Scabies

Scabies mite under microscope	Scabies eggs under microscope

Scabies is caused by a mite called Sarcoptes scabeii. It is picked up from others with the condition and can be passed on to others. It is particlularly common in children and in nursing homes. Although it is generally regarded as a disease of overcrowding, it is certainly not restricted to any particular group of individuals or social class.

Common sites of scabies involvement are:

between the fingers
the wrists
armpits
belt line
buttocks
genitalia

scabies-hot-spots-cutaneous-involvement.

Common sites of scabies - Image courtesy University of Washington

Scabies between the fingers is a common site

Scabies on the abdomen

Treatment

Ascabiol (Benzyl benzoate)

Quellada

Eurax

5% Sulphur ointment

Spregal

Ivermectin

Ascabiol

Day 1:

Bath

Dry with rough towel

Apply ascabiol from neck to toe

Wait for 15 minutes for ascabiol to dry

Re-apply ascabiol

Day 2:

No bath

Apply ascabiol from neck to toe

Wait for 15 minutes for ascabiol to dry

Re-apply ascabiol

Day 3: Bath

Do no apply any more ascabiol

Wash all linen, pyjamas, clothing etc in boiling water or washing machine. Hang all items in sunlight.

Iron all items before using. Mattress to be left out in the sun.

All family members and household contacts must be treated at the same time, whether scratching or not.

Below the age of 1 year, ascabiol can be diluted 50% with water and applied in the above manner.

Quellada

One application from neck to toe, after a bath. Repeat after 7 days.

Eurax Cream

One application daily after a bath for 5 days. Ideal for children under 1 year as it is not associated with burning sometimes experienced with Ascabiol or Quellada.

5% Sulphur ointment

One application daily after a bath for 2 weeks. May be applied on the face in kids but avoid the eyes.

Spregal

This spray is applied once after a bath. It can be repeated after one week. It's main advantage is the lack of irritation. One can is usually enough to treat the family.

Ivermectin

This medication has been used successfully for the treatment of resistant scabies. It is given by injection. Special arrangements need to be made with the Medicines Control Council to obtain this medication as it is not commercially available.

Classic scabies S-shaped burrow. Mite seen on left side of burrow. Delta sign seen as red delta shape at extreme left - making up biting mouth parts and front legs. Mite's excreta seen inside burrow.

Classic wake sign seen on right end of burrow ie splaying out of the scaling of the burrow much like the wake of a boat as it glides through water.

Live scabies mite extracted carefully from the left end of the burrow in the photograph above. Biting mouth parts and front legs are seen on the left side of the video.