Scabies is a type of skin infection caused by the sarcoptes scabiei mite, characterized by skin itching. Also termed “sarcoptic mange”, the term scabies is actually derived from the Latin word for “scratch”, scabere. The tiny mites burrow within the skin, causing an allergic reaction which in turn leads to a rash and acute itching. Worldwide, there are an estimated 300 million people infected with scabies at any one time.

Symptoms

Mites may or not be visible, but usually will leave small red bumps and tiny zig zag pathways where they have burrowed into the skin. These bumps may look like tiny pustles or blisters or resemble small pimples on the skin. Scabies tends to affect areas of skin folds, such as the inside of elbows, between fingers, behind knees, wrists, and other areas.

In patients where the immune system is weakened, scabies can develop to form crusted scabies, an advanced form of the disease where crusted patches of scabs form as a result of infestation. Thickened patches of skin containing hundreds of mites can form in crusted scabies.

Typically, the face and scalp are not affected by scabies. Scabies may remain localized in one area or gradually spread over the surface of the skin.

Risk Factors

Scabies is transferred via skin to skin contact from one human being to another. There have been cases where humans contract scabies from their pets, such as an infected dog or cat, but such occurrences are rare. Highly contagious, scabies mites can live in infected bedding, furniture, mattresses, clothing, keyboards, towels, and literally almost any surface where an infected human’s skin may have rubbed off. Additionally, scabies can survive without a host for up to three days. Once they have infected a human host, the parasitic mites can live anywhere from three to four weeks.

The most common way of contracting scabies is from prolonged physical contact with an infected person. While patients have been known to get scabies from infected bedding or clothing, this is less common. Prolonged physical contact usually means skin to skin contact with an infected person which lasts longer than the average handshake.

Scabies often becomes a problem in areas where people exist in close quarters, such as nursing homes, summer camps, or schools. In these environments, one infected individual can spread the disease to anyone he or she comes in close contact with.

The type of scabies that affects humans is different from the mite that infects dogs and cats. Humans typically cannot be infected by the same type of scabies mite that affect pets.

Weak Immune Systems

In patients with compromised immune systems such as HIV, AIDS, or auto immune deficiency, healthcare providers should be alerted immediately to the possibility of scabies. Secondary infections can occur as complications in these patients who contract scabies, as well as increased likelihood of acute infection.

Remedy options

Sulfur Soap

Sulfur soap in concentrations of 6% to 10% is a long standing treatment to combat scabies. Patients should wash thoroughly with sulfur soap at least once daily for four days in order to effectively treat the skin. Bedding, clothing, and any other items should be washed in extremely hot water and soap to prevent recontamination.

Neem Oil

Along with sulfur soap, Neem Oil is another effective homeopathic treatment for scabies. Neem Oil is known to have anti fungal and antibacterial properties, which can help treat or soothe the skin of patients infected with scabies.

Tea Tree Oil and Elimite

Tea Tree Oil has been used but with only moderate to little success. For this reason, prescription medications are often warranted for treatment.

One of the most commonly prescribed topical treatments for scabies is Elimite, a cream that must be applied to all areas of the skin (including under the fingernails and toenails) to effectively penetrate the epidermis. Elimite is topically applied all over the infected individual’s body, taking care to cover all surfaces of the skin. After 10 to 14 hours, the Elimite is washed off of the skin in the shower with hot water and soap. A follow up treatment is usually required one to two weeks after the initial treatment.

Permethrin, Oral Medications, & Antihistamines

Permethrin is another popular topically applied medication for the treatment of scabies. The ointment is applied at night and washed off after eight to fourteen hours.

A newer treatment for scabies is an oral medication Ivermectin, taken twice: once at onset, and then another dose two weeks later to completely eradicate the infection. While Ivermectin has some mild side effects, these disappear after treatment and are typically a minimal trade off compared to the uncomfortable constant itching of scabies. Ivermectin is sold as Stromecol in brand name, and is typically given as two 3mg doses two weeks apart.

Antihistamines may also be prescribed to combat the itchiness that often accompanies scabies outbreaks.

When to see a doctor

It is highly recommended that patients visit a doctor.

While some infestations may resolve on their own, left untreated scabies can escalate into a highly unpleasant problem. Increased itching, formation of bloody scabs, and patches of scaly skin may accompany an advanced infestation. In such instances, medical treatment is the most efficient and best option. Scabies can also become resistant to medications over time, though this usually only occurs in repeat infections.

Once an infection is confirmed, the patient’s nails should be cut to prevent scabies from hiding under the fingernails or toenails.

Treatment of Family Members

Due to the highly contagious nature of scabies especially in close quarters, doctors frequently recommend treating the entire family for scabies even if only one member has contracted it. Given the propensity of the mite to spread and populate bedding, furniture, clothing, and other areas, it is highly likely that if one member of a family has scabies, other members either already have it or will have it shortly. Therefore, treating all family members for scabies at the same time is an effective method at preventing continual re-infection.

Care must be taken to ensure that once all family members are treated, scabies does not return and continue to re-infect members of the family. This requires a diligent household cleaning routine during and after treatment as the entire house must be disinfected in order to eradicate the outbreak.

Prevention

There is no vaccine against scabies. Therefore, the best way to prevent scabies is to avoid prolonged contact, or any contact, with people infected with scabies. If scabies contact is suspected, any bedding, clothing, towels, or items the infected person may have touched should be immediately washed in very hot water and soap.

Adding a small amount of borax to laundry can also be helpful. Rugs and floors should be steam cleaned and vacuumed.

Permethrin sprays are often used to treat items or areas that cannot be laundered. A synthetic chemical and pesticide, care should be taken when using Permethrin around infants and pets. The EPA has also categorized Permethrin as a carcinogen in extremely strong concentrations. For household use, however, Permethrin sprays can kill scabies mites, dust miles, fleas, termites, and ticks.

Borax powder is natural remedy than can be sprinkled on carpets, floors, and other areas of the house to prevent and kill mites. While natural, boric acid can still irritate the skin in some individuals and animals, so caution should be used when applying