Once scabies mites transfer to another host, they will usually move to warm areas of

the body, where they thrive best. These include the skin folds, between the fingers and
under the fingernails, around the buttocks and genital areas, and in the creases of the
breast. They may also hide under rings, watch straps, and bracelets. 5

Although these parasites cannot live without a human host, the bad news is that they
can live for a short amount of time in the external environment, even without feeding
on human skin. This means that they can be transferred on surfaces, clothes, bedding,
and furniture, where they can live for a few days.

Unfortunately, scabies symptoms do not immediately show up after a person has been
infested, especially if it’s for the first time. The symptoms typically show up in around
four to six weeks. They also develop more quickly in individuals who already
experienced a scabies infestation before. Usually, if it’s a recurrence, the symptoms
can appear within one to four days after the exposure.

The hallmark symptoms of scabies, itchy skin and rashes, are said to be

triggered by your immune system, in response to the parasite that burrows
into your body. But to know exactly what causes this infestation, you must
know more about Sarcoptes scabiei – the mite that leads to scabies.

1.The female mites tunnels into the person’s skin, causing visible pencil-like
lines to appear, where she then deposits her eggs. Each female mite lays
around 40 to 50 eggs in her lifetime.

2.The larvae begin to hatch within three to 10 days. They then morph and
become nymphs.

3.The nymphs mature and become adults within 10 to 15 days, with a lifespan
of approximately four weeks. They then deposit additional eggs on the skin.

The burrowing and the movement of the mites inside the human skin cause
extreme itching, as it triggers an allergic reaction to the mite proteins. The
saliva and the feces of the mites may also trigger this allergic reaction.

………..
Scabies is a highly contagious, erythematous, and intensely pruritic skin condition. The word “scabies” is
believed to originate from “scabere,” the Latin term that means “to scratch.” It is caused by a species-specific
mite, Sarcoptes scabiei, which is motionless at room temperature and unable to fly or jump from person to
person.
The tortoise-shaped female mite is approximately 0.3 mm long, has eight legs, and is barely visible to the
naked eye. The male, approximately half of the size of the female, mates with the female on the skin surface.
Once gravid, the adult female burrows into the stratum corneum, the outer layer of the skin. The female lays up
to three eggs per day as it burrows into the skin and dies after 5 weeks at the end of the burrow.

The burrow is the pathognomonic sign of scabies and is described as a white or gray threadlike, linear, wavy
papule that has a small vesicle with a black dot at one end. The black dot is the female mite. Typically,
burrows are located in the interdigital web spaces, flexor aspects of the wrist and elbows, navel, waist, genitals,
and buttocks. Other lesions include papular excoriations, scaly eczematoid patches, and red-brown nodules and
vesiculopustules. In infants and children younger than 2 years of age, the lesions usually are vesicular and are
located on the face, head and neck, palms, and soles. In older children, teens, and adults, the more typical
locations are from the neck down.

Pruritus is the primary symptom and is caused by an allergic reaction to the mite’s saliva, eggs, and feces once
the host becomes sensitized. The itching generally is worse at night. The hypersensitivity may not develop for
4 to 6 weeks with the first exposure, but with reinfestation, the pruritus begins in 1 to 4 days because the host
has been sensitized previously.

The infection is transmitted through direct skin-to-skin contact from an infected individual and occurs most
commonly in households. Less commonly, scabies is transmitted from clothing and bedding and uncommonly
from animal scabies. The animal scabies mite burrows, but it is unable to reproduce in humans. The human
mite can live up to 3 days off an appropriate host.

The diagnosis should be considered strongly in patients who have an intensely pruritic rash or when there is a
history of contact with an infected person. The diagnosis may be confirmed by isolation of the mite from skin
scrapings of affected lesions. The burrow is the ideal lesion from which to obtain a specimen. Burrows, not
easily seen, may be identified by using a washable marker that is rubbed across the interdigital web space, then
removed with water or alcohol. Burrows, if present, will retain the ink, making them more visible.

If no burrows are present, the newest lesions without excoriations and eczematization should be scraped.
Multiple burrows or lesions should be sampled to increase the yield. Mineral oil or water is placed directly on
the skin to facilitate specimen collection. A #15 blade is moistened with the same fluid used on the skin so that
the removed scrapings adhere to the blade. The scrapings are placed on a glass slide, oil or potassium
hydroxide is added, and the sample is examined under low power. Visualization of the mite, eggs, or feces
(scybala) confirms the diagnosis. Rarely, a punch biopsy is needed to reveal the diagnosis.

The differential diagnosis includes atopic dermatitis, seborrheic dermatitis, histiocytosis X, contact dermatitis,
papular urticaria, impetigo, recurrent pyoderma, drug reaction, lichen planus, and syphilis.

