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What are Scabies

What are Scabies

Scabies is an itchy skin condition in children, teens, and adults that comes from a tiny “mite.” The mite is a parasite that lives in the tough outer layers of human skin. The adult mites burrow through the skin, eating skin cells. They lay their eggs in the skin. When the eggs hatch, the new mites make their living the same way. As they grow, they shed their outer shell, like crabs and other hard-shelled creatures. The mites themselves, their eggs, and bits of their shells all cause irritation and inflammation in the skin. This inflammation causes the itching and redness of scabies.

Scabies appears differently depending on the person’s age. Teens and adults tend to have scabies sores between their fingers and toes and in the skin folds near their armpits. These sores usually look like small red spots or bumps. The bumps often have shiny surfaces, and they may appear to be lined up with each other. Sometimes you can see tiny, short red lines in the area. These are the mites’ burrows or tunnels in the skin. Teens and adults with scabies complain of severe itching in the area. Their skin may crack, peel, and even bleed, especially if they apply alcohol or use harsh soaps in attempts to get rid of the rash.

Infants, toddlers, and younger children may have scabies that looks entirely different. Younger children have thinner skin, and the mites can live in many different places on their bodies. The sores in young children with scabies often look like small, single red bumps, often in clusters. They may develop tiny blisters over the surface. These sores can appear on the face, scalp, palms, soles, and trunk. Because young children often can’t control their scratching, their sores often become infected. This can make the diagnosis difficult, because it changes the appearance of the sores. Infected sores also need additional treatment.

What is the biggest concern?

For most people with scabies, the biggest concern is the intense itching. The itching can make younger children miserable, and disturb their sleep and play habits. If a person scratches continuously at the sores, they can become infected with bacteria. This can cause a condition called “impetigo.” You can also read our Aftercare Instructions on Impetigo. Children witheczema (dry skin) can often have more severe reactions to scabies. If your child has eczema, you might want to read our Aftercare Instructions on Eczema as well. Children with some kinds of immune problems can develop a more serious form of scabies, called “crusted scabies.” In this condition hundreds of mites infest the child’s skin and serious infections with complications like kidney damage can occur.

Scabies treatment

Your child needs treatment to control the itching and to eliminate the mites that cause scabies. You can give your child diphenhydramine (dye-fen-hi-drah-meen; Benadryl® and many others) for itching. The main side effect of diphenhydramine is drowsiness, which is actually often helpful to a child whose itching is making him or her frantic. Diphenhydramine in topical lotions does not help itching more than the lotion itself.

Permethrin 5% cream (Elimite®, Acticin®) is what most doctors recommend for killing the mites that cause scabies. Please note: this medicine also comes as a 1% lotion for treating lice. The 1% lotion will not work for scabies. Please be sure you buy only the 5% cream to treat scabies. The medicine works by killing the mites and their eggs. Because the mites, eggs, and body parts remain under the skin after treatment, the itching will not go away immediately. In fact, many patients continue to itch for up to 4 weeks. Please do not repeat a treatment unless you have talked with your doctor about it first.

Your doctor may recommend treating everyone in the house, or at least the other young children. Please be sure that you set things up so that you can treat everyone at once and clean the home on the same day, to be sure you break the cycle of infestation. It may be best to wait a couple of days until you can coordinate everyone’s schedules and get all the help you need. The few extra days of itching will be worth it if you can avoid having to start all over again in a few weeks!

To use the permethrin 5% cream to treat scabies, please follow these instructions, and any others that your doctor gives you:

