Recognize Scabies Rash

Scabies is a common condition worldwide and affects all ages, races, and income levels. It is unrelated to hygiene. Scabies is caused by an infestation of the skin by the human itch mite, which is known scientifically as Sarcoptes scabiei. The human itch mite is an eight-legged creature that can only be seen with the aid of a microscope. The adult female mites burrow into the epidermis (the upper layer of skin), where they live, feed, and lay their eggs. They very rarely burrow past the stratum corneum, which is the most superficial layer of the epidermis. If you think you may have scabies, follow a few simple steps to learn how to recognize scabies and measures you can take to diagnose, treat, and prevent them in the future.

Steps

Noticing the Signs of Scabies

1. Look out for intense itching. There are many signs and symptoms of scabies. The most common and earliest one is intense itching. The itching represents sensitization, a type of allergic reaction, to the adult female mites, their eggs, and their waste.
   • Itching tends to be more severe at night and has the potential to interrupt the sleep of infested individuals.
2. Recognize a rash. Along with the itching, you may develop a rash. The rash also represents an allergic reaction to the mite. The rash is typically described as pimple-like with surrounding inflammation and redness. Mites prefer to burrow into the skin in certain parts of the body.
   • The most common places that adults can have an itchy rash associated with scabies are the hands, especially the webbing between the fingers, the skin folds of the wrist, elbow, or knee, the buttocks, the waist, the penis, the skin around the nipples, the armpits, the shoulder blades, and the breasts.
   • In children, the most common sites of infestation include the scalp, face, neck, palms of the hands, and soles of the feet.
3. Watch out for burrows. When you have scabies, tiny burrows are sometimes visible on the skin. These appears as tiny raised and crooked grayish-white or skin-colored lines on the surface of the skin. They are usually a centimeter or more in length.
   • Burrows may be difficult to find as most people have only 10 to 15 mites in an average infestation.
4. Pay attention to skin sores. The intense itching caused by scabies sometimes leads to sores on the skin. The sores are at high risk for infection, which is often a complication of scabies. The sores are most often infected with bacteria such as Staphylococcus aureus, or beta-hemolytic streptococci, which predominate on the skin.
   • These bacteria can also lead to inflammation of the kidneys and sometimes sepsis, which is a life-threatening bacterial infection of the blood.
   • To avoid this, try to be gentle on your skin and do not scratch it. If you can't help yourself, consider wearing mittens or wrapping your fingertips with band-aids to keep yourself from damaging the skin. Keep your nails trimmed short.
   • Signs of infection include increased redness, swelling, pain, or pus or discharge from the sores. If you believe your rash is infected, call your doctor right away. Your doctor can prescribe an oral or topical antibiotic to treat the infection.
5. Notice skin crusting. There is another form of scabies that has an additional symptom. Crusted scabies, also known as Norwegian scabies, is a severe form of the infestation. It is characterized by tiny blisters and thick skin crusting that can cover large areas of the body. Crusted scabies primarily occurs in individuals with weakened immune systems. The impaired immune response allows mites to reproduce unchecked, with some infestations reaching upwards of two million mites.
   • Another consequence of the impaired immune response is that itching and the rash may be less severe or totally absent.
   • You are at risk for the development of crusted scabies if you are elderly, have a weakened immune system, or are living with HIV/AIDS, lymphoma, or leukemia. You are also at risk if you have received an organ transplant and have any condition that may prevent you from itching or scratching, such as a spinal cord injury, paralysis, loss of sensation, or mental debility.

Diagnosing Scabies

1. Get clinically evaluated. If you suspect you may be infested with scabies, you should quickly consult a physician for a clinical diagnosis. Your physician will diagnose scabies by examining you for the scabies rash and mite burrows.
   • Your physician will likely use a needle to scrape off a very small piece of skin. The doctor will then examine the matter under the microscope to confirm the presence of mites, eggs, or mite fecal matter.
   • It is important to note that an individual can still be infested with scabies even if mites, eggs, or fecal matter cannot be found. An infestation of scabies averages 10 to 15 mites found over the entire body.
2. Get a burrow ink test. Your doctor can use an ink test to identify the burrows of scabies mites. Your doctor will rub ink around an area of skin that is itchy or irritated and then use an alcohol pad to wipe off the ink. If a mite burrow is present in your skin, it will trap some of the ink and the burrow will show up as a dark, wavy line on your skin.
3. Rule out other skin conditions. There are numerous other skin conditions that may be confused with scabies. The main way to distinguish them is through the mite burrows, which are not associated with any of the skin conditions that may be confused with scabies. Ask your doctor to rule out these other conditions so you can be sure you have scabies.
   • Scabies is sometimes confused with other insect bites or stings, or with bed bugs.
   • These skin conditions include impetigo, which is a highly contagious skin infection. The red pimple-like rash of impetigo is most commonly seen on the face around the nose and mouth.
   • It can also be confused with eczema, which is a chronic skin condition involving inflammation of the skin. The red pimple-like rash of eczema represents an allergic reaction. People with eczema can also get scabies, and the condition is more severe for them.
   • You could also have folliculitis, which is an inflammation, and usually infection, in the area associated with a hair follicle. This conditions causes small white-headed pimples to crop up on a reddened base around or near hair follicles.
   • It may be confused with psoriasis as well, which is a chronic inflammatory skin condition characterized by excessive growth of skin cells that leads to the formation of thick, silvery scales and itchy, dry, red patches.

