What is scabies? Scabies is an infestation caused by the microscopic mite (Sarcoptes scabiei)

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1 SCABIES

2 OUTLINE What is scabies Scabies mite Lifecycle of the scabies mite How long are people infectious Symptoms Areas of scabies infestation Appearance of scabies Differences to other skin conditions Treatment Other advice bedding and clothing Itching and treatment Companion products

3 What is scabies? Scabies is an infestation caused by the microscopic mite (Sarcoptes scabiei) It is found worldwide and affects people of all races and social classes it is NOT associated with a lack of hygiene Scabies spreads rapidly in conditions where there is frequent skin-to-skin contact between people, such as aged care facilities, childcare centres, backpacker hostels and residential facilities

4 Scabies mite

5 Lifecycle of the scabies mite The female mite, which is only a few millimetres long, is transmitted onto the skin and then burrows into the top layer of the skin with jaws and first two pairs of legs She lays her eggs into the tunnel that is formed Faecal matter from the mite is also left in these tunnels The eggs hatch into larvae and grow to adult after 10 to 14 days

6 Lifecycle of the scabies mite After several days, the larvae hatch, form burrows, develop into adults and travel back up to the surface of the skin Adults copulate and the impregnated female begins a new life cycle

7 Lifecycle of the scabies mite Organisms multiply to dozens in 2-3 weeks Female mites live for about two months, laying three eggs a day and travel up to three centimetres a minute Mites live in skin and are not shed easily Mites survive away from the human host (e.g. on bed sheets) only for hours or less

8 Lifecycle of the scabies mite Scabies mite and larvae in skin epidermis

9 Symptoms of scabies The main symptoms are: pimple-like irritations, burrows and/or rash of the skin - especially the webbing between the fingers, the penis, the breast, or shoulder blades, and the skin folds on the wrist, elbow, or knee the head and neck are not affected intense itching, especially at night and over most of the body sores on the body caused by scratching - these sores can sometimes become infected by bacteria.

10 Symptoms of scabies The burrows or tunnels are visible to the naked eye although they can be faint and difficult to see They can also be completely obscured by the patient scratching over the area burrow Magnified burrow Normal hand no magnification

11 Symptoms of scabies Symptoms only appear one month after infestation This is because the itching and rash are due to an immune or allergic reaction from either the presence of the mite itself or the faecal mater that it leaves in the burrows or tunnels The immune reaction may kill mites but sufficient numbers remain to stay contagious The itching may persist days to weeks even after successful scabies treatment Reinfection in pre-exposed persons will produce rash in 2-3 days because the body remembers the allergens of mite and faecal matter

12 How long are people infectious with scabies? People are infectious for about 1 month before the itching appears People with scabies can pass on the scabies mite until the day after they have commenced their treatment for scabies Thus child care facilities and people who have had contact with that person during these times should be advised to watch for symptoms and treat accordingly The scabies mite can live for two to three days on the clothes, bed linen and other personal items of people who have scabies

13 Area of scabies infestation

14 Scabies appearance Scabies in skin folds under breast Scabies in between fingers

15 Scabies appearance Scabies on wrist Scabies on back of hand

16 Scabies appearance Scabies that have become infected by excessive skin scratching

17 Can scabies look like other skin diseases Even experienced doctors will miss the diagnosis of scabies at least once Skin conditions that may be confused with scabies include: Dermatitis or eczema School sores (impetigo) Insect bites

18 Differences in skin conditions Condition Differences between various skin conditions and scabies Itching present Area affected Family history Onset Other indications Scabies yes especially at night Wrists, between fingers, skin folds No but other contacts may get it at same time Sudden Burrows on close examination Eczema yes especially at night Head and scalp, neck, inside of elbows, behind knees, and buttocks Usually may also have asthma Early age Dry skin School sores Area sore or tender but not itchy Usually nose, mouth and exposed areas of legs and arms No Sudden Sores enlarge quickly Insect bites Yes Exposed areas No After outdoor or unscreened exposure Bites if scratched scab over and heal quickly

19 How do you get scabies? Scabies is transmitted by direct, prolonged, skin-to-skin contact with a person already infested with scabies - contact must be prolonged (a quick handshake or hug will usually not spread infestation) Infestation is easily spread to sexual partners and household members It is also spread by sharing clothing, towels, and bedding (eg children sleeping over with a child who already has scabies) Anyone can get scabies regardless of age, sex, race or standards of personal hygiene

20 Scabies treatment Treatment of scabies is with: Permethrin 5% (in Lyclear Cream, Quellada Scabies lotion) Permethrin is the active ingredient of choice in Australia because of its effectiveness and low toxicity Lyclear is available on the Pharmaceutical Benefits Scheme but not Quellada Benzyl benzoate 25% (in Ascabiol, Benzemul) Benzyl benzoate is a irritant to the skin and must be diluted in children

21 Scabies treatment

22 Scabies treatment Lyclear Application of Lyclear All over application of Lyclear kills mites in their burrows. It contains no colour agent and no perfume, it is odourless and absorbed completely into the skin leaving no residue. Lyclear is completely effective in 91% of infestations after only one application

