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What Are Scabies?
Scabies is a skin infestation caused by the Sarcoptes scabiei mite. These mites burrow into the outermost layer of skin, the stratum corneum, to lay their eggs and complete their life cycle. The resulting infestation leads to intense itching and visible skin irritation.
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How Are Scabies Spread?
Scabies spreads through prolonged skin-to-skin contact or contact with infested surfaces, such as furniture or clothing. It is highly contagious. It is difficult to say how long this contact needs to be without precise data to support it. While brief interactions like shaking hands or hugging are unlikely to transmit scabies, spending extended time in close contact with an infested person or environment increases the risk. In my practice after seeing hundreds of cases of scabies over the past two decades, the majority of cases I have seen are from spending hours not minutes with a person or a location that is infested. Cases in dormitories or homes often stem from prolonged exposure to infested furniture or shared spaces. Scabies are generally not spread through pets or swimming pools.
What Are the Symptoms of Scabies?
In the first few days, you may not experience symptoms. Symptoms of scabies often begin subtly, with mild itching at the site of contact. Often there is a delay of days and even 4 to 8 weeks before the intense itching sets in. Scabies tend to cause reddish intensely itchy bumps that can become scabby, scaly, and crusty and often form linear burrows as it tracks across the skin. These symptoms can worsen over time, causing severe discomfort. Sometimes the time frame can differ amongst family members.
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How Are Scabies Diagnosed?
Most scabies cases are diagnosed clinically based on their classic symptoms and presentation. Patients often report worsening itchiness, scabs, and a lack of relief from typical anti-itch treatments. They have often been to a primary care physician or urgent care before seeing me and already received a course of steroids with no relief. While skin scrapings or biopsies can confirm scabies, these tests may not always detect mites, especially in the early stages of infestation.
How Can Scabies Be Treated?
Treatment for scabies requires a comprehensive approach. Although scabies in individuals can be treated, the reality is that if we do not consider the environment and others in close contact with the individual diagnosed with scabies, there is a better chance than not that a re-infestation will occur.
Patient Treatment
Oral Ivermectin: Effective in killing live mites and their eggs with minimal side effects.
Topical Treatments:
Permethrin Cream: Targets live mites but not eggs; requires a second application after a week to break the mite's life cycle.
Lindane Lotion: May require multiple applications.
Spinosad Suspension: Offers better efficacy with just one treatment.
Close Contacts and Household Members
Everyone in close contact should be treated simultaneously to prevent re-infestation, even if they show no symptoms.
Environmental Treatment
Launder recently used bedding and towels.
Leave unused items untouched for 72 hours, as scabies mites cannot survive off a host for longer than this.
Use easily cleaned furniture and designate specific areas for activity during the first 72 hours post-treatment.
Wipe down car seats and avoid upholstered surfaces during this time.
How to Treat Your Home for Scabies
Treating your home effectively is essential to prevent re-infestation:
Simultaneously treat all affected individuals.
Launder all recently used linens and clothing in hot water.
Isolate unused items for at least 72 hours.
Avoid upholstered furniture for 72 hours or wipe down non-upholstered surfaces.
Consider steam cleaning areas that cannot be laundered or wiped.
One study demonstrated that topical antiseptics such as hand sanitizers do not stop the spread of scabies. This also makes it challenging to understand which disinfectants can be effective against scabies. Even bleach does not directly list scabies as one of its activities. Scabies is susceptible to anti-mite approaches and is thought to not be able to survive temperatures over 50 degrees Celsius or 122 degrees Fahrenheit.
Can Scabies Spread Disease?
Scabies mites live only in the superficial layers of the skin, where there is no direct blood supply. While scabies itself does not transmit diseases, scratching the affected areas can introduce bacteria and lead to secondary skin infections.
How Do You Know If Scabies Treatment Was Successful?
After treatment, itching may persist for 2 to 4 weeks due to a condition called “Post-Scabetic Hypersensitivity.” This lingering itch is natural and does not indicate treatment failure. Regular follow-up with your dermatologist can help monitor progress and address any concerns.
FAQs About Scabies
What are scabies?
Scabies is an infestation caused by mites burrowing into the skin, leading to intense itching and irritation.
How are scabies spread?
Scabies spreads through prolonged skin-to-skin contact or contact with infested surfaces.
What are the best treatments for scabies?
A combination of oral Ivermectin, topical treatments like permethrin cream, and environmental decontamination is most effective.
Can scabies mites survive off the skin?
Scabies mites cannot survive off a human host for more than 72 hours.
How long does it take to recover from scabies?
Symptoms like itching can persist for 2 to 4 weeks post-treatment due to hypersensitivity, even after successful mite elimination.
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