Scabies is a transmissible ectoparasite skin infection characterized by superficial burrows, intense pruritus (itching) and secondary infection. The word 'scabies' is Latin for 'itch'.
Caused by the mite Sarcoptes scabiei, variety hominis, it produces intense, itchy skin rashes when the impregnated female tunnels into the stratum corneum of the skin and deposits eggs in the burrow. The larvae, which hatch in 3-10 days, move about on the skin, molt into a "nymphal" stage, and then mature into adult mites. The adult mites live 3-4 weeks in the host's skin. The motion of the mite in and on the skin produces an intense itch which may resemble an allergic reaction in appearance. The presence of the eggs produces a massive allergic response which, in turn, produces more itching. Scabies is transmitted readily, often throughout an entire household, by prolonged skin-to-skin contact with an infected person (e.g. bed partners), and thus is sometimes classed as a sexually transmitted disease. Spread by clothing, bedding or towels is a less significant risk, though possible.
It takes approximately 4-6 weeks to develop symptoms after initial infestation. Therefore, a person was contagious at least a month before they were diagnosed. This means that person could have passed scabies to anyone at that time with whom they had close contact. Someone who sleeps in the same room with a person with scabies has a high possibility of having scabies as well although they show no symptoms.
The symptoms are caused by an allergic reaction that the body develops over time to the mites and their by-products under the skin, thus the 4-6 week "incubation" period. There are usually relatively few mites on a normal, healthy person--about 11 females in burrows. Scabies are microscopic although sometimes they are visible as a pinpoint of white, but most people can't see them. The females burrow into the skin and lay eggs there. Males roam on top of the skin however can burrow and do, but both males and females surface at times especially at night. They can be washed off or scratched off (however scratching should be done with a washcloth to avoid cutting the skin as this can lead to infection), which, although not a cure, helps to keep the total population low. Also, humans create antibodies to the scabies mites which do kill some of them.
People with compromised immune systems do not develop antibodies to the mites and may develop crusted Norwegian scabies, where many form scabs or have very red skin especially in the elderly and the mentally handicapped where white or gray crusted areas develop with little itching and little or no red bumps and mite population numbers soar to hundreds, thousands, or in AIDS patients millions. These cases require additional treatment options to ensure a complete kill. Ivermectin is the treatment of choice in these patients combined with any other topical treatment.
U.S. doctors normally prescribe topical applications of a chemical called Permethrin 5%, a poisonous pesticide. Brand names include Acticin and Elimite. Never use these topical pesticides twice in the same week as this can produce pesticide poisoning which can be lethal. Application of these creams should be made from the top of the head if you live in a humid climate or have had scabies misdiagnosed for several months to tips of toes, all crevices. Other climates may use them from the neck down. Leave the cream on at least 12 hours but up to 24. The optimal duration of application is 16 hours for a kill. Repeat the process in seven days to ten days if necessary.
The least toxic treatment is Kleen Free. Kleen Free is a non-toxic, non-pesticide, enzyme based concentrate that helps to fight scabies. Use it in bath water, the washing machine, directly on the skin and in many more ways to eliminate the problem.
After treatment has been applied or taken, (or directly before treatment if you are careful and wear gloves) cleaning of environment should occur. Wash all recently worn clothing in hot water and dry in a hot dryer. There is no need to wash clean clothes that haven't been touched in the past week. Place clean clothes on a clean sheet out of the dryer. Things that cannot be washed can be dry cleaned. Place other stuffed animals and pillows in a plastic bag for two weeks or freeze these items and shoes in the freezer overnight in a plastic bag with twist tie. This will kill any mites. Towels and bedding should be removed and washed daily for at least three days after each treatment, including mattress pad and pillow covers. Pillows can be tossed in hot dryer for 30 minutes and mattresses can be vacuumed. Vacuum all carpets, rugs and upholstered furniture daily. Don't forget about things like coats, gloves, hats, slippers, robes, kitchen towels, wetsuits, etc. Either isolate long enough for the mites to die in a plastic bag (at least 2 weeks) or clean or freeze overnight. Mop all floor surfaces and clean bathroom surfaces (this only needs to be done after the first treatment). Thoroughly clean brushes and combs too (this is extra precaution and may not be necessary). This routine needs to be repeated at the time of the second follow-up treatment to ensure a thorough kill.
If there are pets in the house, they should be either treated with a pemethrin shampoo at the same time as the humans or isolated and treated with Revolution. There are other herbal treatments if desired. Ivermectin products are also available for pets.
The key is timing. All household members should be treated at the same time and cleaning must be thorough and simultaneous. Sulfur treatment is a little messier, but many have found complications later by taking Permethrin treatments (Acticin or Elimite) due to the pesticide content. Sometimes the effects of too much pesticide can cause bad complications for a year or more. 10% sulfur ointment needs to be left on the body 24/7 for a week. This is effective and the least toxic method.
Expect increased itching and red bumps for the first week after taking any medication for scabies. The dead mites remain in the skin for 30 days. They are removed with the body's natural shedding process. During those 30 days expect new bumps and itching.
Kleen Free can be found at http://www.licescabiesandbedbugs.com
