Now here's a disease to become familiar with. Unfortunately, many will take a pass on reading about scabies just because they've never heard of it. I don't think I had ever come across it before attending some grid-down medicine classes last year. But maybe I did. I should have as a zoology major in school; if I did, it sure didn't leave an impression. And that's probably because it's more commonly found in crowded, impoverished conditions of third world countries and those lacking basic hygiene habits. That's not me, so no worries, right?
Wouldn't that be nice?
Unfortunately, while scabies is commonly found among the unwashed masses, it is very easily spread to all, even the very most hygienic and sanitary of people. There are numerous reports of transmissions to health care providers in hospitals. Compounding the problem is that many physicians aren't able to recognize a scabies infestation and the afflicted individual continues to suffer while spreading the buggers everywhere. And it's not something that is screened for by immigration officials, which doesn't matter much anyway with all the illegals coming in.
So what, exactly, is scabies? It rhymes with
rabies and is about as pleasant to consider. Scabies is a skin infection caused by the tiny burrowing mite
Sarcoptes scabiei. The eight-legged mites reproduce on skin, but generally only the female burrows into the skin, where she lays eggs and lives. For months, if you let her/them. Most infestations on people involve 10-15 scabies mites, though if untreated the infestation may quickly escalate into Norwegian scabies, with
millions of mites involved. Worldwide, it's estimated that between 100 and 300 million people are affected at any given time. That's a lot of creepy crawlies. Scabies is highly contagious; Norwegian scabies is even more so. Both are transmitted by direct physical skin contact or by infested linens or clothing or furniture. Because it is so contagious, usually the whole group of people living together are treated when one individual is infected. But be aware that infestations have also occurred in schools and hospitals. However, no one likes to talk about that. While scabies is most often passed to family members in the home, it is also spread easily
in day care centers, rehab centers, sports facilities, prisons, and public
transportation. Also, though it is not really a sexually transmitted disease, it is often found in sexually
active teens and young adults.
One of the great things about scabies is that for a first time occurrence, the symptoms may take two to six weeks to appear. So during this incubation period, it's being spread to the rest of the family, who will also take two to six weeks to exhibit symptoms. And so on. And what are the signs and symptoms of scabies? Nothing more than an itchy, red rash on the skin. An itching so intense that its victims will do anything to get rid of it. An itching so intense that the sufferers cannot even sleep at night. And indeed that is the biggest clue that the rash is scabies--the itching is worse at night. The itching is actually an allergic response to scabies' bites, eggs, and waste. In repeat infestations, the body has already been sensitized, so the response is much more rapid--in as little as 24 hours.
The scabies rash looks like tiny bites or pimples, or hives or bumps under the skin. Sometimes the burrow tracks of the mites can actually be observed. A magnifying glass may help you see the mites going in and out of their burrows in the skin. Sounds lovely, doesn't it? The most common places for the scabies to burrow are where it's likely to be a little warmer and moister: wrist, arm, genitals (especially in males), breasts, armpits, elbows, waist, buttocks, and the areas between the fingers. In babies and toddlers scabies also burrow into the palms of their hands and soles of their feet.
One of the chief complaints of those afflicted with scabies is that physicians do not understand how intense the itching is and that a lot of treatments are ineffective. Furthermore, the intense scratching of the afflicted areas creates sores which can then become infected (impetigo) and require antibiotics to treat.
Norwegian scabies, or crusted scabies, is a much more serious form of scabies found most often in the immunocompromised (HIV, AIDS, rheumatoid arthritis, chemotherapy) and elderly, where thick crusts of skin containing thousands of mites develop, and it is extremely contagious. Noteworthy is that itching may be minimal or absent.
Scabies is often confused, even by physicians, with psoriasis. So how do you tell the difference? In psoriasis, lesions may or may not itch, they appear in patches, and they may cause the skin to flake or scale. In contrast, scabies lesions are intensely itchy and do not cause the skin to flake or scale.
