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Scabies facts

Scabies is an itchy, highly contagious skin disease caused by an infestation by the itch
mite Sarcoptes scabiei.

Direct skin-to-skin contact is the mode of transmission.

A severe and relentless itch is the predominant symptom of scabies.

Sexual contact is the most common form of transmission among sexually active young
people, and scabies has been considered by many to be asexually transmitted disease (STD).

Scabies produces a skin rashcomposed of small red bumps andblisters and affects specific
areas of the body.

Treatment includes oral or topical scabicidal drugs.

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What Is "Norwegian Scabies"?

Scabies is a well-known infection that results in a particularly relentless and devastating itch that
starts out slowly and increases in severity over time. The mites that cause the condition,
scientifically known as Sarcoptes scabiei, burrow into the skin of infected humans. While they
are so tiny that it's not possible to see them with the naked eye, they can be appreciated by
examination with a magnifying glass or microscope.
Learn more about Norwegian scabies
occur each year throughout the world. Human scabies has been reported for over 2,500 years.
Scabies has been reported to occur in epidemics in nursing homes, hospitals, long-term care
facilities, and other institutions. In the U.S., scabies frequently affects the homeless population. It
also occurs episodically in other populations of all socioeconomic groups, as well.
How do you get scabies?
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Direct skin-to-skin contact is the mode of transmission. Scabies mites are very sensitive to their
environment. They can only live off of a host body for 24-36 hours under most conditions.
Transmission of the mites involves close person-to-person contact of the skin-to-skin variety. It is
hard, if not impossible, to catch scabies by shaking hands, hanging your coat next to someone
who has it, or even sharing bedclothes that had mites in them the night before. Sexual physical
contact, however, can transmit the disease. In fact, sexual contact is the most common form of
transmission among sexually active young people, and scabies has been considered by many to
be a sexually transmitted disease (STD). However, other forms of physical contact, such as
mothers hugging their children, are sufficient to spread the mites. Over time, close friends and
relatives can contract it this way, too. School settings typically do not provide the level of
prolonged personal contact necessary for transmission of the mites.
Can you catch scabies from a dog or cat?
Dogs and cats are infected by different types of mites than those which infect humans. Animals
are not a source of spread of human scabies. Scabies on dogs is called mange. When canine or
feline mites land on human skin, they fail to thrive and produce only a mild itch that goes away
on its own. This is unlike human scabies which gets worse and worse unless the condition is
What are risk factors for scabies?

Scabies can infest any human who comes in contact with the mites. The only known risk factor is
direct skin contact with someone who is infested. The contact one experiences in social or school
settings is not likely to be sufficient to transmit the mites. Sexual or other close contact (such as
hugging) is required to spread the condition. The condition does appear in clusters, so outbreaks
may occur within a given community.
What does scabies rash look like? What are scabies symptoms and signs?
Scabies produces a skin rash composed of small red bumps and blisters and affects specific areas
of the body. Scabies may involve the webs between the fingers, the wrists and the backs of the
elbows, the knees, around the waist and umbilicus, the axillary folds, the areas around the
nipples, the sides and backs of the feet, the genital area, and the buttocks. The bumps (medically
termed papules) may contain blood crusts. It is helpful to know that not every bump is a bug. In
most cases of scabies affecting otherwise healthy adults, there are no more than 10-15 live mites
even if there are hundreds of bumps and pimples on the skin.
The scabies rash is often apparent on the head, face, neck, palms, and soles of the feet in infants
and very young children but usually not in adults and older children.
Textbook descriptions of scabies always mention "burrows" or "tunnels." These are tiny
threadlike projections, ranging from 2 mm-15 mm long, which appear as thin gray, brown, or red
lines in affected areas. The burrows can be very difficult to see. Often mistaken for burrows are
linear scratch marks that are large and dramatic and appear in people with any itchy skin
condition. Scratching actually destroys burrows.
What does scabies feel like?
It is important to note that symptoms may not appear for up to two months after being infested
with the scabies mite. Even though symptoms do not occur, the infested person is still able to
spread scabies during this time. When symptoms develop, itching is the most common symptom
of scabies. The itch of scabies is insidious and relentless and often worsens over a period of
weeks. The itch is typically worse at night. For the first weeks, the itch is subtle. It then gradually
becomes more intense until, after a month or two,sleep becomes almost impossible.
What makes the itch of scabies distinctive is its relentless quality, at least after several weeks.
Other itchy skin conditions -- eczema, hives, and so forth -- tend to produce symptoms that wax
and wane. These types of itch may keep people from falling asleep at night for a little while, but
they rarely prevent sleep or awaken the sufferer in
How is a scabies infestation diagnosed?

