How to recognise and treat a scabies infection
Scabies is quite a common condition that we see in the pharmacy. It is contagious and the primary symptom that people report is extreme itching. Scabies is caused by a mite known as Sarcoptes scabiei. There is an outbreak of scabies at the moment so it is useful to know some extra information about the condition.
Scabies is spread by skin to skin or sexual contact with an infected person. Less often it can also be spread by sharing towelling and clothing with someone with scabies. It takes up to eight weeks for symptoms to appear after infection. Outbreaks of scabies occur in places where people are in close contact such as schools or nursing homes.
Scabies mites tend to prefer warm areas on the skin such as between the fingers, under fingernails or around creases such as those at the groin or breast area. The rash can also be commonly seen at the wrists and the elbows. It also sometimes appears around the waist, on the soles of the feet and shoulder blades, on the lower legs and underarm area. It is the intense itching that people complain of the most. This itching is usually worse at night because the skin temperature tends to be warmer. In most cases the itching takes a month to six weeks to develop as it takes the body awhile to react to the infection. On the other hand if you have previously had scabies then the symptoms will appear within a few days as the immune system recognises a scabies reinfection. Some people such as those whose immune system is compromised and the elderly or young children can develop a rash on their head or neck. In infants and young children the rash can appear on the face, neck, head, scalp and soles of the feet and palms.
Scabies are resistant to soap and hot water, and so cannot be scrubbed from the skin. An infection needs treatment or the infection can last indefinitely. The exact cause of the intense itching is mostly unknown. It is thought that the itching is caused by the reaction of the immune system to the scabies mites and their saliva, eggs and stools. However the mites cannot fly or jump. They have to be spread by direct and prolonged physical contact such as sex, holding hands for a prolonged period of time or in rare case from shared bedding or towels. Scabies can live outside the body for 24-36 hours.
It is important to get a suspected scabies rash examined in order to confirm the diagnosis. It is possible to buy an over the counter treatment called Lyclear in the case of a definite infection. It is necessary to treat all close household contacts at the same time to prevent reinfection. The cream contains an insecticide called Permethrin which kills the mites. The cream is applied to cool, dry skin. It should not be applied after a hot bath or the cream will be absorbed too deeply into the skin and will not work on the area with the burrows from the mites. The cream should be applied all over the body from the chin and ears down. All clothing, bedding and towels should be washed in a hot wash (over 50 degrees). It is very important to treat all close contacts in order to prevent reinfection. It can take weeks for symptoms to appear so it is important to treat everybody even if they are not showing any signs of infection. In the case of someone who has a weak immune system or is very young or very old, the cream should be applied all over including the head and scalp. Lyclear should be left on for 8-12 hours and if the hands are washed before 8-12 hours the cream should be reapplied to the hands. The treatment can be repeated after a week and within 2 weeks.
It can also be helpful to use an anti-itch cream such as Eurax and antihistamines. Some antihistamines can cause drowsiness so care should be taken when driving. Calamine can also help with the itch. The itch can continue for weeks after the infection is cleared as your immune system can still react to the dead mites. If the itch continues for more than 6 weeks you should go back to your GP for a follow up appointment.