Treating Scabies

1. Use permethrin. Treatment for scabies involves getting rid of the infestation with prescription medications, which are called scabicides because they kill the mites. There are currently no over the counter medications to treat scabies. Your doctor may prescribe you permethrin 5% cream, which is the drug of choice for the treatment of scabies. It kills the scabies mites and eggs. The cream should be applied from the neck down over the entire body and washed off after eight to 14 hours.
   • Repeat the treatment in 7 days (1 week). Side effects may include itching or stinging.
   • You should talk to your doctor or pediatrician about treating infants and young children with scabies. Permethrin cream is safe for infants as young as 1 month old, but most experts recommend also applying it to the head and neck area for infants and young children. Make sure you can do so without getting it into your child's eyes or mouth.
2. Try crotamiton 10% cream or lotion. Crotamiton cream or lotion may also be prescribed to you. To use it, apply it from the neck down over the entire body after a bath. Apply a second dose 24 hours after the initial dose and bathe 48 hours after the second dose. Repeat both doses in seven to 10 days.
   • Crotamiton is considered safe when used as directed. However, frequent treatment failure has been reported with this scabicide, which means it isn't the most effective or widely used anymore.
3. Get a prescription for lindane 1% lotion. This lotion is similar to other scabicides. The lotion should be applied from the neck down over the entire body and washed off after eight to 12 hours in adults and after six hours in children. Repeat the treatment in seven days. Lindane should not be given to children younger than two, women who are pregnant or nursing, or people with weakened immune systems.
   • It is potentially neurotoxic, which means it can cause damage to the brain and other parts of the nervous system. The prescription of lindane should be restricted to individuals who have failed treatment with or cannot tolerate other medications that pose less risk.
4. Use ivermectin. There is one oral medication for scabies. Evidence suggests that this oral medication is safe and effective for the treatment of scabies. However, it is not approved by the U. S. Food and Drug Administration (FDA) for this use. Ivermectin is prescribed in a single oral dose of 200 mcg/kg. It should be taken on an empty stomach with water.
   • Repeat the dose in seven to 10 days. The prescription of ivermectin should be considered in individuals who have failed treatment with or who cannot tolerate FDA-approved topical medications for the treatment of scabies.
   • A potential side effect of ivermectin is an elevated heart rate.
5. Treat skin irritation. Symptoms and skin lesions may take up to three weeks to resolve despite the killing of the scabies mites with scabicides. If they do not resolve in this time frame, retreatment should be considered as there may have been treatment failure or reinfestation. Symptomatic treatment of itching may be accomplished with the cooling of your skin. Soak in a tub of cool water or apply cool compresses to the irritated areas of skin to help with the itching.
   • Sprinkling some oatmeal or baking soda in your bath can have a soothing effect on the skin.
   • You can also try calamine lotion, which is available over the counter and has been shown to effectively relieve the itching of minor skin irritations. Good options include Sarna or Aveeno anti-itch moisturizers. Avoid anything with added fragrances or dyes, as these can irritate the skin.
6. Buy topical steroids or oral antihistamines. Both of these drugs can help with the associated itching of scabies, which is actually due to an allergic reaction to mites, eggs, and waste. Steroids are very powerful inhibitors of itch and inflammation. Examples of topical steroids include betamethasone and triamcinolone.
   • Since it is an allergic reaction, over the counter antihistamines can also be used. These include Benadryl, Claritin, Allegra, and Zyrtec. These can be especially helpful at night to reduce itching so you can sleep. Benadryl also acts as a mild sedative for many people. You can also get prescription antihistamines such as Atarax.
   • Topical hydrocortisone 1% cream can be purchased over-the-counter. It is often effective for itch.

Preventing Scabies

1. Be careful of exposure. The most common way to transmit scabies is by direct skin-to-skin contact with someone who is already infested. The more prolonged this contact is, the greater the chance to get scabies. Less often, scabies may be transmitted via items such as bedding, clothing, and furniture. The human itch mite can survive 48 to 72 hours devoid of human contact. In adults, scabies is often contracted through sexual activity.
   • Crowded conditions are a common cause for scabies outbreaks. Thus, areas such as prisons, barracks, child-care and elder-care facilities, and schools are common sites. Only humans, not animals, can spread scabies.
2. Think about the incubation period. In a person newly exposed to scabies, it can take two to six weeks to develop signs and symptoms of the disease. It is important to note that an infested individual can spread scabies even if he is not exhibiting signs and symptoms of the disease.
   • In a person with previous exposure to scabies, signs and symptoms develop much quicker within a time frame of one to four days.
3. Know if you are at risk. There are certain groups of people who are more likely to pass scabies to one another. These groups include children, mothers of young children, sexually active young adults, and residents of nursing homes, assisted-living residences, and extended-care facilities.
   • The mechanism responsible for the increased risk in the above populations is skin-to-skin contact.
4. Clean and sanitize your home. Measures to control and prevent re-exposure and re-infestation with scabies include simultaneous scabies treatment. This is usually recommended for other family members residing in the household and close contacts, including sex partners.
   • The day scabies treatment is started, all personal clothing, bedding, and towels used within the last 3 days should be washed in hot water and dried on the highest heat setting or be dry-cleaned. If it cannot be washed and dried or dry-cleaned, place it in a closed plastic bag for at least seven days. Scabies mites can only survive for 48 to 72 hours away from human skin.
   • The day scabies treatment is started, vacuum all carpet and furniture in your home. Throw away the bag or empty and thoroughly wash the canister after you've finished vacuuming. If the canister is not removable, wipe it clean with a damp paper towel to remove any scabies mites.
   • Don’t treat your pets. The human itch mite cannot survive on other animals and other animals cannot transmit scabies.
   • Environmental removal of infestation using pesticide sprays or fogs is unnecessary and is discouraged.

Tips

• Children and adults can usually return to normal activities, such as school, day-care, or work, the day after beginning treatment.

Warnings

• Call your doctor if your rash does not improve within 2-3 weeks, gets noticeably worse, comes back after treatment, or seems to be infected (increased redness, swelling, or presence of pus).

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