scabies


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Scabies

 

Definition

Scabies is a relatively contagious infection caused by a tiny mite(Sarcoptes scabiei).

Description

Scabies is caused by a tiny insect about 0.3 mm long called a mite. When a human comes in contact with the female mite, the mite burrows under the skin, laying eggs along the line of its burrow. These eggs hatch, and the resulting offspring rise to the surface of the skin, mate, and repeat the cycle either within the skin of the original host, or within the skin of its next victim.
The intense itching almost always caused by scabies is due to a reaction within the skin to the feces of the mite. The first time someone is infected with scabies, he or she may not notice any itching for a number of weeks (four to six weeks). With subsequent infections, the itchiness will begin within hours of picking up the first mite.

Causes and symptoms

Scabies is most common among people who live in overcrowded conditions, and whose ability to practice good hygiene is limited. Scabies can be passed between people by close skin contact. Although the mites can only live away from human skin for about three days, sharing clothing or bedclothes can pass scabies among family members or close contacts. In May 2002, the Centers for Disease Control (CDC) included scabies in its updated guidelines for the treatment of sexually transmitted diseases.
The itching, or pruritus, from scabies is worse after a hot shower and at night. Burrows are seen as winding, slightly raised gray lines along the skin. The female mite may be seen at one end of the burrow, as a tiny pearl-like bump underneath the skin. Because of the intense itching, burrows may be obscured by scratch marks left by the patient. The most common locations for burrows include the sides of the fingers, between the fingers, the top of the wrists, around the elbows and armpits, around the nipples of the breasts in women, in the genitalia of men, around the waist (beltline), and on the lower part of the buttocks. Babies may have burrows on the soles of their feet, palms of their hands, and faces.
Scratching seems to serve some purpose in scabies, as the mites are apparently often inadvertently removed. Most infestations with scabies are caused by no more than 15 mites altogether.
Infestation with huge numbers of mites (on the order of thousands to millions) occurs when an individual does not scratch, or when an individual has a weakened immune system. These patients include those who live in institutions; are mentally retarded, or physically infirm; have other diseases which affect the amount of sensation they have in their skin (leprosy or syringomyelia); have leukemia or diabetes; are taking medications which lower their immune response (cancerchemotherapy, drugs given after organ transplantation); or have other diseases which lower their immune response (such as acquired immunodeficiency syndrome or AIDS). This form of scabies, with its major infestation, is referred to as crusted scabies or Norwegian scabies. Infected patients have thickened, crusty areas all over their bodies, including over the scalp. Their skin is scaly. Their fingernails may be thickened and horny.

Diagnosis

Diagnosis can be made simply by observing the characteristic burrows of the mites causing scabies. A sterilized needle can be used to explore the pearly bump at the end of a burrow, remove its contents, and place it on a slide to be examined. The mite itself may then be identified under a microscope.
Occasionally, a type of mite carried on dogs (Sarcoptes scabiei var. canis) may infect humans. These mites cannot survive for very long on humans, and so the infection is very light.

Treatment

Several types of lotions (usually containing 5% permethrin) can be applied to the body, and left on for 12-24 hours. One topical application is usually sufficient, although the scabicide may be reapplied after a week if mites remain. Preparations containing lindane are no longer recommended for treating scabies as of 2003 because of the potential for damage to the nervous system. Itching can be lessened by the use of calamine lotion or antihistamine medications.
In addition to topical medications, the doctor may prescribe oral ivermectin. Ivermectin is a drug that was originally developed for veterinary practice as a broad-spectrum antiparasite agent. Studies done in humans, however, have found that ivermectin is as safe and effective as topical medications for treating scabies. A study published in 2003 reported that ivermectin is safe for people in high-risk categories, including those with compromised immune systems.

Prognosis

The prognosis for complete recovery from scabies infestation is excellent. In patients with weak immune systems, the biggest danger is that the areas of skin involved with scabies will become secondarily infected with bacteria.

