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Scabies
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All information above has been reviewed by Dermatology specialists Edited and published by the Department of Nursing,
Taichung Veterans General Hospital
Health education number:DERM-103 Set date:2009.02.25.
Review date:2020.06.04.
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Etiology：
Scabies is a contagious parasitic infestation of the skin caused by the mite named Sarcoptes scabiei. The mites which cause scabies are not visible with the naked eye. They are tiny (0.3 millimeter long), and they burrow into the epidermis to lay their ova and feces which cause the skin to itch intensely.
Infectious route：
Scabies is contagious, and is usually transmitted by skin-to-skin contact with a person already infested with Scabies or by sharing towels, bed linen, sheets, blankets, underwear, etc. with such a person. The mite can only survive for 2 weeks without a human host. Therefore, the clothing of an infested person is capable of transmitting the disease to other people only within such a period of time. Scabies spreads rapidly under crowded conditions where there is frequent skin-to-skin contact between people, such as in school, military, institutions, prisons, child-care facilities, etc.
Infestation is common, found worldwide, and affects people of all social classes.
Signs and Symptoms：
The most common symptom of scabies is severe itching, which may be worse at night or after a hot bath. A scabies infection begins as small, itchy bumps, blisters, or pus-filled bumps that break when you scratch
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them. Itchy skin may become thick, scaly, scabbed, and crisscrossed with scratch marks. The areas of the body most commonly affected by scabies are the hands and feet (especially the webs of skin between the fingers and toes), the inner part of the wrists, and the folds under the arms. It may also affect other areas of the body, particularly the elbows and the areas around the breasts, genitals, navel, and buttocks. If a patient with scabies scratches the itchy areas of the skin, it increases the chance that the injured skin will also be infected by bacteria, or eczematization may occur.
Diagnosis：
The dermatologist checks the skin from head to toe, then asks the symptoms（especially if the itch is worse at night and seems to center around the wrists or the webbed part of the fingers）and history（ex：
family or group members who live together have the same symptoms）.
If scabies is suspected, the doctor may scrape a small part of the affected skin and examine the scrapings under a microscope for signs of scabies mites. Positive diagnosis is made when the mite, ova, or fecal pellets are found.
Treatment：
Follow the Doctor’s prescription to apply a mite-killer, such as Eurax solution or cream, BBL solution, etc. It needs to be applied to the skin all over the body after the patient takes a bath everyday, for one week.
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Another agent of scabicide is r-Benzene hexachloride, which usually must remain on the skin for 8 to 12 hours before it can be washed off.
This treatment is limited to once a week, and should not be used on children younger than three years old, pregnant or nursing women or anyone who have a history of seizure or other neuropathic diseases. The doctor may prescribe antibiotics if the patient develops a bacterial skin infection such as impetigo in addition to the scabies infection. The doctor may also prescribe an antihistamine and a cream-like hydrocortisone to help relieve the eczema. To prevent reinfection, treat all household members at the same time as the patient is being treated.
Prevention：
All bed linens (sheets, pillow cases, blankets) and clothing worn next to the skin (underwear, T-shirts, socks, pants) should be laundered in a hot cycle wash （60℃） and hot drying cycle.If hot water is not available, place all linen and clothing into plastic bags and store it away from the family for two weeks. The mite does not survive without skin contact.
During the Scabies infestation, don’t share the bed linen, tower, underwear with people.During the Scabies infestation, don’t go to the public place（ex.: hotel, restaurant, on duty room）and stay over night; and don’t take a Sauna bath.