There are no approved over-the-counter medications for treating scabies.
Conventional medications commonly prescribed to kill scabies include:
- 5% permethrin cream (Elimite), applied to the entire body and left on the skin for 8-10 hours, safe for people aged 2 months and older, including pregnant women;
- 25% benzyl benzoate lotion;
- 1% lindane lotion, only for people who can't use other medications, children over the age of 10 years, and not for pregnant women, or anyone who weighs less than 110 pounds. May cause seizures. It is not a first choice treatment.
- 10% sulfur ointment;
- 10% crotamiton cream, not for children, people over the age of 65, or pregnant or nursing women;
- ivermectin, not for pregnant women or children under 33 pounds. It is not approved by the FDA for human use, though it has been shown to be effective. The CDC recommends a dosage of 200 micrograms per kilogram of body weight in a single dose, followed by another dose two weeks later. Oral ivermectin has a greater risk of side effects than permethrin and usually does not work better. It is only used when topical medications have failed or the patient cannot tolerate them.
Sulfur in petroleum jelly is one of the earliest known treatments for scabies. It is not FDA approved, but it is safe for pregnant women and children. It does not smell good.
What many patients apparently do not realize is that even
when the mites are killed, the itching may continue for several weeks
afterwards. After all, as noted above, the itching is due to biting, but it is also an allergic reaction to eggs and waste, which do not magically disappear from under the skin. The usual course is that the itching intensifies for the first
week after treatment, and then gradually tapers off to no itching by the fourth week
after treatment. Physicians often prescribe or suggest antihistamines to reduce itching and help with sleep. Other methods of reducing the itching include:
- a bath with cool water and oatmeal;
- calamine lotion;
- paper towels dipped in rubbing alcohol and applied to the skin.
The following are home remedies that scabies patients reported using. No claim is made as to efficacy or safety. Many of these sufferers had already tried conventional, prescribed treatments, without finding any relief. However, as noted above, it takes time for the itching to subside even if the scabies have been killed, so patients may have improved even without these treatments.
- apple cider vinegar bath
- horse ivermectin and 10% permethrin
- diatomaceous earth and baking soda mixed with water into a liquid paste applied all over the body twice, one week between applications
- neem oil bath daily for six weeks
- full strength apple cider vinegar and salt soak (will burn, but only for a little while)
- diatomaceous earth and olive oil paste
- a hot bath with 1-2 cups of salt each night for a week
- scratch all blisters open, fill tub with hot water and a lot of Clorox, add more hot water, blot dry
- witch hazel and tea tree oil
- Hart's mite shampoo for dogs
- Dettol antibacterial soap--leave on body for eight hours, two treatments with three days between each treatment
- Lysol and Ben-Gay
- dry wood ash
- Lysol, Ben-Gay, and Vicks Vaporub
- hot water and Lysol
- rosemary essential oil and tea tree oil
- kerosene mixed with Vaseline to make an ointment to rub all over the skin
- 1:1 tea tree oil and olive oil to dab on affected areas
- Japanese honeysuckle (Lonicera japonica) leaves prepared as an infusion and used as an external wash
No matter what method of treatment is used, all bedding, towels, clothes, stuffed animals, any personal items that could harbor the mites need to be washed in water as hot as possible, but at least above 120 degrees. Items that cannot be washed need to be strictly avoided for at least three days.
Permethrin is available at feed stores. Amazon carries several options as well. The physician who taught the grid-down medicine classes I attended stores four to six pints for his family alone.
Time to go shopping.
Links to related posts:
Lice
Ticks
Bed Bugs
For more information:
https://www.healthline.com/health/scabies
https://www.mayoclinic.org/diseases-conditions/scabies/symptoms-causes/syc-20377378
https://comments.medicinenet.com/scabies/patient-comments-37.htm (loads of home remedies)
https://articles.mercola.com/scabies/treatment.aspx
https://sectionhiker.com/permethrin-soak-method-guide/(how to treat your clothes and other items with permethrin)
