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Scabies: Causes, Symptoms, Diagnosis, and Treatment

Introduction

Scabies is a highly contagious skin condition caused by the infestation of a microscopic mite known as Sarcoptes scabiei var. hominis. These mites burrow into the upper layer of the skin where they live and lay eggs, leading to intense itching and a characteristic rash. Although it can affect anyone, scabies is more common in crowded living conditions and spreads easily through close physical contact.

Causes and Transmission

Scabies is caused by the human itch mite, which is transmitted mainly through:

• Direct skin-to-skin contact with an infected person.
• Prolonged physical contact such as hugging or sexual activity.
• Sharing personal items like bedding, clothing, or towels (less common).

The mites cannot jump or fly; they crawl slowly, so transmission usually requires close or prolonged contact.

Signs and Symptoms

The symptoms of scabies typically appear 2–6 weeks after infestation in individuals who have never had it before. In previously infected individuals, symptoms may appear within a few days. The main signs include:

• Intense itching, especially at night.
• Rash with tiny red bumps or blisters.
• Burrow tracks: thin, wavy, raised lines on the skin, caused by mites tunneling under the skin.
• Sores from scratching, which can lead to bacterial infections.
• Commonly affected areas: between fingers, wrists, elbows, armpits, waist, buttocks, genitals, breasts, and feet.

In infants and elderly patients, scabies may also affect the scalp, face, palms, and soles.

Types of Scabies

1. Typical Scabies – the common form with itching and rash.
2. Crusted (Norwegian) Scabies – a severe form with thick crusts containing thousands of mites, usually seen in immunocompromised individuals. It is extremely contagious.

Diagnosis

Diagnosis of scabies is based on:

• Physical examination of the rash and burrows.
• Skin scraping test, where mites, eggs, or fecal matter are identified under a microscope.
• Ink test, where ink highlights the burrows in the skin.

Treatment

Scabies can be effectively treated with prescription medications called scabicides, which kill the mites and their eggs. Treatment options include:

• Topical Permethrin 5% cream – applied over the entire body from neck down and left overnight.
• Oral Ivermectin – often used in severe or crusted scabies, or when topical treatment fails.
• Other options: Benzyl benzoate lotion, sulfur ointments, or crotamiton cream.

Additional Measures

• Treat all household members and close contacts at the same time to prevent reinfestation.
• Wash clothing, bedding, and towels in hot water and dry on high heat.
• Items that cannot be washed should be sealed in a plastic bag for at least 72 hours.
• Itching may persist for a few weeks after treatment, even if the mites are killed, due to allergic reactions.

Complications

If untreated, scabies can lead to complications such as:

• Secondary bacterial infections (impetigo, cellulitis).
• Crusted scabies, especially in immunocompromised individuals.
• Severe itching, causing sleep disturbances and decreased quality of life.

Prevention

• Avoid direct contact with infected individuals.
• Maintain good personal hygiene.
• Do not share personal items such as clothes, towels, or bedding.
• In institutions like nursing homes or schools, early detection and treatment are crucial to prevent outbreaks.

Conclusion

Scabies is a common but treatable skin condition caused by tiny mites. While it is not life-threatening, it causes significant discomfort and spreads easily if left untreated. Prompt diagnosis, effective treatment, and proper hygiene measures can completely eliminate the infestation and prevent recurrences.

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