In the mid-1990’s, Jay Harold worked as an infectious disease pharmacist primarily taking care of HIV patients in a hospital setting. The 1990’s were a difficult time because of the lack of understanding of AIDS (HIV) and the best treatment options for the patient.
There were so many patients being admitted that isolation protocols apparently weren’t always followed and Jay Harold got scabies. Having scabies is something that you never forget.
Human scabies1 is caused by an infestation of the skin by the human itch mite (Sarcoptes scabiei var. hominis). The microscopic scabies mite burrows into the upper layer of the skin where it lives and lays its eggs. The most common symptoms of scabies are intense itching and a pimple-like skin rash. The scabies mite usually is spread by direct, prolonged, skin-to-skin contact with a person who has scabies.
Scabies occurs worldwide and affects people of all races and social classes. Scabies can spread rapidly under crowded conditions where close body contact is frequent. Institutions such as nursing homes, extended-care facilities, and prisons are often sites of scabies outbreaks. Child care facilities also are a common site of scabies infestations.
What is crusted (Norwegian) scabies?2
Crusted scabies is a severe form of scabies that can occur in some persons who are immunocompromised (have a weak immune system), elderly, disabled, or debilitated. It is also called Norwegian scabies. Persons with crusted scabies have thick crusts of skin that contain large numbers of scabies mites and eggs. Persons with crusted scabies are very contagious to other persons and can spread the infestation easily both by direct skin-to-skin contact and by contamination of items such as their clothing, bedding, and furniture. Persons with crusted scabies may not show the usual signs and symptoms of scabies such as the characteristic rash or itching (pruritus). Persons with crusted scabies should receive quick and aggressive medical treatment for their infestation to prevent outbreaks of scabies.
How soon after infestation do symptoms of scabies begin?
If a person has never had scabies before, symptoms may take as long as 4-6 weeks to begin. It is important to remember that 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.
In a person who has had scabies before, symptoms usually appear much sooner (1-4 days) after exposure.
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 sites3 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 tunnels 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 challenging to find. They are located 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.
Can scabies be treated?4
Yes. Products used to treat scabies are called scabicides because they kill scabies mites; some also kill eggs. Scabicides to treat human scabies are available only with a doctor’s
prescription; no “over-the-counter” (non-prescription) products have been tested and approved for humans.
Always follow carefully the instructions provided by the doctor and pharmacist, as well as those contained in the box or printed on the label.
When treating adults and older children, scabicide cream or lotion is applied to all areas of the body from the neck down to the feet and toes; when treating infants and young children, the cream or lotion also is applied to the head and neck. The medication should be left on the body for the recommended time before it is washed off. Clean clothes should be worn after treatment.
In addition to the infested person, treatment also is recommended for household members and sexual contacts, particularly those who have had prolonged skin-to-skin contact with the infested person. All persons should be treated at the same time to prevent reinfestation.
Retreatment may be necessary if itching continues more than 2-4 weeks after treatment or if new burrows or rash continue to appear.
Never use a scabicide intended for veterinary or agricultural use to treat humans!
Who should be treated for scabies?
Anyone who is diagnosed with scabies, as well as his or her sexual partners and other contacts who have had prolonged skin-to-skin contact with the infested person, should be treated. Treatment is recommended for members of the same household as the person with scabies, particularly those persons who have had prolonged skin-to-skin contact with the infested person. All persons should be treated at the same time to prevent reinfestation.
Retreatment may be necessary if itching continues more than 2-4 weeks after treatment or if new burrows or rash continue to appear.
How soon after treatment will I feel better?
If itching continues more than 2-4 weeks after initial treatment or if new burrows or rash continue to appear (if initial treatment includes more than one application or dose, then the 2-4 time period begins after the last application or dose), retreatment with scabicide may be necessary; seek the advice of a physician.
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.
As a retail-based pharmacist, Jay Harold filled many scabies treatment prescriptions. A potential occupational hazard of the job. Scabies could cause more than physical discomfort. Your partner will ask you about sexual involvement with someone else.
Enjoyed this post? Share it and read more here. Jay Harold has put together a Resource page that you may find useful when trying to improve your health and wealth. Please take this advice of Muhammad Ali and give back to others. “Service to others is the rent you pay for your room here on earth.”
