by Sanaz Majd, MD
Every once in a while, I get a distraught patient in my office and the visit goes a little something like this:
Patient, scratching uncontrollably: “Doc, I’m itching all over. On my neck, on my butt, in my groin, on my legs, on my arms…everywhere. You gotta help me!”
These patients look so very uncomfortable and are unable to sit still. So what’s the cause of their pain and agony? More often that I would like, it’s scabies. Of course before I make that diagnosis, I have to make sure they don’t suffer from other causes of itchy skin. I ask itchy patients about allergic reactions, new medications, and other health related problems that can cause itching (such as problems with the liver). But when I see such helpless scratching and itching, scabies is always at the forefront of my small doctor brain.
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What Is Scabies?
Scabies is a type of mite less than half a millimeter in size that is just small enough to be invisible to the naked eye. The scabies mite digs underneath the surface of the skin and lays its eggs there. These eggs hatch about three days later, producing more mites that further thrive on the human body.
Scabies is transmitted from person to person, and despite popular belief, is not passed on from animals to humans.
What Are the Symptoms of Scabies?
The severe itching that comes as a result of scabies begins about one month after a person first becomes infected--with one exception. If you’ve had scabies before, symptoms may begin within several days, not weeks, since the body has already been sensitized to these parasites before.
Itching is enough to drive my patients completely nuts. It’s bad. And the itching tends to be even worse in the evenings when you are less distracted.
What Are Other Signs of Scabies?
I like to think of scabies as an itch without much of a rash. What I mean by that is for an infestation that is so itchy, there really is not much of a visible rash. There might be small (less than 1 cm) red, raised spots with small scabs on top (typically from scratching). But overall, there’s not too much to see.
What is really diagnostic, but not always present, is a thin, linear, red line of several millimeters up to two centimeters long referred to as a “burrow.” But again, many patients with scabies don’t show up with any of these burrows.
What Body Parts Do Scabies Attack?
Although scabies can attack any part of the body, it really doesn’t affect the face or scalp (except in some young kids). In fact, body parts that a scabies mite likes to dig under are often the following:
Between the webs of the fingers and toes
In the groin or genitals
In the buttocks
In the folds of the abdomen or waistline
Underneath the breasts
On the neck
Underneath the armpits
But again, it can really affect anywhere from the neck and downward.
Who Is Most At Risk of Scabies?
Those who spend time in enclosed, crowded spaces full of people are at a greater risk of contracting scabies. For instance, hospitals, nursing homes, and prisons are notoriously known for housing these organisms and passing them from person to person rapidly.
How Is Scabies Diagnosed?
No testing is required to diagnose these mites. Basically, doctors diagnose scabies based just on the history the patient provides along with the physical exam. The following clues are the dead giveaways:
Severity of itching
Location of itching
Itching that becomes worse at nighttime
Family members with similar symptoms
Itch that occurs without much of a rash
How Can You Get Rid of Scabies?
The bad news is that, yes, the thought of having scabies is totally gross. However, there is some good news --there is a good cure.
The medication: Your physician will prescribe you a cream called permethrin that you apply from the neck down all the way to the soles of the feet at night before bedtime. One quick and dirty tip is to not forget to apply it behind the ears, in the groin and buttocks folds, and even in between the webs of the fingers and toes. Make sure you cover every nook and cranny.
The cream needs to be left on the body for at least eight hours, so I typically tell my patients to rinse off upon awakening in the morning. And everyone can go back to school or work that morning, and should no longer be contagious!
The cream needs to be used by every single member of the household, whether or not they are symptomatic. Like I mentioned before, it can take up to one month for people to show any symptoms. People can have scabies without realizing it, and if not everyone is treated they can continue to swap it back and forth. So everyone in the house has to apply the cream at the same time, whether or not they have symptoms.
Some people may still have some milder itching for a couple of weeks after treatment due to an allergic reaction to the eggs. I often recommend that my patients do one more application of the cream seven days after the first treatment just to make sure no remaining eggs went uneradicated.
The laundry: It’s not over though. After your super cream fest, it’s laundry time! Any clothing worn in the past week, all bedding, and all stuffed animals should be washed in hot water and dried in heat. Alternatively, if you are unable to wash something in water you can place it in a plastic bag, tightly close it, and leave it alone for one week. If the mite does not have a human host in several days, it cannot survive.
Treating your pets is not recommended; as I mentioned before, scabies is transmitted from person to person only. Fogging or fumigating the home is not necessary. Vacuuming and cleaning fabric surfaces may be a good idea, however.
How Can You Get Rid of the Itch?
Taking over-the-counter diphenhydramine can help make the itching more tolerable. Diphenhydramine does make people sleepy, so for during the day, I would recommend any of the non-drowsy anti-histamines, such as loratidine or cetirizine.
Once you’ve treated the whole family with the cream, finished laundry night, and rinsed off in the morning, the nightmare should be all over. Congratulations, you have successfully survived scabies!
On a lighter note, now that I have truly grossed you out to the max on my show once again, I’d like to invite you all to join my GirlfriendMD Facebook page, where you can get further grossed out by my other health-related posts and links, and where you can ask me your health questions! Come on, don’t be shy!
Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.