Prevention

Good hygiene is essential in the prevention of scabies. When a member of a household is diagnosed with scabies, all that person's recently-worn clothing and bedding should be washed in very hot water.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Scabies (The Itch)." Section 10, Chapter 114 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Periodicals

Burroughs, R. F., and D. M. Elston. "What's Eating You? Canine Scabies." Cutis 72 (August 2003): 107-109.
Scabies is a contagious skin infection common among people who live in overcrowded, less than ideal hygienic environments. It is caused by the infestation of female scab mites that, upon contact, burrows under the victim's skin and lays eggs along the lines of passage. Once the eggs hatch, the new mites rise to the skin's surface, mate, and repeats the infestation. Scabies can occur anywhere on the body, including the armpit, groin, buttocks, genital area, and ankles, as shown in the illustration above.
Scabies is a contagious skin infection common among people who live in overcrowded, less than ideal hygienic environments. It is caused by the infestation of female scab mites that, upon contact, burrows under the victim's skin and lays eggs along the lines of passage. Once the eggs hatch, the new mites rise to the skin's surface, mate, and repeats the infestation. Scabies can occur anywhere on the body, including the armpit, groin, buttocks, genital area, and ankles, as shown in the illustration above.
(Illustration by Electronic Illustrators Group.)
Burstein, G. R., and K. A. Workowski. "Sexually Transmitted Diseases Treatment Guidelines." Current Opinion in Pediatrics 15 (August 2003): 391-397.
Fawcett, R. S. "Ivermectin Use in Scabies." American Family Physician 68 (September 15, 2003): 1089-1092.
Santoro, A. F., M. A. Rezac, and J. B. Lee. "Current Trend in Ivermectin Usage for Scabies." Journal of Drugs in Dermatology 2 (August 2003): 397-401.

Organizations

American Academy of Dermatology (AAD). 930 East Woodfield Road, Schaumburg, IL 60173. (847) 330-0230. http://www.aad.org.

Key terms

Mite — An insect parasite belonging to the order Acarina. The organism that causes scabies is a mite.
Pruritus — An unpleasant itching sensation. Scabies is characterized by intense pruritus.
Topical — A type of medication applied to the skin or body surface.

scabies

 [ska´bēz, ska´be-ēz]
a contagious skin disease caused by the itch mite, Sarcoptes scabiei. Scabies, sometimes popularly called “seven-year itch,” is most likely to erupt in folds of the skin, such as in the groin, beneath the breasts, or between the toes or fingers. It is classified as a sexually transmitted disease.



The adult itch mite has a rounded body about one-fiftieth of an inch long. The skin lesions are caused by the female, which burrows beneath the skin and digs a short tunnel parallel to the surface, in which it lays its eggs. The eggs hatch in a few days, after which the baby mites find their way to the skin surface, where they mate and complete the life cycle.
Symptoms. During the initial tunnel digging and egg laying, the human host may be oblivious to what is happening. There is little itching and there are few lesions. In about a month, the itching becomes intense because of hypersensitivity to the mite. The itch is often worse at night. The tunnels in the skin can now be discerned as slightly elevated grayish white lines. The mite itself can often be seen—with the aid of a magnifying glass—as a tiny black speck at the end of the tunnel. Blisters and pustules also may develop in the skin near the tunnel.
Transmission. Scabies is usually transmitted from person to person by direct skin contact. Transmission via clothing and other inanimate objects is uncommon. Epidemics are fairly common in such places as camps, barracks, and institutions. It is unusual for one member of a family not to communicate it to the others. The Centers for Disease Control and Prevention recommend the wearing of gowns and gloves for close contact with an infested person. Masks are not necessary. All contacts that the patient has had should be treated at the same time.
Treatment andPrevention. Scabies treatment consists of topical permethrin cream (Elimite), lindane, or crotamiton (Eurax), applied from the neck down and then washed off. For infants, 5 to 6 per cent precipitated sulfur in petrolatum, applied twice daily for a week, is usually adequate.
Norwegian scabies a rare, severe form of scabies associated with a heavy infestation of Sarcoptes scabiei, seen especially in the senile and mentally retarded, in patients with poor sensation or severe systemic disease, and in immunocompromised patients; it apparently represents an abnormal host immune response to the etiologic agent. Characteristics include a marked crusting dermatitis of the hands and feet with subungual horny debris, erythematous scaling plaques on the neck, scalp, and trunk that may become generalized, and usually lymphadenopathy and eosinophilia.

