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ScabiesIntroduction Scabies is an itchy condition of the skin caused by a tiny mite (Sarcoptes scabiei), less than half a millimetre long. The female mite burrows into the outer layer of skin to lay its eggs. As the larvae hatch and grow into mites, the skin produces an allergic reaction and intense itching develops. The scabies mite can burrow into any part of the skin, but is most commonly found around the hands, feet and male genitalia. It does not usually affect the neck and head, although it may in infants, the elderly and those whose immune system is not functioning properly. Scabies can affect people of any age but is most common in children and young adults. It is highly contagious and is spread by close physical contact, especially in overcrowded living conditions. There are sometimes outbreaks in schools and residential or nursing homes. It can also be passed on by sexual contact. The elderly and people who do not have a fully functioning immune system are more likely to have crusted scabies (also called Norwegian scabies). This is a highly contagious condition in which the skin thickens, forming a crust, and rather than having the usual amount of female mites (around 12), a person with crusted scabies can have an infestation of thousands. Crusted scabies is transmitted by physical contact and can also be transmitted via bedding, towels, clothes and upholstery. Symptoms The symptoms of scabies begin to appear about 2-6 weeks after infestation. However, if a person is re-infested after a previous experience of scabies, then the symptoms can appear in a few hours because the body is already sensitised to the mites. The mites burrows can be seen as thin, light brown or silvery, wavy lines. They usually appear on the wrists, elbows, or genitals, or between the fingers. Burrows can be between 2mm and 15mm long, and it is sometimes possible to see a dark speck at one end (the mite). Burrows can be hard to find because they are easily destroyed or distorted by scratching. Widespread itching will be experienced, particularly at night, as the infested person develops an allergic reaction to the mites, their eggs and their faeces. A rash of raised, pinkish-red spots will appear, most commonly on the inner thigh, underarms, buttocks and genitals, and around the belly button. Excessive scratching can cause a bacterial infection such as impetigo, which may make symptoms worse. In infants and children, other parts of the body are sometimes affected, including the face, scalp, palms and soles of the feet. Causes Scabies is caused by a mite that burrows under the skin. The skin produces an allergic reaction and intense itching develops. Scabies is highly contagious and is spread by close physical contact. Like head lice, scabies mites do not prefer a particular type of person, whether they have good personal hygiene or not, and can be transferred on to anyone who has contact with an infested person. Young children, elderly people with limited mobility, and people with HIV/AIDS are among the groups who may have larger quantities of mites on them, when an infestation occurs. They sometimes develop crusted scabies, with thickened skin and possibly thousands of mites. Crusted scabies is extremely contagious, because of the larger number of mites, and can be passed on through bedding, towels, clothes and upholstery, as well as close physical contact. Household pets also have mites but these are not the same type of mite that infest humans. Although people can have a temporary allergic reaction to mites on pets, it is very unlikely that they will be infested with scabies by these mites. Treatment Washing yourself will not remove scabies, so it is important to visit your GP if you have an unidentified itchy skin condition. There are two main types of lotion in use for scabies in the UK. These are applied to the whole body, including the scalp, face, neck and ears. Special attention should be paid to skin between the toes and between the fingers, and under the nails. To prevent re-infestation, all people in close contact should be treated at the same time. This includes sexual partners and all members of the household, even if they are not yet showing any symptoms. It is recommended that scabies should be treated with one of two medicines: Permethrin cream or lotion. It tends not to irritate the skin and should be left on for 8 to 12 hours, or overnight, before being washed off. Malathion lotion. This should be washed off after twenty-four hours. A small brush may help with application. You can get these medicines on prescription from your doctor or you can buy them over-the-counter (OTC) from a pharmacy. But you should always check you definitely have scabies with a doctor or nurse before buying and using these creams or lotions OTC. It is not advisable to apply your treatment straight after a hot bath or shower, because the lotion will be absorbed deeper into the body. To work effectively, it needs to stay on the surface of the skin. If hands are washed during the period of treatment, then the cream or lotion should be reapplied. To prevent you becoming re-infested and to prevent you transmitting the mite to others, all clothing, towels, and bed linen should be machine-washed (at 50 C or above) after the first treatment is applied. Items that cannot be washed, for example, upholstery, can be kept in plastic bags or covered in plastic for at least 72 hours to contain the mites until they die. If applied correctly, the prescribed lotion or cream will kill the mites, but their bodies are still in the skin, which means that itching may continue for up to three weeks after successful treatment. Your GP may prescribe a topical corticosteroid or an antihistamine lotion to help relieve itching. Calamine lotion and cool showers or baths may also be helpful. If the itching does not begin to lessen or gets worse, or new burrows appear, treatment may need to be repeated. Crusted scabies, in which thousands of mites may have infested the skin, can be more resistant to treatment. It may require more than one set of treatment to remove all the mites, and your GP may refer you to a specialist to ensure that the most appropriate treatment is given. Aromatherapy treatment usually combines external treatment with creams and garlic capsules which are to be taken several times a day. A combination of Lavender and Peppermint essential oils can be helpful and also try Cinnamon, Clove, Lemon and Rosemary essential oils. One of the best ways of using the oils is to mix a few drops of the oils listed into a cream base and alternate them. The cream should be applied to the itching areas twice a day preferably after a bath and the treatment will be more beneficial if the oils are also added to the bath. Also try Chamomile in the bath as it can be soothing. Once the scabies has been cleared the skin can often be dry and flaky so try using Benzoin, Myrrh, Lavender and Neroli and a carrier oil to help to repair the skin. During treatment attention to hygiene is vital. Anything which can be washed at a high temperature should be treated that way and try using a solution of Lavender and Camphor oils to clean mattresses and pillows and anything else which cannot be washed. |
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