursing 97, no. 10 (November 15, 1996): 2293+.
  • Pariser, Robert J. "Scabies: The Myth and the Reality." Consultant 36, no. 3 (March 1996): 527+.

Gale Encyclopedia of Alternative Medicine. Gale Group, 2001.

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