Night Itch/Scabies

Night Itch/Scabies: Symptoms and Treatment

Scabies is one of the several other skin conditions that causes itching and rashes. It is contagious and can spread easily through close contact. It can affect people of all ages, gender and ethnic group. A dermatologic condition triggered by sarcoptes scabiei – and eight legged microscopic mite; it can affect the immunocompromised, the elderly and those housed in institutional settings. Itching, rashes, sores and thick crusts are the known symptoms that lead to scabies.

Causes:

1. Intensely pruritic skin infestation caused by the host-specific mite, sarcoptes scabiei var hominis usually transmitted through direct contact with an infested individual.
2. Mites can survive up to 3 days from human skin. Same is the case with fomites such as infested bedding or clothing - an infrequent source of transmission.

Clinical picture:

1. Common, extremely pruritic eruption consisting of papules, pustules, vesicles, and linear burrows.
2. Distribution - wrists, finger web spaces, toe webs, umbilicus, genital area, breast [women], axillae. May involve the face and scalp in infants.
3. Nodular scabies more common in children.
4. Prevalence rates are higher in children and sexually active individuals than others.
5. Norwegian crusted variant is more common in:

1. Poor sensory perception due to entities such as leprosy, cerebral palsy & paraplegics

2. Immunocompromised patients - organ transplantation, HIV disease, and old age

Home Treatment:

1. All family members and close contacts must be evaluated and treated, even if they do not show symptoms.

2. Pets do not require any treatment.

3. All carpets and upholstered furniture should be vacuumed.

4. Instruct patients to launder clothing, bed linens, and towels used in hot water the day after the treatment is initiated and again in 1 week. Items that cannot be washed may be dry cleaned or kept in plastic bags for at least 1 week.

5. Affected individuals should avoid skin-to-skin contact with medical tx.

6. Patients with typical scabies may return to school/work 24 after the first treatment.

Medical Treatment:

-Application of topical antiscabietic agents to be repeated for 7-10 days

- Antihistamines to control itching

Pearls and Pitfalls:

1. Failure to repeat the treatment in 7-10 days is a common reason for relapse.
2. Failure to treat close contacts [even those without symptoms] is a common reason for relapse.
3. Treatment of any secondary infection/s.
4. Scabies nodules can be treated symptomatically.