Scabies

Rash Comparisons

                                         Scabies

Scabies (say: SKAY-beez) is an itchy skin condition caused by teeny, tiny mites that dig tunnels underneath the skin's surface. Scabies is caused by a small, eight legged mite called Sarcoptes scabiei.  Mites are part of the arachnid family, the same family that includes spiders and ticks. Scabies mites have eight legs and a round body and are pretty hard to see. When they're fully grown, each mite is no bigger than the size of the point of a pin.  Scabies is spread by close physical contact and is common in school-age children. If left untreated, it will usually spread to all members of a child's family. The mites and their eggs may live on clothes or bed linen for 1-2 days.

Anyone can get scabies — little babies, adults, children. The mites aren't picky. They don't care if you're clean, dirty, rich, or poor. All they want is to live on or in the skin of a human being, and any human being will do.

Signs and symptoms

It is often difficult to diagnose scabies because the symptoms vary and the signs can be very subtle. Commonly, the symptoms include:

• Bullae - raised, clear fluid-filled spot or lesion that are bigger than 1cm in diameter
• Papules - solid, raised areas of skin with distinct borders less than 1cm in diameter
• Pustules - raised, fluid-filled spot that appear yellow
• Vesicles - raised, clear fluid-filled spots

Lesions or spots are areas of skin disease and are generally small.

A number of mites burrow into the skin, particularly between the fingers, around the wrists and elbows, the armpit, nipples and penis. In infants and young children, there are often vesicles and pustules on the palms and soles and sometimes on the scalp. It is the allergic reaction to these mites that causes the rash and symptoms.

Sometimes the only symptom is an itch, without a rash. Usually the itch is worse at night and after a hot bath or shower. Bathe your child in warm water as hot water may make the itching worse.

Your doctor may make a diagnosis by scraping a burrow and looking at that skin under a microscope. Scabies may be easier to diagnose by rubbing a black marking pen over a suspected burrow and then wiping it off with an alcohol swab. This leaves a burrow outlined with the ink from the pen.

Treatment

• The child and all close contacts should be treated at the same time
• 5% permethrin cream is recommended and should be applied to all body surfaces from the neck down (paying particular attention to hands, under the nails and the genitals) and left on overnight. This treatment can be bought from a pharmacy.
• Treatment should be repeated a second time, 1 week later
• In young babies, 6% precipitated sulphur is preferred
• Bedding and clothing should be washed in hot water and if possible, dried in a machine on a hot setting.
• Items that cannot be washed and dried this way can be put in air-tight containers or bags for 36 hours or in the freezer for a couple of days.  There’s no need for extensive washing or decontamination of the child’s room or the rest of the house, since the mite usually lives only in people’s skin. 

Do not apply the initial treatment more than twice. The itching caused by scabies may take up to three weeks to go away after treatment. In fact, the treatment itself may cause some irritation. Your doctor can prescribe a corticosteroid cream for this if needed.

Sometimes nodules (raised, solid lesions) caused by scabies can last for months, even with the corticosteroid cream. If this happens, see your doctor for further treatment.

Return to work/school — Children can usually return to school after one treatment for scabies. Classmates and teachers do not usually need to be treated unless there are signs or symptoms of scabies infection.

Key points to remember

• Scabies is spread by close physical contact and is common in school-age children
• If left untreated, it will usually spread to all members of a child's family
• The mites and their eggs may live on clothes or bed linen for 1-2 days
• 5% permethrin cream is recommended and should be applied to all body surfaces from the neck down
• In extremely young infants, 6% precipitated sulphur is preferred
• Treatment should be repeated a second time, 1 week later