sca·bies

(skā'bēz), Scabies, a singular noun, is the name of a skin disorder, not of the mite that causes the disorder. Although the word is correctly pronounced skā'bē-ēz, the latter two syllables are usually fused in the U.S.
1. An eruption due to the mite Sarcoptes scabiei var. hominis; the female of the species burrows into the skin, producing a vesicular eruption with intense pruritus between the fingers, on the male or female genitalia, buttocks, and elsewhere on the trunk and extremities.
2. In animals, scabies or scab is usually applied to cutaneous acariasis in sheep, which may be caused by Sarcoptes, Psoroptes, or Chorioptes.
[L. scabo, to scratch]

scabies

/sca·bies/ (ska´bēz) a contagious skin disease due to the itch mite, Sarcoptes scabiei; the female bores into the stratum corneum, forming burrows (cuniculi), attended by intense itching and eczema caused by scratching.scabiet´ic
Norwegian scabies  a rare, severe form associated with an immense number of mites, with marked scales and crusts, usually accompanied by lymphadenopathy and eosinophilia.

scabies

(skā′bēz)
n. pl. scabies
1. A contagious skin disease caused by a parasitic mite (Sarcoptes scabiei) and characterized by intense itching.
2. A similar disease in animals, especially sheep.

scabies

[skā′bēz]
Etymology: L, scabere, to scratch
a contagious disease caused by Sarcoptes scabiei, the human itch mite, characterized by intense itching of the skin and excoriation from scratching. The mite, transmitted by close contact with infected humans or domestic animals, burrows into outer layers of the skin, where the female lays eggs. Two to 4 months after the first infection, sensitization to the mites and their products begins, resulting in a pruritic papular rash most common on the webs of fingers, flexor surfaces of wrists, and thighs. Secondary bacterial infection may occur. Diagnosis may be made by microscopic identification of adult mites, larvae, or eggs in scrapings of the burrows. All contacts are treated simultaneously with topical application of permethrin, crotamiton, or another scabicide. Oral antihistamines and salicylates reduce itching. It is also recommended that clothes and bedding be washed in hot water and dried in a hot dryer. A more severe form of scabies is observed in immunocompromised patients and is characterized by vesicles and thick crusts over the skin. This form is known as Norwegian scabies and is treated with Ivermectin.
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Scabies
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Scabies rash in an infant

scabies

Mite infestation Dermatology A severe form of infestation with the itch mite, Sarcoptes scabiei var hominis, which most commonly affects children, and spreads by direct physical contact with infected individuals–ergo it is often familial or institutional; it is characterized by intense itching that develops ± 1 month after the first exposure to the mite, which infers that the manifestations are due to hypersensitivity Clinical Intensely pruritic linear eruption corresponding to the tracks of the burrowing beasts; the pruritus results in excoriation and secondary pyoderma, often in the head & neck with sparing of the palmoplantar regions; while the papules and 'tracks' of the burrowing mite are most prominent on the hands and arms, the 'scabies rash' is found on the armpits, waist, buttocks, inner thigh, and ankles, sites that where S Scabiei is rarely found Diagnosis Established by dissecting organisms or eggs from mite tunnels, placing them in 20% KOH or mineral oil and examination by the LM Treatment Lindane lotion, benzene hexachloride. See Crusted scabies.

sca·bies

(skā'bēz)
A dermal eruption caused by the mite Sarcoptes scabiei var. hominis; the female of the species burrows into the skin, producing a vesicular eruption with intense pruritus between the fingers, on the male or female genitalia, on the buttocks, and elsewhere on the trunk and extremities.
[L. scabo, to scratch]

scabies

(skā′bēz) [L. scabies, itch]
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SCABIES
A contagious infestation of the skin with the itch mite, Sarcoptes scabiei. It typically presents as an intensely pruritic rash, composed of scaly papules, insect burrows, and secondarily infected lesions distributed in the webs between the fingers and on the waistline, trunk (esp. the axillae), penis, and arms. It readily spreads in households, among playmates, and between sexual partners—that is, among people having close physical contact. illustration; scabietic (-ĕt′ĭk), adjective

Symptoms

An itchy rash that worsens at night and that involves multiple members of the same household is a common presentation.

Diagnosis

Because the disease is often missed and occasionally overdiagnosed, scrapings from suspect lesions are examined microscopically to confirm the presence of the mite, its eggs, or its excretions.

