Infectious Disease Ward: Scabies
Greetings K12 IA future doctors from around the world. I bring you the second edition to the infectious disease series. Last month we covered Ringworm. This month, the topic is scabies which is another skin infection that can be mistaken not only for ringworm, but bed bug bite among other insects. The downside? This particular skin infection is difficult to treat. You may have heard of this infection, you may have not. This article will hopefully inform you on all things scabies. Like, how not to catch it, why you should really avoid it, and what to do about it should it really get under your skin!
Disease: Scabies
Background info: According to Kidshealth, scabies is “a common skin infestation of tiny mites called Sarcoptes Scabiei. The mites burrow into the top layer of human skin to lay their eggs, causing small itchy bumps and blisters.”
Symptoms and Diagnosis: Scabies will generally appear as a rash, which would be the first symptom. The rash will likely begin to itch. It will usually start in the hands, and later on spread to other parts of the body. The itching will likely be intense, and will only get worse. Even with only a few mites, the itching is awful. Another thing to watch out for are lines of the burrows mites dig. It might appear as silvery or dark lines on the skin. These lines indicate where the burrows are that the mites dig underneath the skin to lay eggs and…whatever else mites do.
One can usually tell they have scabies just by looking at their infection. However, the problem with that is scabies looks similar to many other types of skin infections, as it appears to initially be a rash of raised bumps. If you want to make sure you of a scabies infection, a doctor might take a skin scraping to examine the flesh underneath a microscope. If there are eggs, or the actual bug itself, it is certain that you have them. (aad.org)
According to Patient, an online UK health magazine, “Scabies mites are tiny. 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 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 on an infested person is 12.”
Transmission: Fortunately, close skin to skin contact is necessary to catch scabies. The mite itself does not fly, and cannot jump like other insects such as fleas. Scabies is most often found in overcrowded conditions and in impoverished communities. Refugee camps are a commonplace haven for this mite to succeed. However, it is not exclusively a disease found only in impoverished communities. Nursing homes, daycares, and schools are also excellent breeding grounds. The good news only is that skin contact typically needs to be for several minutes at a time, but the more mites a person is infected with makes it easier for them to spread the illness. The mite itself can live on towels and bedding for about 36 hours.
Anyone can get scabies. After infection, symptoms take up to six weeks to show.
Treatment: All household members of an infected person must be treated on the same day in order for treatment to be successful. The medicine usually recommended either over the counter or by prescription is Permethrin cream (Patient). A dermatologist is the best specialist to recommend medication for getting rid of scabies. According to aad.org, the topical skin medication “is applied at bedtime. The medicine is then washed off when the patient wakes up. You may (likely) need to repeat this process one week later.”
If Permethrin cream is unavailable, malathion liquid can also be used. Either can be found at a local pharmacy. It is important to emphasize to patients that hot baths and soap will not cure this skin infection. Treatment should begin as soon as possible to minimize spreading the mites to others.
Complications: NHS Choices, a United Kingdom health information database, says that “A secondary infection and crusted scabies are two possible complications of scabies.”
According to them, a secondary infection is typically caused by scratching and breaking the surface of the skin. Other bacteria can set into the broken skin and multiply illnesses such as impetigo, folliculitis, and some antibiotic resistant strains of bacteria such as MRSA.
Crusted scabies is a result of a weakened immune system. In brief, a weakened immune system allows the mites to multiply exponentially into thousands and thousands all over the body. Instead of a small rash, a not so itchy crusting forms on the skin that can be mistaken for psoriasis develops.
Tune in next month for: Bed Bugs!
Sources:
"Excellence in Dermatologic Surgery™" Scabies: Diagnosis, Treatment, and Outcome. Web. 21 Mar. 2015.https://www.aad.org/dermatology-a-to-z/diseases-and-treatments/q---t/scabies/diagnosis-treatment
Gupta, Rupal. "Scabies." KidsHealth - the Web's Most Visited Site about Children's Health. The Nemours Foundation, 1 June 2014. Web. 21 Mar. 2015. http://kidshealth.org/parent/infections/skin/scabies.html
"Scabies. What Is Scabies? Symptoms and Treatment | Patient.co.uk." Patient.co.uk. Web. 21 Mar. 2015. http://www.patient.co.uk/health/scabies-leaflet
"Scabies - Complications ." Scabies. Web. 21 Mar. 2015.http://www.nhs.uk/Conditions/Scabies/Pages/Complications.aspx