The
parasite Sarcoptes scabiei is a tiny skin mite, almost impossible
to see without a microscope. It causes a fiercely itchy skin
condition known as scabies. Dermatologists estimate that more than
300 million cases of scabies occur worldwide every year. The
disease can strike anyone of any race or age, regardless of
personal hygiene. Scabies are not the same as body lice.
The microscopic mite is a tiny, eight-legged creature with a
round body, somewhat like a spider. The mite burrows between the
skin layers. The body develops a reaction to the mite that results
in severe itching; often intense enough to keep sufferers awake
all night, and frequently leading to skin infections.
Human scabies is almost always caught from another person,
anyone who has come into close contact; it could be from a child,
a friend, or another family member. Some people do react more
severely than others do, and a rare infected person hardly itches
at all.
Attracted to warmth and odor, the female mite is drawn to a new
host, making a burrow, laying eggs and producing secretions that
cause an allergic reaction. Larvae hatch from the eggs and travel
to the skin surface, lying in shallow pockets where they will
develop into adult mites. It may be four to six weeks before a
newly infected person will notice the itching or swelling that can
indicate the presence of scabies. A re-infection will itch right
away.
The earliest and most common symptom of scabies is itching,
particularly at night. An early scabies rash will show up as
little red bumps, like hives, tiny bites or pimples. In more
advanced cases, the skin may be crusty or scaly. Scabies will
usually begin in the folds and crevices of the body --
particularly between the fingers, under the arms, on the wrists,
buttocks or belt line, around the nipples for women and on the
penis for men. Mites also tend to hide in, or on, the skin under
rings, bracelets or watchbands or under the nails. The head and
face are not affected, except in children or those with weak
immune systems.
Once diagnosed it is essential that the treatment is properly
completed. Thoroughly massage Elimite Cream into all
skin surfaces from head to the soles of your feet. It is critical
to apply this on every square inch of your body, not only where
the rash is.
Apply between the finger and toe creases, in the folds of the
wrist and waistline, in the cleft of the buttocks and on the
genitals and in the belly button. Keep your nails clipped short.
Scabies mites can hide under your fingernails. Use a toothpick or
old toothbrush to apply beneath your fingernails and toenails.
Leave on for 8 to 14 hours, then remove it by bathing and
shampooing (usually sooner for young children). You may notice
mild itching, burning or stinging sensation after applying. This
is usually just a minor, temporary reaction to the medication.
If you wash your hands or any other area of your body during
the treatment period, new cream must be reapplied immediately. The
cure rate is 95 % with one application. It is usual for itching
and rash to continue for as long as two to four weeks after
treatment. Because the 5% of people who are not cured also keep
itching, a second application a week later is often advised. In
some cases, repeat applications weekly are needed until cured.
For infants, young children and the elderly follow the same
instructions as above, except also thoroughly massage Elimite
Cream into the neck, scalp hairline, temples and forehead.
Although scabies mites cannot live long without a human host,
there have been a few cases of apparent transmission through
infested clothing and bedding. Even so, heroic cleaning efforts
are generally unnecessary. Normal washing of towels, linens and
all clothes used within the previous 48 hours is typically
sufficient to prevent re-infestation. The temperature
of the wash water doesn't matter as the mites
could not possibly survive a normal washing procedure.
Clean clothes or heavy
winter jackets and sweaters need not be cleaned. Pesticides should
not be used to fumigate the affected areas, as the scabies mite
is only contagious if it is already
infecting someone.
The itch usually persists
for up to a few weeks, even if the treatment
worked. To lessen the itch, medications for itch may also be prescribed. Antihistamines and
steroids orally or topically will help make it more tolerable. If
you feel that the itching and rash are excessive or persistent,
contact the office. The itch may fade faster if you soak
in a warm tub of water until your fingertips turn into
"raisins," then
scrub the areas that tend to itch. This will eliminate the dead
mites and
their debris much faster than allowing them to be shed normally.
Occasional patients will have to
repeat this once or twice to stop the itch. Alternate treatments are
available, the latest being oral
Ivermectin pills. This is a new, and probably more effective treatment.
It is not yet widely used for ordinary cases of scabies, but will
be useful for outbreaks. Some of the older remedies, such as
Kwell (lindane), are felt to be too toxic for routine use, but are
effective when the Elimite fails (which is rare). Selsun
lotion and sulfur ointments are occasionally used.