March 12, 2018
ARTICLE:

Scabies

By Dr Megan Yap - Paediatrician

So after my brilliant (*ahem*)  school-kid infection-trifecta (school sores, head lice and threadworms), I decided that no blog collection about gross infections could possibly be complete without a post about SCABIES.

So after blogging about this today, I can literally “stop-itching” to write about it, and leave it be!  Har har.

Co-incidentally after my post last Monday, I have seen 3 cases of head lice in clinics in a WEEK!  OMG.  Bad things happen in threes.  The kids/parents didn’t even know they HAD the lice… I just happened to see the lice crawling over their heads (**SHUDDER**).   Now you all know I hate creepy crawlies and insects – but the scabies mite (Sarcoptes scabiei) has 8 legs so they technically AREN’T an insect.  They are an arthropod more closely related to spiders (I’m still not selling it am I? ha ha ha – whilst we’re at it, I hate spiders too) but they are still a parasite.

So, the lovely thing about the personality of all these parasites is that they do not discriminate.  Whether you are rich or poor, blonde or brunette, fat or thin, old or young, they will LOVE you for WHO. YOU. ARE.  (Uh huh)   And they will burrow into your skin regardless – provided they are given the opportunity (contact) to spread (ewwww…).  They do tend to spread more easily and quickly in extended-care facilities and when there is crowding, lots of people together with close contact (day-care, kindy, school, nursing homes etc).

(Scratching yet? I am.  I have been for weeks since I started this darned thread of blog posts!)

 

Scabies is an infestation of the skin by teeny-tiny 8-legged mites that causes an intensely itchy, red, bumpy rash.  Each mite is less than a millimetre long so can be hard to see with naked eye, but can be more easily visualised with a magnifying glass.

Scabies spreads by close physical contact with someone who is already infested with the bug and for this reason (just like head lice, school sores and threadworms) is common in school age children.  If not treated promptly, these mites can spread to all members of an infected person’s family because they can live up to 2-4 days off a person – usually in bed linen, clothes, mattresses and furniture (like couches).

What does a scabies rash look like?

The rash caused by the scabies mite can look different in different people.  Typically it consists of small, red, raised, solid bumps (called papules – see the pics in the gallery) that are less than a centimetre in diameter.  These are most often noted in moist skin areas, like between the fingers, inside wrists, elbows and knees, under breasts and around nipples, waist bands, buttocks, upper thighs, scrotum and penis, and the sides and bottoms of feet. It would be extremely rare for all of these areas to be affected. The head and back are usually spared (although the scalp is commonly affected in infants).  Scratching at lesions may cause the skin to become inflamed and infected (and then you can have BOTH scabies AND school sores/cellulitis – oh joy!!). Other times, the rash can present as raised, clear, fluid-filled blisters that can be big (“bullae”) or small (“vesicles”) or even pustules (like little pimples filled with pus).

When the mites burrow under the skin, it looks like red lines most commonly in the webs of the fingers and toes (but can be anywhere). The itching is usually worse at night time, or after a hot shower or bath.  And ohhhhh how it itches.  Itches like the freaking dickens.

 

TREATMENT

As with threadworm treatment, the child and all close contacts should be treated at the same time.  There are a few different scabies treatments (“scabicides”) in Australia, but the 2 I am most familiar with are (a) Ascabiol lotion and (b) Quellada lotion.  These have been around since I first qualified as a pharmacist (over 18 years ago).  Both can be irritant on the skin, and should be patch tested first.  There are different instructions for adults vs children and babies – either reduced time on skin before washing off or the lotion needs diluting.  Re-treatment is recommended ONLY IF there is evidence of live mites a week after treatment (but not otherwise because both are so irritant on the skin).

 

Ascabiol lotion – Benzyl Benzoate 250mg/mL (taken from product information)

Adults: First have a hot bath and dry thoroughly. Let the skin cool down before applying the lotion. Apply Ascabiol lotion in a thin layer to the whole body from the neck down, using a soft brush (such as a painter’s brush). let the lotion dry (5 – 10 minutes) and then put on clean clothing. Wait for 24 hours for the Ascabiol to act and then have another hot bath. This treatment should cure the scabies, however the itching may not go away at once. A second treatment after 5 days is only needed if there are still live mites.
Children under 12 years:  Dilute with an equal quantity of water before using as per instructions for adults.
For babies:  Dilute with 3 parts water.

Quellada lotion (for scabies): Contains 1% (m/m) gamma benzene hexachloride (taken from product information from manufacturer)

Adults and children over 6 months: A thin layer of Quellada lotion is applied to the whole body except for the face and scalp. It is left on for 24 hours and then washed off. If the hands or any part of the body are washed in the course of 24 hours the lotion should be reapplied to that area for the remainder of the 24 hours.  If evidence of viable mites or lice are present seven days after treatment, the dosage schedule should be repeated.
Children under 6 months:  not recommended for children under 1 month of age.
Children of 1 – 6 months should be treated (under appropriate supervision) as adults, but the lotion should be washed off after 8 – 12 hours.  Children over 6 months should be treated as adults.  All children should be under supervision, constant or as required, to ensure that they do not lick the lotion off and ingest it.

 

The ITCH caused by scabies can be really distressing and it can prevent people from sleeping well.  Antihistamines can be used to reduce the itch, but often do not get rid of it completely.  A drowsy antihistamine (like Polaramine or Phenergan) can be used at night to help (both the itch and to help sleep) or a non-drowsy antihistamine (like Claratyne, Zyrtec or Telfast) can be used through the day.  The itch can persist for up to 1-2 weeks after the mites are eliminated due to the allergy reaction set up by the infection initially.  Steroid creams can also be used to reduce inflammation and itch topically.

 

Prevention of reinfection

  • Wash all clothes, bed linen, doonas, covers etc in HOT water and hang in sun to dry OR stick in a hot clothes dryer (mites die if exposed to 50 degrees Celcius for 10 min)
  • Since the scabies mite cannot survive off a human host for more than 2-4 days, placing these items in a plastic bag for 5 days before re-using will ensure that there are no live mites left to re-infest the host.
  • Furniture (couches, carpet etc) should be vacuumed thoroughly
  • Treat all family members (or everyone who lives in the house and has had close contact with the infested child) at once to avoid “ping-pong” infections.

 

So IT IS DONE!!  No more “itchy” posts for a while!  Scratch all you like and get it out of you system now!!

Hope as usual that you have found this post both informative and amusing ;P

xxDr Megs

For more articles from Dr Megan Yap visit her blog – “Dr Megs – Paeds & Feeds” at http://www.kids-health.guru/

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