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Tips on Managing Scabies

How to Manage The Seven Year Itch

Oct 23, 2008 Hanish Babu

Scabies is a highly contagious, severely itchy skin disease caused by infestation with an itch mite known as Sarcoptes scabei.

Scabies is a highly contagious, severely itchy skin disease caused by infestation with an itch mite known as Sarcoptes scabei. It is a very common disease, but still misdiagnosed due to many clinical presentations. If proper treatment is not provided, it can remain in the family for months or years. No wonder it was called the seven year itch before effective treatments were discovered.

Scabies is more common in children and young adults, though it can affect all age groups. It is spread by close physical contact and through fomites. Outbreaks are common in schools, overcrowded residential areas, jails, hospitals etc. Scabies is also transmitted through sexual contact. Itching of scabies is typically more common during the night.

The scabies mite burrows into the superficial layers of the skin, lays eggs and multiplies within the skin. It is most commonly found on finger web spaces, inside of the wrist and elbows, below the breast fold, other parts of the body, and, in males, the genitals. In infants it can also affect the palms, soles and the skin of head and neck.

Treatment of Scabies

Following are the common medications used in the treatment of scabies.

Permethrin 5% Cream or Lotion: This is the most effective scabicidal medication. Usually applied overnight and repeated weekly once for 2-3 weeks. Can be used in pregnancy and in small children above 6 months of age.
Malathion 0.5% liquid: Not as effective as Permethrin.Applied for 12-24 hours weekly once.
Gamma Benzene Hexachloride 1% lotion: Applied overnight(6-8 hours): As it is a neurotoxin, GBHC should not be used in children and women who are pregnant or feeding.
25% Benzyl Benzoate emulsion: To be applied daily for 3 days a week, repeated for 2-3 weeks. The medication should remain on the body for full 3 days to kill the mites.
6% Precipitated Sulphur: Safe to use in infants and pregnant women. It is applied twice daily for 1 week. Then again repeated after one week if necessary.
Crotamiton cream/lotion: Crotamiton will relieve itching and is a weak scabicidal agent.
An oral medication, Ivermectin is available for very severe, chronic and stubborn scabies that does not respond to conventional therapies.

Tips on Managing the Scabies Infestation

Treat the whole family and close contacts even if they do not have any itching or rashes yet. The itching of scabies starts only after about 2-3 weeks.
The skin should be cool and dry before applying the anti-scabies medications. Avoid taking hot water baths before as this will cause the medication to be absorbed deeper. To be effective, the medication has to act on the superficial layers where the mite and its larvae reside.
Treat all the fomites, like dress, bed sheets, blankets etc. Suits etc may be kept closed in cupboards for 5 days, which will effectively get rid of the mites.
The medications should be applied all over the body below the neck in adults and face in infants. Apply the medications liberally to the nail folds and cuticles after each hand wash.
Repeat the application after one week to cover the larvae and mites hatching out of the eggs.
Even after successful treatment of scabies, itching may remain up to 3 weeks. Antihistamines will help in such situations.

Reference

CDC: Scabies Fact Sheet

The copyright of the article Tips on Managing Scabies in General Medicine is owned by Hanish Babu. Permission to republish Tips on Managing Scabies in print or online must be granted by the author in writing.

Scabies