Special forms of scabies also exist. Nodular scabies, which comprise 10% of cases, are red-brown lesions on
axillary folds, upper back, and genitalia. Lesions are persistent and do not represent inadequately treated
infection. They resolve spontaneously after weeks or months. Another atypical form of scabies, Norwegian or
crusted scabies, may be seen in institutionalized or immunocompromised patients and pregnant women. The
lesions are crusted with gross scaling and can be generalized or localized to the hands and feet. Affected
patients may be infested with hundreds to millions of mites and are very contagious. Some advise testing these
patients for human immunodeficiency virus. Bullous scabies is another form in which bullae and vesicular
lesions are common. In neonatal scabies, distribution is generalized to all body areas that have increased mite
counts. The lesions are located on the face, neck, trunk, palms, and soles and present as papules, pustules, and
nodular crusts. This form also is associated with failure to thrive, poor feeding, and secondary bacterial
infection.
Unless the patient and all family members and close contacts are treated, even if asymptomatic, a single person
can reinfest close contacts. The treatment of choice, especially for infants, young children, and pregnant or
nursing women, is permethrin 5% lotion. This synthetic pyrethrin is a neurotoxin that paralyses mites, lice,
ticks, and fleas. The lotion is applied for 8 to 14 hours, then removed. Many advise reapplication in 1 week,
but a single application is associated with an overall cure rate of 89% to 92%. Less than 2% of the lotion is
absorbed into the skin, so it has a low potential for toxicity. Side effects include mild, transient burning,
stinging, redness, and rash.

Prior to the introduction of permethrin, lindane 1% cream was the treatment of choice. However, there was
concern about potential central nervous system and systemic toxicity associated with this agent. The lindane
absorption rate is up to 10%, and reported side effects include seizures, nausea, headache, vertigo, amblyopia,
and irritability. There are cases of lindane-resistant scabies.

Alternative therapies include sulfur and crotamiton 10% cream. Sulfur is the oldest known treatment of scabies
and usually is available as 5% to 10% precipitated sulfur in petrolatum. It is applied nightly for 3 consecutive
nights and washed off thoroughly 24 hours after the last application. It is the choice for infants younger than 2
months of age and for pregnant or lactating women. Crotamiton cream is used less commonly because it is
considered less effective. It generally is applied for 5 consecutive days.

Other general guidelines relate to application of the treatment used. For infants and young children, the entire
body surface should be covered, as should the scalp and face (avoiding areas around the eyes and mouth).
Older children, teens, and adults should apply the medication from the neck down, including intertriginous and
genital areas, the intergluteal cleft, and under trimmed nails. Bed linen and clothing should be washed in water
that is at least 120°F. Dry cleaning or storage for 1 week also may be effective.

Pruritus may be ameliorated with antihistamines or mild-to-intermediate strength topical corticosteroids.

Secondary bacterial infections of excoriated scabies may be treated with antibiotics. Parents should be told that
the itch may persist for several weeks despite treatment. Children may return to child care or school after
completing treatment. Overtreatment should be discouraged strongly.

Treatment failure is common and usually is due to failure to treat all exposed individuals simultaneously.
Follow-up at 2 and 4 weeks is imperative; patients who are not“ clear” at these intervals are considered
treatment failures.

Correct identification and treatment of all exposed contacts generally leads to eradication and cure of this
condition.

http://pedsinreview.aappublications.org/content/22/9/322

…………This skin condition that causes itching and, typically, raised red spots
starts when human itch mites (called Sarcoptes scabiei) burrow under your
skin and lay eggs there. In most healthy adults, just 10 to 15 mites can
cause scabies.
This skin condition that causes itching and, typically, raised red spots starts
when human itch mites (called Sarcoptes scabiei) burrow under your skin
and lay eggs there. In most healthy adults, just 10 to 15 mites can
cause scabies.

Links:

https://healthfully.com/differences-scabies-rash-eczema-rash-5759381.html

https://healthresearchfunding.org/eczema-vs-scabies/

https://aneskey.com/rash-atopic-dermatitis-contact-dermatitis-scabies-and-erythroderma/

https://www.niddk.nih.gov/health-information/digestive-diseases/dermatitis-herpetiformis

https://www.healthline.com/health/dermatitis-herpetiformis#causes

https://en.wikipedia.org/wiki/Dermatitis_herpetiformis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5567089/

Scabies must also be differentiated from insect bites. Insect bites are characterized by
erythematous-based papules and intense pruritus. Microscopically, insect bites present
as urticaria in a zigzag pattern, especially on legs and at the waist─similar to the
patterns found in scabies.  7

Pediculosis, characterized by excoriated skin from intense scratching, present as

erythematous-based papules, and similar to scabies, develop in genitalia, axilla, and the
trunk area.  7

