Itchy Rash... Could It Be Scabies?
Scabies are tiny insects (mites) that burrow into the skin, feeding off skin cells. Although any area of the skin can be affected, the mites prefer the thicker areas and rarely venture above the neck.
Anyone can get scabies, but having worked quite a bit in the slums of India, I have seen my fair share. In fact, in some areas, it was more common to have it, than to not! But then, I have also seen scabies here in the U.S. in affluent patients. Basically, if you have skin, you can get scabies.
But among the different itchy skin rashes out there, scabies is not the most commonly seen in the U.S and is probably the most emotionally charged. Just the thought of mites burrowing in and eating off the skin makes many peoples' skin crawl. Believe me, I see it on faces when I bring up the possibility of scabies.
This blog will offer characteristics of the typical scabies rash and pearls/pitfalls in treatment.
How Do You Get Scabies? Skin to skin contact can cause the mites to infect. An intermediate host can also help facilitate transmission such as a couch cushion, sheets or clothing.
What Are The Symptoms? The rash of scabies is intensely itchy. It often starts in one area and spreads from there as the mites reproduce. Thick skinned areas are favored, classically the webs of skin between the fingers. On close inspection, the burrows or tunnels can be seen in the linear welts of the rash. Further support for scabies exists when other close contacts (sharing the same household) have a similar rash. While most doctors go on these mentioned factors, the hands-down confirmation comes with scraping the skin and looking for mites under the microscope.
How is Scabies Treated?
Treating scabies is definitely a challenge because every mite needs to be killed in the household.
Elimite (permethrin) is the treatment of choice as a scabicide (scabies killer). It comes in a lotion that is applied from the neck down and washed off eight hours later. A "just to make sure" dose is given one week later.
I typically treat all household members, regardless of symptoms, at the same time also as a another "just to make sure" measure. All clothing and sheets should be laundered in hot water in conjunction with treatment. Treat cloth couch cushions with upholstery cleaner.
After these efforts all you can really do is hold your breath and wait, hoping that new skin eruptions do not develop. I caution patients that the rash does not disappear quickly after treatment. The reason for this is that the rash occurs due to our body's immune reaction against the mites and their fecal matter. Dead mites can still cause a rash and it takes at least a week for these to clear.
Scabies can affect anyone with skin. Some characteristic findings can help distinguish scabies from other itchy rashes. Success in treatment involves a meticulous eradication toward killing every mite in the home.
Live...and live well!