Patient care

For children 2 months and older and nonpregnant adults, permethrin 5% cream is applied to the entire body surface. The eyes and mouth are avoided when the cream is being applied. The cream is thoroughly washed off after about 8 to 14 hr. Retreatment is sometimes required if the itch persists for more than a few weeks. Alternatively, nonpregnant patients may be treated with ivermectin given orally. Pregnant women and infants under 2 months of age should be treated with 6% precipitated sulfur in petrolatum daily for 3 days. Infection control in the home includes the washing of all linens, towels, and clothing with hot water and drying them thoroughly.

illustration

scabies

Skin infestation with the mite parasite Sarcoptes scabei which burrows into the superficial layers, usually of the hands or wrists, to feed on dead epidermal scales and lay eggs. Scabies is acquired by direct close contact, sometimes from domestic animals with mange. There is intense itching and damage is often caused by scratching and secondary infection. Treatment with insecticide lotions such as benzyl benzoate, is effective, but all members of the family should be treated if the parasite is to be eliminated.

scabies

highly contagious, very pruritic, vesicular skin reaction caused by host acute inflammatory response to female scabies mite faeces within the epidermis; typical skin sites affected include finger webbing, volar aspect of wrist; patient and all contacts should be treated with topical scabicides (e.g. permethrin (Lyclear) or 25% benzyl benzoate BP preparations) and antipruritic preparations (e.g. 10% crotamiton cream [Eurax])

scabies (skāˑ·bēz),

n an infectious condition caused by the human itch mite
Sarcoptes scabiei and distinguished by persistent itching that creates a raw, irritated lesion. A papular, pruritic rash may develop on the thighs, flexor region of the wrist, or the webs between the fingers approximately 2 days to 4 months after the first infection. A secondary bacterial infection is a potential complication.
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Scabies.

sca·bies

(skā'bēz)
A dermal eruption producing a vesicular eruption with intense pruritus between the fingers, on the male or female genitalia, on the buttocks, and elsewhere.
[L. scabo, to scratch]

scabies (skā´bēz),

n a contagious disease caused by
Sarcoptes scabiei, the itch mite, characterized by intense itching of the skin.
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Scabies.

scabies

infestation by mites of the genus Sarcoptes. See also sarcoptic mange.

feline scabies
see notoedrescati.
scabies incognito
a variant of sarcoptic mange in dogs in which mites are difficult or impossible to recover in skin scrapings, presumably because of the extensive grooming and generally high level of skin hygiene that lacks only the use of a scabicide. Also there are usually only a few mites present once an immunity develops. Further infection may cause a hypersensitivity but the mites present will still be in small numbers.
Norwegian scabies
a variety characterized by immense numbers of mites and marked scaling of the skin. Seen in immunocompromised patients.

Patient discussion about scabies

Q. Can scabies be on the face? About a week ago, several bumps, red and itchy, appeared on my face. I have had scabies on other parts of my body and although it feels quite similar, it doesn’t really look the same. Can it be scabies? Is it other thing?

A. If you indeed have scabies on your face, it may come from two sources: either from your scalp, where it hides when you treat the rest of your body, or your pillow. First you should be sure it's scabies (have you seen a doctor?) If it's scabies, try to wash all your pillows and change them, and then treat your face.

More discussions about scabies
References in periodicals archive ?
Norwegian scabies - also known as crusted scabies - is a rare form of scabies and spread by skin to skin contact.
Prevalence of scabies diagnosed in sheep and goats during Hajj season in Makkah.
The use of videodermatoscopy to monitor treatment of scabies and pediculosis.
A spokesman for the independent healthcare provider Four Seasons Health Care, which runs the home, said: "FSHC followed policy and procedure for dealing with scabies, and notified CQC, Public Health England, Clinical support nurse for Infection, Prevention and Control for Warwickshire and Coventry, who advised the home accordingly.
Scabies isn't serious but it's very contagious and can run through a family if not treated promptly.
In light of the assessment's findings, Nab, in cooperation with the Johanniter aid agency, with support from the Lebanese Foreign Affairs Ministry, is contributing to controlling the spread of head lice and scabies among 840 Palestinians from Syria and hosting families from seven Palestinian camps.
The soldiers are suffering from intense itching skin, which means they have scabies, he said.
8220;We will now be able to imply our superior foam platforms and technologies into a patent protected product for treating head lice and scabies.
You can get scabies by direct contact with someone who has these mites or by contact with contaminated clothes or bedding.
The skin condition, caused by the scabies mite, has struck down children in Holyhead and Llangefni.
One of the most heartbreaking patients I saw was a nine month old baby who was so severely infected with scabies that open pustules had developed over most of his body.
Our research is applying this theory to the human scabies mite," said Pasay.