Children in daycare, boarding school pupils more prone to scabies — Expert
Dr Sebastine Oiwoh is a Senior Registrar, Dermatology and Venereology, Ladoke Akintola University of Technology Teaching Hospital, Ogbomoso, Oyo State. He tells TOBI AWORINDE about how to detect scabies and those who are most at risk of exposure to the infestation
What is scabies?
Scabies is a parasitic infestation caused by Sarcoptes scabiei var. hominis. It is a distressing disorder that has been opined by some workers to be underreported. It is common in resource-poor settings, hot tropical climate and areas of high population density. It is one of the neglected tropical diseases, according to the World Health Organisation, and there has been renewed efforts at prompt recognition, diagnosis and treatment. It affects an estimated 200 million people globally. This is about six times more than the number of people affected by HIV and a little above that of Hepatitis C virus infection but less than those affected by Hepatitis B virus infection.
What are the symptoms of scabies?
Itching is the commonest symptom. It can be troubling and discomforting. This itching in adults presents as an itchy raised rash in between the fingers, web spaces of the fingers, wrists, elbows, armpits, nipples of women, around the umbilical (region), the buttocks, genitals (crown and shaft of the penis as well as scrotum in men). Children can also present with an itchy raised rash on the face, palms and soles.
Some people may not present with any itching at all, save for a raised rash in the aforementioned areas, while others may present with a very intense crusted rash on the body of people with compromised immunity; those who have disorders where they can’t even sense the itching (neuropathies) or difficulties scratching.
There may also be secondary bacterial infection with crusting (dried serum), pus containing a rash with possible attendant involvement of the kidneys and the heart. Because of its similar presentation to some other itchy skin disorders, some patients having wrongly used steroids present with an attendant altered presentation called scabies incognito.
Atypical presentation in what has been called scabies surrepticius, where scabies presents as a mimic of other skin disorders (especially pityriasis rosea) had been reported. Atypical presentation of scabies makes diagnosis pretty challenging for the untrained eye, hence the possibility of outbreaks. Impaired quality of life with depression and suicidal ideations with scabies have also been reported.
Is scabies contagious?
Scabies can be contracted by prolonged contact (say 15-20 minutes) with someone who is infested with the mite.
Is scabies a sexually transmitted disease?
Scabies can be contracted through prolonged sexual exposures with someone with scabies, hence it can be classified under sexually transmitted diseases. Genital scabies, where the rash is concentrated on the penis and scrotum in men, for instance, is the sole reason some visit the hospital.
Are there ways one can contract scabies without skin-to-skin contact?
It can be got by prolonged contact with clothing, beds, underwear, etc. of an affected person.
How is scabies diagnosed?
Scabies can be diagnosed by microscopic or dermoscopic examination of scraped sites where these mites typically appear, alongside detailed history taking and clinical examination. Visualisation of the eggs, mites or faeces of scabies is standard to diagnosis.
To better standardise the diagnosis of scabies for research and clinical setting, the International Alliance for the Control of Scabies had published a set of criteria in 2020 comprising three levels of diagnostic certainties – confirmed, clinical and suspected scabies. There is also an assay for antibody to scabietic mites aimed at better management of scabies.
Polymerase Chain Reaction has also been tried to enhance the diagnostic array for scabies, especially for atypical or subtle presentation in what some reports have termed ‘hidden scabies.’ PCR serves to amplify the DNA of scabies mites, where they may be very few and atypical in presentation or may have even been treated for ‘atypical eczema.’ But it must be emphasised that the visual recognition of the mite through microscopy or dermoscopy still stands as standard.
Can scabies be treated?
Scabies can be treated. Therefore early presentation is advocated before there is an involvement of superimposed bacterial infection that may snowball into other deadly complications.
Is any form of home treatment recommended for scabies?
Anyone with symptoms relating to itching that fits into any of the aforementioned areas and modes should visit the hospital. A doctor trained in the art and science of recognition of the specific patterns and distribution will attend to them and if the itching (since it is the commonest presentation), among other features, fits the diagnosis of scabies, the doctor will treat as appropriate. This is important because the clinical features of scabies could mimic a lot of other skin disorders. Also, drugs used to treat scabies could worsen the skin disorder and may cause, as the case may be, toxicity of the nervous system, if used inappropriately.
How long after treatment will the patient recover?
Patients with scabies who have been treated for scabies may start noticing relief of symptoms from a few days to weeks after treatment, depending on the type of scabies, other associated diseases, and possible complications. Though some may still have itching after appropriate treatment, this does not mean the mite has not been killed. The continued itching in an appropriately treated patient can be from bodily reaction to the coverings of the dead mites still present on the skin.
Do pets transfer scabies?
Scabies is species-specific. So, even if the type from pets gets to the human body, it may not cause significant symptoms as the mites die since it can replicate on another species.
How does one get rid of scabies mites in one’s house, clothes and so on?
The affected person should wash all of his/her clothing and dry them in the sun and then iron all of them, especially in between the seams. Also, the contacts in the household be treated. And under epidemic proportions of scabies, an aerial spray of scabicides to the area involved, as well as regular skin and public health education, would be reinforced, among others.
Is treatment required after coming in contact with a person who has scabies?
It depends on the type of contact, whether casual or prolonged. Prolonged bodily contact of say more than 15-20 minutes with the person with scabies will also need to be treated. And these people often fall into the category of close contacts to the patient involved, whether in the family, school hostels, healthcare settings, barracks or displaced communities. Casual hugs, handshakes or even sitting beside them has not been established to be a risk for scabies.
What is crusted scabies?
This is the type of scabies found in those with compromised immunity, inability to sense itching (neuropathies) or inability to even scratch the itchy part of body. Crusted scabies (also known as Norwegian scabies) is a more extensive type of scabies where, unlike the classical scabies where the symptoms may result from about 10-15 mites, one can have up to 1,000 mites on the body.
It takes a relatively longer time for treatment than classical scabies, as well as more diligent need to search for underlying diseases in the affected person.
How does one treat crusted scabies?
This can entail treatment directed at the mites, associated symptoms and signs as well as treatment of underlying conditions and complications. Adequate contact tracing should as well be done with a need for proper health education to help forestall such in the future. Established contacts should also be treated.
What demographic is most exposed to scabies?
Children; adults; those living in institutions and boarding houses, barracks, healthcare settings; those attending daycare; and those with compromised immunity or neuropathies, among others, are at risk of scabies infestation.
Can scabies lead to death?
Complications of scabies like sepsis, rheumatic heart disease and kidney failure can lead to death.
What can one do to prevent scabies infestation?
Although scabies does not discriminate between the rich and the poor, tall and short, well paid or poorly paid people, it is important to do everything possible to avoid prolonged contact with someone with scabies. Avoid overcrowding in institutions, boarding houses, hostels, etc. But it must be clearly stated that studies haven’t confirmed scabies to be caused by poor hygiene. When one lives with a person with scabies, the aforementioned care of clothing, bed linen, etc. must be practised to avoid infestation from the affected person. Those with immune compromised conditions must be catered for appropriately with adequate and regular skin care.