Scabies is suggested by the presence of the typical rash and symptoms of unrelenting and
worsening itch, particularly at night. Ultimately, the definitive diagnosis is made when evidence
of mites is found from a skin scraping test. By scraping the skin (covered with a drop of mineral
oil) sideways with a scalpel blade over an area of a burrow and examining the scrapings
microscopically, it is possible to identify mites, eggs, or pellets. This process can be difficult,
however, since burrows can be hard to identify. Sometimes scratch marks are mistaken for
burrows, and even the examination of scrapings from 15 or more burrows may only reveal one or
two mites or eggs. If the characteristic physical findings are present, scabies can often be treated
without performing the skin scrapings necessary to identify the mites. Polymerase chain reaction
(PCR) testing is available to identify the genetic material of the scabies mites when the diagnosis
is difficult, though this is not generally used. The mites can also be identified in skin biopsies
that are performed when other causes of skin disease are suspected.
What are treatment options and home remedies for a scabies infestation?
Curing scabies is rather easy with the administration of prescription scabicide drugs. There are
no approved over-the-counter preparations that have been proved to be effective in eliminating
scabies. The following steps should be included in the treatment of scabies:
1. Apply a mite-killer like permethrin(Elimite). These creams are applied from the neck
down, left on overnight, then washed off. This application is usually repeated in seven
days. Permethrin is approved for use in people 2 months of age and older and is
considered to be the safest and most effective treatment for scabies.
2. An alternative treatment is 1 ounce of a 1% lotion or 30 grams of cream oflindane,
applied from the neck down and washed off after approximately eight hours. Since
lindane can cause seizures when it is absorbed through the skin, it should not be used if
skin is significantly irritated or wet, such as with extensive skin disease, rash, or after a
in pregnant or nursing women, the elderly, people with skin sores at the site of the
application, children younger than 2 years of age, or people who weigh less than 110
pounds. Lindane is not a first-line treatment and is only recommended if patients cannot
tolerate other therapies or if other therapies have not been effective. Resistance to this
medication has also been frequently reported.
What are treatment options and home remedies for a scabies infestation? (Part 2)
3. Ivermectin (Stromectol), an oral medication, is an antiparasitic medication that has also
been shown to be an effective scabicide, although it is not FDA-approved for this use.
The CDC recommends taking this drug at a dosage of 200 micrograms per kilogram body
weight as a single dose, followed by a repeat dose two weeks later. Although taking a
drug by mouth is more convenient than application of the cream, ivermectin has a greater

risk of toxic side effects than permethrin and has not been shown to be superior to
permethrin in eradicating scabies. It is typically used only when topical medications have
failed or when the patient cannot tolerate them.
4. Crotamiton lotion 10% and cream 10% (Eurax, Crotan) is another drug that has been
approved for the treatment of scabies in adults, but it is not approved for use in children.
However, treatment failures have been documented with the use of crotamiton.
5. Sulfur in petrolatum (Sulfo-Lac, Sulfo-Lo) applied as a cream or ointment is one of the
earliest known treatments for scabies. It has not been approved by the FDA for this use,
and sulfur should only be used when permethrin, lindane, or ivermectin cannot be
tolerated. However, sulfur is safe for use in pregnant women and infants.
What are treatment options and home remedies for a scabies infestation? (Part 3)
6. Antihistamines, such asdiphenhydramine (Benadryl), can be useful in helping provide
relief from itching. Sometimes, a short course of topical or oral steroids is prescribed to
help control the itching.
7. Wash linens and bedclothes in hot water. Because mites don't live long away from the
body, it is not necessary to dry-clean the whole wardrobe, spray furniture and rugs, and so
8. Treat sexual contacts or relevant family members (who either have either symptoms or
have the kind of relationship that makes transmission likely).
Just as the itch of scabies takes a while to reach a crescendo, it takes a few days to subside after
treatment. After a week or two, relief is dramatic. If that doesn't happen, the diagnosis of scabies
must be questioned.
Are cases of scabies often misdiagnosed?
Scabies is very easy to misdiagnose because early subtle infestation may look like small pimples
or mosquito bites. Those affected may believe they have another condition, such asbedbug bites
or other kinds of rashes. Over a few weeks, however, mistakes like this become evident as
patients feel worse and worse with symptoms they can't ignore.
What are possible complications of scabies?
The intense itching of scabies leads to prolonged and often intense scratching of the skin. When
the skin is broken or injured due to scratching, secondary bacterial infections of the skin can
develop from bacteria normally present on the skin, such as Staphylococcus aureus or betahemolytic streptococci.

Can a scabies infestation be prevented?

Scabies can be prevented by avoiding close personal contact with infested people. Sexual
contacts and household members of people who develop scabies can be treated as soon as the
condition is identified so that they will not develop the signs or symptoms of the condition. The
treatment for these exposed people is the same as the treatment of the infested individual.
In what special situations can scabies be more easily spread?
Elderly and weakened people in nursing homes and similar institutional settings may harbor
scabies without showing significant itching or visible signs. In such cases, there can be
widespread epidemics among patients and health-care workers. Such cases are dramatic but,
fortunately, uncommon.
What is Norwegian or crusted scabies?
Norwegian scabies, or crusted scabies, is a severe form of scabies first described in Norway.
Crusted scabies almost always affects people with a compromised immune system and is
observed most frequently in the elderly, those who are mentally or physically disabled, and in
patients with AIDS, lymphoma, or other conditions that decrease the effectiveness of the immune
response. Due to the poor function of the immune system, an individual may become infested
with hundreds of thousands of the mites. The lesions of this distinctive form of scabies are
extensive and may spread all over the body. The elbows, knees, palms, scalp, and soles of the
feet are most commonly the original sites of involvement, and the scaly areas eventually take on
a wart-like appearance. The fingernails can be thickened and discolored. Interestingly, itching
may be minimal or absent in this form of scabies.
A particular danger of crusted scabies is that these lesions often predispose to the development of
secondary infections, as with Staphylococcus orStreptococcus bacteria.
What is the prognosis (outlook) for scabies?
Scabies is curable with scabicide medications. Treatment failures are not common but are
possible, and people with Norwegian scabies may require a combination of different treatment