  • Give your child (have your older child or teen take) a thorough bath with a gentle soap, and dry him or her off
  • Thoroughly massage the cream into the skin from the top of the head to the soles of the feet. Pay special attention to areas where you see the sores. In teens this will be between fingers and toes, and in the armpits and groin. Younger children may have the sores everywhere.
  • Please leave the cream on the skin for 8 – 14 hours (for example, overnight).
  • While the cream is doing its work, please wash all the clothes, toys, and other items as we indicate below. This way your child will come into a clean environment when the treatment is finished.
  • At the end of 8 – 14 hours, please wash the cream off with another warm soapy shower or bath.
  • Because the scabies mites and their eggs can live for some time when they are not on a person, it is important to clean the environment as well as treat the person. The best time to do this is during the 8 – 14 hours that you are leaving the cream on your child or family. Here are the steps to take to be sure you get rid of all the mites and their eggs:
  • Machine wash all washable clothing that hasn’t been in closed storage areas. Please use the hottest possible water and the hot cycle of the dryer for at least 20 minutes.
  • Please wash all toys (especially stuffed animals, etc, that your child keeps in or on the bed). Please use the hottest water possible and lots of soap. Wash them for at least 10 minutes.
  • For clothes and toys that are not washable or might be damaged, please seal in airtight plastic bags for at least 2 weeks. This will starve and suffocate the mites.
  • Shampoo any wigs, hairpieces and other hair accessories.
  • Wash combs, brushes, rollers, and other hair care equipment in the hottest possible water for at least ten minutes
  • Vacuum the whole house or apartment. Please pay special attention to rugs, carpets, and stuffed furniture.

To help prevent your child from getting infected sores, you can cut the nails as short as safely possible. This means cutting them only as short as the end of the fingers, so they don’t become ingrown. Also, please be sure to wash the child’s hands several times during the day.

In especially severe cases or under special circumstances, doctors may prescribe an oral medication called ivermectin (Stromectol®). This drug works to kill worms and other internal parasites, and some scientist feel it is promising for treating scabies and other skin parasites as well. Testing in children larger than 33 pounds (15 kilograms) shows that the drug is safe. There will be more information on this drug for use in treating lice and scabies over the next few years.

Dangerous Scabies Symptoms

Scabies is both annoying and potentially dangerous if it causes an infection. Younger children are most prone to developing infections because they get the mites all over their bodies and they may scratch uncontrollably. Younger children also tend to put their hands in their mouths and to have dirt on their hands and nails. Good attention to hygiene and washing can help prevent infections, but they sometime happen anyway. Here are some things to look out for:

  • Redness that spreads away from the scabies sores
  • Pain or tenderness in the skin near the sores
  • Blistering or peeling of the skin
  • Swelling in the groin or armpits
  • Large areas of crusted, oozing, or swollen sores
  • Fever
  • Vomiting or diarrhea

If any of these occur, please be sure to call your doctor’s office right away.

 Other points of concern

People with scabies are not only miserable, but they can feel unclean or unwelcome. Scabies is a condition that spreads rapidly in crowded households and those with many small children, but it is not a disease of “dirty” people. If you or your children have scabies, you are among the thousands of people who get the disease every year. Please try not to add you your burdens by blaming yourself or feeling guilty.

In households where many people, both children and adults, have scabies, tensions can rise and tempers can flare. If you have a friend or relative who can watch your children for a few hours while you take a break, that can make a big difference for all of you. Please remember that the scabies mites are dead as soon as the treatment has finished. Your friends and family don’t have to worry about catching scabies from a treated child or adult.

Also, please remember that the itching from scabies can last for weeks after treatment. This doesn’t mean the treatment has failed, or that there are still live scabies mites. You may want to use diphenhydramine or other anti-itch medicines, especially at bed-time.

Other Conditions that Might Be Present with Scabies

Scabies can look like a number of other diseases, or can be present at the same time as other diseases. Eczema can produce intense itching, though it is less common in the finger/toe spaces and armpits. Younger children with eczema can look as if they have scabies. In younger children, other bug bites like flea or mosquito bites can look a bit like scabies (read Aftercare Instructions on Bites and Stings). Children with viral infections such as herpes simplex can sometimes get sores on their hands and feet if they spread the virus from their mouths. Some people confuse lice and scabies – you can see lice and their eggs on hairs, but scabies mites are too small to see.

Please remember that sexual contact is a common way to spread scabies among teenagers. If your teen has scabies in the groin or genital area, please remind him or her that s/he should be sure to get testing for sexually transmitted infections (STIs). This is also sometimes a good opportunity to talk about choices regarding sexual activity in general.