PR, which also resembles scabies, primarily affects the trunk and is not contagious. PR
lesions are salmon pink or tawny-colored and oval-shaped. The large, oval-shaped
herald as well as the “Christmas tree” shape of the lesions makes PR’s presentation
somewhat unique.  7

SD, another skin condition similar to scabies, has maculopapular lesions that appear
yellowish-red and greasy, or white, dry and scaly. People with SD have a rash, pruritus,
and excoriated erythematous skin in body folds, axillae, and groin

Based on the history of the present illness of the patient, hepresents with pruritic papules and vesicles
initially on the interginous area between his fingers. This may be due to the laying of eggs of the
parasite. When the impregnated feamal cbies was transmitted to the patient’s skin, it resides to the
warm areas of the body, which include the webs of the fingers. As the parasite lay up its egg, it burrows
inot the stratum corneum of the skin. Upon doing so, papules often arises.
Vesicle may be visible near the blind end
Upon the transmission of the impregnated female parasite, it resides to the warm areas of the body
which includes skin folds, between the fingers and under the fingernail. It may also affect the knees,
elbows, axillae, waist or buttocks genitalia, breast and shoulder. The parasite burrows into the stratum
corneum and lays up its egg into the skin. Raised red spots, which appears as papule often arise as the
parasite lay down its egg. This is present as the prutic papule and visciales initially experienced/observed
by the patient on the interginous area between his fingers (which eventually spred into the xillae,
adominal are, gluteal and scrotal area).

This causes pruritus, which generally worsen at night. (the pruritus and rash epereinced by the patient
may be caused by the sensitization reaciotion to the mites and their secretion.
) harrison: burrows become surrounded by inflammatory iniltrates composed of eosinophils,
lymphocytes, and histiocytes, and a generalized hypersensitivity rash later develops in remote sites.
Immunity anda associated scratching limit most infestation to <15 mites per person; pruritus typically
intensifies at night and after hot shows. Classic burrows are often difficult to find because they are few
in number and may be obscured by excoriation.

Presence of excoation and burrows in the physical findings of the skin of the patient is due to the
‘action’ of the scabies. Burrows, describe as linear gray-white plaque, in the physical examination of the
patient is similar to the pathognomic burrow of a scabies. Hence this support the primary diagnosis of
scabies. Excoriation? Due to extreme itchingness of the skin, the patient mat loss some of its skin due to
stracthing. / exocraiton is the loss of skin due to scarthcing which may be due to the pruritus caused by
the parasite

Secondary excoriation due to overly scratching of the patient.

In men itchy papules on the scrotum and penis are virtually pathognomonic

(14) Excoriation. Loss of skin due to scratching is called excoriation. The implication is that the person
has scratched himself, but the scratch mark can also be of unknown origin.

Pruritus is the primary symptom and is caused by an allergic reaction to the mite’s saliva, eggs, and feces once
the host becomes sensitized. The itching generally is worse at night. The hypersensitivity may not develop for
4 to 6 weeks with the first exposure, but with reinfestation, the pruritus begins in 1 to 4 days because the host
has been sensitized previously.

Transmission occurs primarily by the transfer of the impregnated females during person-to-person,
skin-to-skin contac
Burrow (scabies)—A minute, slightly raised tunnel in the epidermis, commonly found on the finger webs and on the sides of the
fingers. It looks like a short (5–15 mm), linear or curved gray line and may end in a tiny vesicle. Skin lesions include small
papules,
pustules, lichenified areas, and excoriations. With a magnifying lens, look for the burrow of the mite that causes scabies.
) Burrow. A burrow is a tunnel or linear train in the epidermal layer of the skin caused by a parasite. The
contagious, parasitic skin disease scabies is a good example of a parasite burrowing. The skin damage is
caused by the female Sarcoptes scabiei who excavates a burrow in the stratum corneum layer of the
epidermis, lays her eggs and dies. The larvae emerge, moult, and the females are fertilized. The most
common sites in which the parasite enters the skin are between the fingers, the hands, and the wrists.
The infection can persist for months or years if a person is not treated, a situation which gave rise to the
expression "the seven-year itch."

 their eggs. The microscopic scabies mite almost always is passed by direct, prolonged, skin-to-skin
contact with a person who already is infested. An infested person can spread scabies even if he or
she has no symptoms. Humans are the source of infestation; animals do not spread human scabies.

Contact Dermatits

Contact Dermatitis is caused by an irritant, and presents as pruritus ras, dry sking

Insect bites

insect bites. Insect bites are characterized by erythematous-based papules and

intense pruritus. Microscopically, insect bites present as urticaria in a zigzag pattern,
especially on legs and at the waist─similar to the patterns found in scabies.  7

Drug reactions

Medication reaction

Irritant contact derma titis

posriasis

Chronic relapsing eruptions of grouped symmetrical, pruritic papulovesicles on scalp,

neck, extensors, and buttocks.
May have gastrointestinal symptoms consistent with celiac disease. [21]

Insect bites

Impetigo?

