Scabies

Although just about anyone, at any time has the potential to get scabies, there are specific groups of people that are at greater risk.  There are also certain behaviors that can put you at greater risk of contracting scabies.  Although sometimes there are circumstances beyond your control that can put you into one of these groups, being aware of this might help you avoid scabies, or failing that, make it possible for you to identify and treat them early on.

Groups at Risk

One of the largest and most susceptible groups is that comprised of infants and small children.  In general, children are more likely to have vulnerable immune systems. In addition, they can often be placed in situations where they are in close proximity to others who might be carriers.   Children in day care and school classrooms are exposed to any number of “bugs” and scabies is just one of many they might come into contact with.  Children in developing countries are the most vulnerable of all, since they often lack adequate nutrition, hygiene and medical care.

The elderly are also at greater risk than the general population.  Their immune systems tend to be weaker, they might be suffering from other illnesses that make them vulnerable to parasitic infestations and skin conditions, and adult foster homes and care centers are ideal environments in which scabies can spread.

Another group at high risk is those whose immune systems are already compromised.  Those suffering from multiple sclerosis, lupus, Grave’s disease, rheumatoid arthritis or HIV are much more likely to contract any number of conditions, and have a much harder time getting rid of them.  They often don’t respond to treatment, need multiple treatment cycles, or need to try a larger variety of remedies before finally seeing some results.

Lastly, anyone who has to live in an institutional setting is at a higher risk of getting scabies. Those in any type of long-term care, assisted living, mental hospital or prison are more likely to get any number of communicable diseases. By the same token, people living in otherwise crowded conditions, especially in the developing world are at similar risk.

Bottom line;  if you are very young or old, have a compromised immune system, or live in very close contact with many other people, you are at a much higher risk of getting scabies.

Risky Behaviors

Unlike many other communicable diseases, there is no specific behavior that guarantees you will get scabies.  By the same token, there is no specific behavior you can stop that can guarantee you won’t get scabies.  There are however, a few behaviors that will make it easier for you to get scabies from someone who is carrying it.

One behavior that can make it easier to get scabies is being sexually active, especially with more than one partner.  While scabies is not a sexually transmitted disease, the skin-to-skin contact of sexual activity can increase the odds of getting scabies from someone who is carrying it.  A larger number of partners simply increase the odds that you will run into someone who has it.  Since most first-time scabies sufferers can go a number of weeks before displaying any symptoms, it can be impossible to tell who can pass it on to you.  There really is no way to mitigate this risk without curtailing the number of sexual partners you have.

Although it may not seem like a choice for some, working in a very crowded or institutional environment can increase the risk of contracting scabies.  Just as those who live in care centers and prisons are more likely to get scabies, so are the staff who works there.  If you get sick easily, have allergies or very sensitive skin, you might seriously consider a different line of work, rather than risk constantly exposing yourself to any number of communicable conditions.

Another behavior that can increase the risk of contracting scabies can be sharing bed linens and towels.  Scabies mites can live without a human host for about 36 hours, and they often do so in beds and bathrooms where there are fabrics where they can hide.  The more people you have sharing a bed or bathroom, the greater the chances of one person spreading scabies to everyone else.  If you share a bed, be sure to wash the sheets often, and make sure every household member has their own towel.  Make sure that clothes and linens are washed often.  Cleanliness isn’t a guarantee of scabies prevention, but being scrupulous about it can help keep it from spreading, even if one family member gets it.

While you may not be able to avoid belonging to a high-risk group, just knowing that you belong to the group can help you do your best to avoid getting scabies, or seeking treatment as soon as you think you might have it, so you can start getting better as soon as possible.

Certain groups, like children, the elderly and those with immune disorders are more susceptible to scabies. There are also some behaviors that create a higher risk.

As soon as you see the first signs of scabies, schedule an appointment to see your doctor.  The longer you wait, the more likely you are to spread the mites to others around you.  Scabies will not go away on its own, and can’t be treated effectively with non-prescription remedies. Fortunately, scabies is easy to treat with prescription medications, in most cases.  Once your doctor has diagnosed you, he or she can determine the best treatment for you.

Creams

The most common, and usually most effective treatment for scabies is a prescription cream called permethrine. One treatment cycle of this cream stops the scabies infestation for most people, and it is safe for use on infants as young as 2 months.  The cream is applied to the entire body, from the neck down, and left on for 8-14 hours before being washed off.  On infants, the cream is also applied to the neck, face and scalp, with care taken to avoid the eyes and mouth.

In most cases, treatment takes 1-3 days.  It is safe for children to return to school or daycare after treatment has been completed and all of the cream has been washed off. Check with your doctor to find out exactly how long treatment should be continued.

Some other topical ointments used in scabies treatment are lindane, which is considerably more toxic than permethrine and is used only when other treatment has failed. Because it can have harmful side effects, it is especially important to use lindane exactly as directed by your doctor. Incorrect or overuse can be dangerous, because it can cause permanent damage to the central nervous system. It is usually prescribed as a single application.  It is not recommended for those with a weakened immune system, those who weigh less than 100 pounds, children, and the elderly, or pregnant or nursing women.

A sulfur ointment is sometimes used to treat pregnant and nursing women because it is safe and mild.  It is also generally less effective than permethrine, however.  Crotamiton is another ointment used only rarely because it is less dependable in killing the mites and their eggs.

Pills

On occasion, a doctor may choose to prescribe an oral treatment for scabies. Invermectin is an anti-parasitic medication taken in pill form.  Its primary use is to kill roundworms, but has a secondary use in treating scabies and head lice.

Antibiotics may be prescribed only if a secondary skin infection develops. This usually doesn’t happen as long as you get treatment promptly.

Other Treatments

Even though the treatments listed above work well in the majority of scabies cases, there are some instances where more serious treatment is needed.  One such instance is if nodular scabies develop.  This happens when there is an unusually strong allergy to the mites, and results in hard, itchy reddish nodules, which sometimes remain long after the mites are dead. In cases like these, steroids might be injected into the nodules.  A less common treatment is the application of coal tar products to the affected area.

Another, more severe form of scabies is crusted or Norwegian scabies.  This is a highly contagious form because there are an unusually high number of mites found under the skin.  Norwegian scabies are usually found in people who have other infectious diseases or a weakened immune system.  In fact, scabies this severe can lead doctors to order HIV testing because it can indicate a severely compromised immune system.  Since Norwegian scabies often doesn’t respond to the usual treatments, doctors may try several in combination, such as a serious topical treatment like lindane together with invermectin pills.

Sometimes, steroid creams and even steroid pills can be prescribed for severe cases of scabies.  These however, just help to relieve the itch and don’t kill the mites themselves, so need to be used in conjunction with other medicines.

Even though over the counter treatments are not strong enough to kill scabies mites, there are some products that can help provide relief from the itch.  One popular anti itch remedy is Benadryl cream or spray.  Antihistamine pills, commonly used for cold or allergy relief, can also be effective in relieving the itching.  Be sure to check with your doctor before administering any of these to a child or infant.

There are a few other things to consider in conjunction with scabies treatments.  First of all, make sure that anyone in your household, or with who you are otherwise in close contact, receives treatment as well.  You don’t want to have family members and friends keep passing it around because one or two people didn’t receive proper treatment. Also, don’t hesitate to return to your doctor if your symptoms aren’t significantly better within 14 days of starting treatment.  If the first round didn’t work, the sooner you start on a second one, the sooner you will be free of the itching and irritation.

Scabies is fortunately easy to treat with a prescription cream, and in some cases, prescription pills. A few other methods are reserved for harder cases.