23 Scabies treatment Lyclear and Quellada Application of Lyclear and Quellada Before application, make sure the skin is clean, cool and dry For adults and children over 2 years: Apply to the whole body from the neck down, rubbing lightly into the skin until it disappears Don't forget to cover all skin surfaces, including between the fingers and toes, palms, under the nails, on the soles of the feet as well as wrists, buttocks and genitals

24 Scabies treatment Lyclear and Quellada For babies over 6 months to 2 years, apply also to the face, neck, ears and scalp, avoiding only the areas immediately around the eyes and mouth Antiscratch mittens may be useful to prevent the cream being sucked off the fingers

25 Scabies treatment Lyclear and Quellada Duration of treatment Leave the cream on for at least 8 hours before washing off with soap and water, but no longer than 24 hours Ideally, apply the cream before going to bed and wash off in the shower the next morning If applied during the day, reapply to any area which may be washed during the 8 hour treatment time

26 Scabies treatment Ascabiol, Benzemul Because of the potential for skin irritation, benzyl benzoate should always be patch tested on the skin to see if any irritation develops Ascabiol and Benzemul 25% preparations should be diluted for children less than 2 years of age (dilute with 3 parts water) and for children 2 to 12 years of age and adults with sensitive skin (dilute with equal parts water)

27 Scabies treatment Ascabiol, Benzemul After a bath, apply a thin layer to the cool dry skin of the whole body from the neck down using a soft brush Allow to dry Leave on for 24 hours then wash off A second treatment after 5 days is only needed if live mites are present Ascabiol recommends scrubbing the body down with a brush after the bath to open up the burrows and allow better access of the product to the mites

28 Other advice bedding and clothing All bed linen and clothes should be changed and washed (wash with hot water this kills the mite and its eggs) Dry cleaning, ironing, or hot clothes drying are also effective. Any clothing or bedding that can t be washed should be put aside for 7 days before using (eg placed in a plastic bag). The mite and eggs will die during this time The treatment of all household members is often repeated at 7-10 days to maximise chance of eradication of the infestation

29 Itching with scabies Itching The itching is due to the immune allergic reaction which presents about 1 month after being first infected Itching with scabies is intense especially at night The itching may persist even after application of scabicides however it should begin to fade 2-3 days after treatment Scabicides should not be reapplied while itching persists it only irritates further

30 Treatment of itching Patients may need a product to control the itching: Sedating antihistamines (Phenergan, Polaramine, Dozile, Restavit) These products reduce the allergic response and may control the itching. The sedative quality may also help the patient sleep if the itching is keeping them awake Be aware of drowsiness during the day and the affect on alertness Topical corticosteroids (Dermaid 0.5% and 1% cream, Sigmacort 1% cream) Topical corticosteroids may reduce the inflammation and redness associated with itching Systemic absorption can occur in young children especially if applied to large surface areas

31 Treatment of itching Eurax (crotamition) While Eurax has been used to treat scabies, studies done in the US found that it was almost one-third of the effectiveness of permethrin However, it does have some anti-itch properties and may be helpful when applied to patients with itchy skin It is no longer used as an effective antiscabies treatment

32 Companion Products Because the scabies rash could be classified as an irritant dermatitis, the inflamed skin would benefit from products that would soother and moisturise the skin. Treatment for scabies can irritate the skin and moisturisers and soothers would also be beneficial if this occurs Pinetarsol (soap, solution, gel) Moisturisers Dermaveen, Aveeno (colloidal oatmeal)

33 Companion Products Moisturisers include: Sorbolene and glycerine cream Emulsifiable oil baths (Alpha Keri, QV) Emusifiable oil baths containing oatmeal (Dermaveen, Aveeno) Anti-itch general products Pinetarsol

34 Companion products Emulsifiable oil baths Alpha Keri (lotion, wash, cream)and QV These products contain a non-reactive mineral oil which will not irritate sensitive skin and which promotes the absorption of water in the product

35 Companion Products Emulsifiable bath oils with oatmeal (Aveeno, Dermaveen) Oatmeal has had a long history of being used to relieve itchy skin Studies show that oatmeal contains avenanthramides and phenols, chemicals which have anti-inflammatory properties Because avenanthramides and phenols reduce skin inflammation, this may explain why oatmeal can temporarily relieve itchiness.

36 Companion Products Aveeno (cream, lotion, wash) Dermaveen (cream, lotion, wash)

37 Companion Products Pinetarsol (contains pine tar) These products contains pine tar which can slow the rapid growth of skin cells and restore the skin's natural appearance Pine tar can reduce the itching and inflammation of the skin Often, tar products like pine tar are used and prescribed instead of prescription steroid creams Pine tar soap is designed to wash and cleanse the affected areas while treating the eczema inflammation

38 Companion Products Pinetarsol (bar, gel, bath oil)

39 Patient Counselling There are four areas that are important in patient counselling of scabies: Identification Ensure the condition is scabies use charts provided Treatment with medication Treatment requires an effective treatment and how to apply medication appropriately in order to rid the body of mites How to deal with clothing and bedding It is important to know how long the mite survives in bedding and hot water in order to advise the patient Management of itch Itching persists beyond killing of the mites and because it is intense it needs good management

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