Drug eruptions/reactions

Varicella
Eczema

Mosquiteo bites

Acne

Sarcoptes scabiei undergoes four stages in its life cycle: egg, larva, nymph and adult. Females deposit 2-3 eggs
per day as they burrow under the skin   . Eggs are oval and 0.10 to 0.15 mm in length   and hatch in 3 to 4
days. After the eggs hatch, the larvae migrate to the skin surface and burrow into the intact stratum corneum to
construct almost invisible, short burrows called molting pouches. The larval stage, which emerges from the
eggs, has only 3 pairs of legs   and lasts about 3 to 4 days. After the larvae molt, the resulting nymphs have 4
pairs of legs   . This form molts into slightly larger nymphs before molting into adults. Larvae and nymphs
may often be found in molting pouches or in hair follicles and look similar to adults, only smaller. Adults are
round, sac-like eyeless mites. Females are 0.30 to 0.45 mm long and 0.25 to 0.35 mm wide, and males are
slightly more than half that size. Mating occurs after the active male penetrates the molting pouch of the adult
female   . Mating takes place only once and leaves the female fertile for the rest of her life. Impregnated
females leave their molting pouches and wander on the surface of the skin until they find a suitable site for a
permanent burrow. While on the skin’s surface, mites hold onto the skin using sucker-like pulvilli attached to
the two most anterior pairs of legs. When the impregnated female mite finds a suitable location, it begins to
make its characteristic serpentine burrow, laying eggs in the process. After the impregnated female burrows
into the skin, she remains there and continues to lengthen her burrow and lay eggs for the rest of her life (1-2
months). Under the most favorable of conditions, about 10% of her eggs eventually give rise to adult mites.
Males are rarely seen; they make temporary shallow pits in the skin to feed until they locate a female’s burrow
and mate.

Transmission occurs primarily by the transfer of the impregnated females during person-to-person, skin-to-skin
contact. Occasionally transmission may occur via fomites (e.g., bedding or clothing). Human scabies mites
often are found between the fingers and on the wrists.

When a person is infested with scabies mites the first time, symptoms usually do not appear for up to two
months (2-6 weeks) after being infested; however, an infested person still can spread scabies during this time
even though he/she does not have symptoms.

If a person has had scabies before, symptoms appear much sooner (1-4 days) after exposure. An infested
person can transmit scabies, even if they do not have symptoms, until they are successfully treated and the
mites and eggs are destroyed.

Common Symptoms
The most common symptoms of scabies, itching and a skin rash, are caused by sensitization (a type of
“allergic” reaction) to the proteins and feces of the parasite. Severe itching (pruritus), especially at night, is the
earliest and most common symptom of scabies. A pimple-like (papular) itchy (pruritic) “scabies rash” is also
common. Itching and rash may affect much of the body or be limited to common sites such as:

 Between the fingers

 Wrist
 Elbow
 Armpit
 Penis

 Nipple
 Waist
 Buttocks
 Shoulder blades

The head, face, neck, palms, and soles often are involved in infants and very young children, but usually not
adults and older children.

Tiny burrows sometimes are seen on the skin; these are caused by the female scabies mite tunneling just
beneath the surface of the skin. These burrows appear as tiny raised and crooked (serpiginous) grayish-white or
skin-colored lines on the skin surface. Because mites are often few in number (only 10-15 mites per person),
these burrows may be difficult to find. They are found most often in the webbing between the fingers, in the
skin folds on the wrist, elbow, or knee, and on the penis, breast, or shoulder blades.

Possible Complications
The intense itching of scabies leads to scratching that can lead to skin sores. The sores sometimes become
infected with bacteria on the skin, such as Staphylococcus aureus or beta-hemolytic streptococci. Sometimes
the bacterial skin infection can lead an inflammation of the kidneys called post-streptococcal
glomerulonephritis.

Crusted (Norwegian) scabies

Crusted scabies is a severe form of scabies that can affect the elderly, persons who are immunocompromised,
or persons who have conditions that prevent them from itching and/or scratching (spinal cord injury, paralysis,
loss of sensation, mental debility). Crusted scabies is characterized by vesicles and thick crusts over the skin
that can contain many mites. Itching (pruritus) may be absent in crusted scabies because of a patient’s altered
immune status or neurological condition. Because they are infested with large numbers of mites (up to 2
million), persons with crusted scabies are very contagious. Persons with crusted scabies may not show the
usual signs and symptoms of scabies such as the characteristic rash or itching (pruritus).