Scabies: Causes, Symptoms & Treatment

Scabies or scabies is a contagious skin infection that can usually be treated with appropriate lotions without complications. To prevent the disease scabies, there are several options, which will be explained in detail here.

What is scabies?

Scabies is a skin disease caused by the so-called scabies mite (Sarcoptes scabiei). In technical language, scabies is also called scabies. Typical symptoms of the disease scabies is a scaly or crusty appearing skin, which is interspersed with nodules. Often the symptoms of scabies are associated with severe itching. Skin lesions caused by scabies often appear on the wrists, armpit area or genital region in adults. In affected children, skin changes may also occur on the face or on the palms of the hands and feet. Although scabies affects people worldwide, the amount of people infected varies, depending on time and region: for example, while the disease was almost absent in Germany in the 1950s, the number of people infected with scabies has been increasing again since the 1960s.

Causes

The cause for the occurrence of scabies is a corresponding infection with the scabies mite. The females of these parasites are primarily responsible for the clinical picture. Female scabies mites cause small holes in the horny layer of the skin in the course of scabies, in which they lay their eggs. Scabies mites feed on skin and lymph cells, damaging the skin. This damage causes the body’s immune system to become active, resulting in some symptoms of scabies (such as itching). Scabies is contagious and can be transmitted through physical contact. Since such transmission is possible, among other things, through sexual intercourse, scabies is considered a sexually transmitted disease. Many people usually associate scabies with dirty and unhygienic living conditions. This may indeed be a reason for the spread of the scabies mite. However, scabies mites are also found in schools, hospitals, nursing homes, and daycare centers, places where many people encounter each other on a daily basis. Similar to lice, these facilities are ideal for rapid spread of scabies.

Symptoms, complaints, and signs

Symptoms of scabies appear within two to six weeks in most cases. Then there are inflammatory reactions of the skin and severe itching. Especially warm areas with thin epidermis are primarily affected by this. These include, for example, the spaces between the fingers and toes, the armpit area, the navel region, the nipple region and the genital region. The back and head are rarely or never affected by scabies. The affected areas are reddened and nodules sometimes form. These nodules are very small and sensitive. Children are more likely to have blisters than nodules, and scabies may also affect their heads. The itching intensifies with increasing warmth. Especially the warmth of the bed causes severe itching. The scratching of the itchy areas leads to scaling for hornification of the skin. Thus, the skin can be damaged accordingly. In some patients, bore tunnels of the mite can be seen with the naked eye. Sometimes individual mites can also be seen. The bark scabies, which occurs only rarely, shows other effects on the skin. Thus the itching is weak here or remains absent. The hornification and scaling of the skin is particularly pronounced on the hands and feet and most of the body is reddened.

Diagnosis and course

A diagnosis of the disease scabies is initially possible on the basis of the typical skin changes. These can be shown especially with the help of a reflected light microscope. If this diagnosis of scabies must still be secured, another possibility is the so-called ink method:

Diluted ink can be used to make the bored ducts of the scabies mite visible on a skin nodule. In addition, to diagnose scabies, an existing skin nodule can be removed and then examined for scabies mites. In most cases, with adequate treatment of scabies, a positive course of the disease can be expected. In some cases, itching may persist beyond successful treatment.Complications can arise from scabies due to a lack of personal hygiene, among other things: Germs can penetrate the injured skin and cause erysipelas or blood poisoning, for example.

Complications

Bacterial inflammation in the area of the pre-damaged skin represents the most common complication of scabies. Frequently, the bacterial colonization is streptococci or staphylococci, which can cause erysipelas associated with fever and chills or swelling of the lymph nodes (lymphadenopathy) as a secondary disease. If the germs spread further via the lymph vessels, these can become inflamed (lymphangitis). If the infection remains untreated, in the worst case the pathogens present in the lymphatic vessels enter the bloodstream and lead to life-threatening blood poisoning (sepsis). Rheumatic fever and a special type of kidney inflammation known as glomerulonephritis can also be caused by streptococci. All of these infections usually respond well to antibiotics, so prompt treatment can usually prevent severe sequelae of scabies. In some cases, the skin reacts hypersensitively to the anti-mite agent used for therapy; cracked skin and redness indicate eczema caused by dehydration. A rare complication of scabies is sometimes persistent itching after treatment is completed, which is due to overactivation of nerve cells: these report a stimulus to the brain long after the trigger has been removed.

When should you see a doctor?

