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In this lesson, we'll be digging into all things scabies related – what it is (the digging into will make more sense then), a common type of scabies, how it's transmitted, the signs and symptoms, how it's diagnosed, and the various ways to prevent and treat scabies.

What is Scabies?

Scabies is a contagious infestation of the skin by human itch mites, otherwise known as, for you Latin-speaking students, sarcoptes scabiei var. hominis. The microscopic scabies mite burrows (or digs) into the upper layer of your skin where it then decides to hunker down, live, and lay some eggs.

Scabies infestations are frequently complicated by the presence of bacterial infections, leading to the development of skin sores that can cause more serious conditions such as septicemia, heart disease, and chronic kidney disease.

Scabies represents one of the most common dermatological conditions and skin diseases for those living in developing countries.

Crusted Norwegian Scabies

This severe form of scabies involves the presence of thick crusts of skin that contain large numbers of scabies mites and eggs. It's very contagious and can easily be spread to others by direct skin to skin contact or by contact with items like bedding, clothing, and furniture. And it might not show the usual symptoms – rash and itching.

Pro Tip #1: People with crusted scabies should receive quick and aggressive medical treatment to prevent further infestations and outbreaks. You'll recognize it by the crustiness of the skin around the infestations.

Crusted scabies can more easily occur in the following groups of people:

  • Those with weakened immune systems
  • The elderly
  • The disabled
  • The debilitated

How is Scabies Transmitted?

Pro Tip #2: Scabies is usually spread by direct and prolonged skin to skin contact with someone who has been infested. It generally must be prolonged. For this reason, it's spread easily and frequently to sex partners.

Scabies can also be spread among household members who aren't sexually active, though less so, by sharing or touching infested items like clothing, bedding, furniture, etc.

The incubation period for scabies is between two and six weeks after being infested. It should be noted that a person infested with scabies can spread the condition to others during this time and even when no symptoms are present.

The period of communicability lasts until all mites and eggs have been destroyed by treatment, which usually consists of two courses of treatment one week apart. Itching can still persist for two more weeks following the successful eradication of mites and eggs.

Signs and Symptoms of Scabies

Pro Tip #3: For anyone who has previously had scabies, signs and symptoms can appear much sooner – one to four days after exposure.

Common scabies symptoms include:

  • Severe itching, especially at night (earliest and most common symptom)
  • Pimple-like rash is also quite common

Scabies can affect much of the body, or it can be limited to common areas, such as:

  • Between fingers
  • Wrists
  • Armpits
  • Penis
  • Nipples
  • Waist
  • Buttocks
  • Shoulder blades

How is Scabies Diagnosed?

Diagnosis is usually done by appearance – the distribution of a rash and the presence of burrows (where scabies mites make their home in the skin).

Diagnosis is usually confirmed by the identification of mites, mite eggs, and mite fecal matter and can be done by carefully removing a mite from the end of its burrow using the tip of a needle, or by scraping the skin. It's then examined under a microscope.

It's important to understand that a person can still be infested with scabies even if no mites, eggs, or fecal matter are found.

Typically, there are fewer than 10 to 15 mites present on an entire body of an infested person. However, for those with crusted scabies, there can literally be thousands of mites. It should go without saying, that anyone with crusted scabies is highly contagious.

Scabies mites can live on a person for as long as one to two months and off a person for usually not longer than 48 to 72 hours. And mites will die if they are exposed to temperatures greater than 50 C and 122 F for at least 10 minutes.

Scabies Treatment

The main treatment for scabies is scabicide (in lotion or cream). This is the most common medication used to kill scabies mites and some even kill the eggs. It must be applied all over the body, from head to toe. It's only available with a doctor's prescription, and all people in the same household should be treated at the same time to avoid reinfestation.

There are over-the-counter lotions and creams used to treat scabies, but these have not been tested or approved.

Warning: For infants, ONLY permethrin or a sulfur ointment should be used.

Scabies Prevention and Control

Scabies is prevented by avoiding direct skin-to-skin contact with an infected person or with the items that an infected person has used, like bedding, clothing, and such.

Also, all bedding and clothing worn or used by an infected person three days prior to completing treatment should be machine washed with hot water and a hot dryer cycle, or dry cleaned. Items that cannot be washed or dry cleaned can be disinfested by storing them in closed plastic bags for several days to one week.

Scabies mites will not usually survive more than two to three days away from human skin.

Institutional outbreaks of scabies can be difficult to control and require swift and aggressive treatment to avoid further spread. Rooms used by people with crusted scabies should be thoroughly cleaned and vacuumed. And environmental disinfestation using pesticides sprays or fogs are usually not necessary and discouraged.