Scabies (Sarcoptic Scapbiei), commonly nicknamed "The Itch"

Scabies: Introduction

Scabies are mites, known to infect humans, with characteristic burrows or "molting pouches" under the epidermal layer of the skin, where the female will lay its' eggs. Symptoms of scabies are most prominently found in the creases and folds of the skin, between fingers and toes, under layers of fatty tissues, the genital area and genital organs, and the buttocks. Scabies are sometimes found in the hair and should not be mistaken for other insects or arachnids.

Who is at risk for scabies?

Scabies affect the young and old, but tends to linger generally with the most vulnerable human populations and society segments that are least able to care for themselves.

How are people infected by scabies?

Scabies is acquired through close, skin-to-skin, prolonged human contact. It may or may not have been spread through sexual contact. Not everyone is symptomatic. These mites are microscopic and resulting rashes are not always present. Even symptomatic individuals may not show signs of infection for 2-6 weeks, furthering the likelihood that they may transfer the infestation to others.

Where do scabies epidemic infestations occur?

Institutions such as nursing homes, prisons and child care centers are examples of group living facilities where scabies often infestations proliferate. Recently, a case of scabies was reported by a number of passengers on a cruise line. This is very possible, just as it is possible wherever sleeping and eating quarters are shared frequently.

Can my pet transfer scabies?

There are variations of scabies mites specific to different animal hosts. You may have heard of "mange," an itch mite that commonly infests dogs and cats. Scabies mites specific to dogs, cats or other animals may temporarily attack humans but are not known to complete the life cycle with successful reproduction on a human host. Likewise, it does not appear that the scabies mite specific to humans can reproduce using wild or domestic animals as hosts.

Crusted scabies (Norwegian Scabies)

While we have just stated that scabies is commonly spread through prolonged skin contact, it would be a mistake to think that this is the only way it is spread. This form of scabies is marked by very large mite infestations on the human host, numbering in the millions. At this volume, the mites are very easily spread from one person to the next with simple human activity and movement throughout a home or facility. Simply brushing against a bed or chair is enough to brush off thousands of mites that then look for a new host. Pets are sometimes being housed at group living facilities as an accepted part of the emotional welfare of the residents, such as senior citizens. Should just one resident become infested with crusted scabies, it is possible that a resident pet (as well as linens as other objects) may inadvertently transfer scabies to other residents.

Diagnosis of Scabies

Commonly, identification of scabies is made by a physician after simple observation of the characteristic burrowing and rashes present. It is beneficial, with the use of a microscope, to accurately identify the mite. The physician will look for mites, mite eggs and mite fecal matter (scybala). With non-crusted scabies, there is the possibility that the physician may not find a very small mite population in an asymptomatic human. Crusted scabies identification often starts with observation of thick crusted rashes, but be aware that irritated rashes may not be present in people who are physically incapable of attending to their bodies.

Scabies Life Cycle Chart (from the Center for Disease Control)

Seven head to toe scabies images (including "sensitive" photography)

Medical complications from scabies

Due to the severe itching and rashes present, bacteria harmlessly present on the surface of the skin, can penetrate through the rash to cause a bacterial staph infection. This can progress to complications, such as impetigo and involving inflammation of the kidneys from a condition known as post-streptococcal glomerulonephritis.

Sex and scabies mites

The male scabies mite will impregnate the female mite just once, but in doing so, the female will be fertile for the remainder of her 1-2 month adult existence.

Treatment Guidelines for Scabies

Anyone and everyone who has been in close contact or living in the same environment as the symptomatic person should be tested and treated simultaneously for scabies, even if mites are not found on the family member or closely connected person.

Your physician will prescribe a scabicide to kill the scabies. Scabicides are only available through prescription. Do ask how well the scabicide is known to kill scabies mite eggs. Lotions and creams specific to scabies should be applied as well. Be sure not to leave any parts of the body untreated. Do not neglect to treat the scalp.

In addition to full body treatment and scabicides, it is imperative to use a hot dry cleaning method for all clothing and linens. New products are now on the market that will can be used to securely encase and/or transfer infested clothing and linens. It has been recommended to vacuum heavily, but the question should be asked if it is possible for mites to escape from a vacuum, even it only a relatively small percentage of them. This has always been a known fact of vacuum flea treatments, which are accompanied by the strong recommendation to change out and remove from the home the vacuum bag containing the mites.

Products labeled for scabies include:

• Eliminate, a %5 permethrin cream
• Eurax and Crotan, 10% permethrin creams
• Lindane 1% cream, while approved for the treatment of scabies, is NOT approved as a first-line treatment and is specifically NOT approved for children. Several additional restrictions occur. Lindane is cause severe toxicity. It's use is clearly restricted.
• Ivermectin is an oral medication approved for use with parasites, but NOT specifically for mites. It is not for first-line treatment and may only be prescribed by a physician after alternative methods have been exhausted. It has been known to be effective against crusted scabies.

Antihistimines will not solve scabies, but can provide some itch relief, and in so doing help to safeguard from further skin irritations and potential bacterial infections.

Rashes may still remain for a period of weeks after treatment. Be alert for new sores and always follow up with your doctor.

What is the role of the pest control professional in scabies prevention and treatment?

Although scabies is commonly seen as solely the province of a physician, that is far from the case. Pest control professionals are often in contact with people who are infested with scabies. Although they are not professionally qualified to treat the infested person, an astute pest control professional will find a significant role, not only in referring a scabies victim for treatment, but in coordinating treatment of rooms, homes, group living facilities and institutions. Modern non-chemical approaches to the elimination of mites in the environment reduce the need for pesticides, nevertheless there is certainly a role for the pest control professional in assisting the scabies sufferer in what is known as IPM or an integrated pest management approach to scabies, assisting with bed encasements, cleaning or sanitizing and coordinating efforts so that the entire environment is brought back to a healthy state of affairs. Encasements that seal in mites are becoming a common tool of the pest control professional. Bedlam is a new product on the market labeled for a family of pests similar to scabies mites, (ticks, lice and dust mites), but not specifically labeled for scabies mites.

Reviewing some of the scabies case studies in these posts from medicineNet, it appears that an integrated pest management approach might have been helpful where a medical professional alone was not recommending or guiding changes in the environment where the infestation festered.