Scabies is a disease with a high risk of infection. To prevent the infection from spreading to other people and from spreading further on one’s own body, a doctor should be consulted at the first signs. If the affected person suffers from skin abnormalities, these should always be clarified by a doctor. Inflammations of the skin are warning signs that should be followed up. The hands, the spaces between the fingers, the armpits and the genital area are considered to be particularly at risk for scabies. If there are changes in the appearance of the skin on these parts of the body, a visit to the doctor is advisable. In case of itching or open wounds, a doctor should also be consulted. If the symptoms spread or increase in intensity, a visit to the doctor is necessary. If gangrene, the development of pus or a burning sensation on the skin occurs, a doctor is needed. In severe cases, the affected person is at risk of blood poisoning. If the surface of the skin is scaly, dry or crusty, a visit to the doctor is necessary to determine the cause. If lumps, swellings or small ulcers form, the changes in the skin must be examined by a doctor. Redness of the skin, an inner restlessness or sensory disturbances should be presented to a physician so that appropriate therapy can be initiated as soon as possible.

Treatment and therapy

If scabies disease is not accompanied by complications, successful treatment is usually possible through the use of locally applied lotions. The effects of such therapy for scabies are both to destroy the mites and to prevent re-infection. Often it may be necessary to treat persons from the private environment of an affected person against scabies. This can also be useful for people who do not yet have acute symptoms of scabies, as symptoms can sometimes only appear a long time after an infection. Active ingredients that are sometimes contained in ointments for the treatment of scabies are the substances permethrin (an artificially generated insecticide) or benzyl benzoate. After application, such ointments usually require certain exposure times before they are rinsed off again. The duration of scabies treatment depends, among other things, on the severity of the disease and the remedy used. If in the course of scabies above-mentioned complications occur, they are treated, for example, with antibiotics.

Outlook and prognosis

Prognosis and outlook for scabies disease depend on whether the patient consistently completes treatment and observes the appropriate precautions. If left untreated, scabies can take a chronic course. In this case, affected patients sometimes suffer from increasingly worsening symptoms for years.Increasingly larger areas of skin are then affected by the lesions. This increases the risk of a deterioration in the general state of health. This is because if pathogens get into the typical scratch wounds, purulent infections or even life-threatening sepsis can be the consequences. In rare cases, however, untreated scabies can heal on its own after a few years. The prognosis for scabies is much better if the patient takes medication and follows hygiene recommendations. In this case, scabies almost always heals without problems and without the affected person having to fear serious late effects. Unlike some infectious diseases, the body does not develop immunity after a scabies disease has been overcome. In particular, after just overcoming the disease, it can come to a new infestation, if, for example, people from the close environment, often without noticing it, are sick with scabies.

Prevention

To prevent scabies is, for example, about avoiding close physical contact with people who are sick with scabies. If scabies disease already exists, preventive treatment of private contacts can prevent re-infection. To prevent a protracted course of scabies, in addition to proper use of medication, regular home and personal hygiene can help make it difficult for scabies mites to reproduce.

Aftercare

No special aftercare is considered after successful therapy. The patient is considered cured. Skin changes and itching may still be present for a short time. However, these can be treated with creams. If a patient wants to prevent a new infection, he must take preventive measures himself. He alone bears the responsibility for this. There is no direct medical support. However, doctors can provide information about transmission routes. Suitable measures include, above all, compliance with high standards of hygiene. Especially in foreign accommodations, one should take a critical look at the sleeping accommodations and sanitary facilities. Infected persons should be avoided at all costs. Patients with a weak immune system and small children should not take a new infection lightly. Inpatient treatment in hospital is unavoidable. There is a risk of complications such as blood poisoning or lymphadenitis in these groups of people. The treatment period is extended. Scabies can also become chronic in rare cases. Then there is a need for continuous treatment. Medication is increased or changed, another course of treatment with anti-mite ointments is started. Affected patients must severely restrict their everyday life. Close contact with other people must be avoided. Laundry and textiles must be adequately cleaned.

What you can do yourself

Anyone who has contracted scabies should first observe a few hygiene measures. It is recommended to wash out the bedding and clothing hot and to shower at least twice a day. In addition, close contacts should be informed about the disease to avoid infection. Typical measures such as cold compresses against the itching, soothing ointments against the pain and cosmetic measures such as natural make-up against the redness help against the actual symptoms. If the scabies is not yet far advanced, various home remedies can also help. Tea tree oil kills the parasites and supports the skin structure. Lavender oil helps relieve skin itching and redness, while aloe vera oil has an overall pain-relieving effect. Equally effective are herbs such as sage, St. John’s wort or peppermint, which are boiled and applied directly to the skin. A proven home remedy is onion skins – also boiled and applied to the itchy areas. From homeopathy, the preparation Psorinum is a good choice, which is said to kill the parasites and relieve the pain. Sulfur is also said to have a soothing effect. The use of these remedies is first best clarified with the attending physician.