Ask a Nurse About: Scabies

I am not only a nurse to my patients, I am also a nurse to my family, friends, neighbors,
and random strangers in Target and our local grocery store.  On a daily basis, I 
encounter numerous questions about health, medications, and random concerns such 
as "What does it mean when my poop turns green?".  And so I started a new feature here, 
Ask A Nurse, where I will attempt to put into laymen terms the very confusing anatomy 
and physiology of the human body.  Am I an expert?  Hardly.  But I am an 
experienced, certified Medical-Surgical Registered Nurse and a mother of two.  I draw 
from my experiences in my medical practice, my journey through motherhood, and 
my endless collection of credible nursing textbooks and resources.  Remember: this is just 
a blog.  Just as you should never base any serious decision on internet ramblings, so 
should you not take anything you read here as concrete fact.  When in doubt, consult 
your doctor/naturopathic/guru.

This week's topic: Scabies

After Isabelle's great big scabies adventure last week, I got lots of emails inquiring about 
this terrible rash.  I've seen it quite often in the hospital and nursing homes amongst 
my patients but neither of my children have ever had it.  This summer, however, 
multiple cases of scabies broke out in our community and our pediatrician informed us 
that we were her 5th case of the day.  Hopefully, none of you have to become familiar with 
this rash.  Here's some info, though, just in case...

What is it?

Scabies is a highly contagious skin disease caused by the infestation of an itch mite known
as Sarcoptes scabiei.  The itch mites burrow under the skin and cause intense itching,
usually worse as night.  Scabies is spread through direct skin to skin contact and is
most commonly found in communal type settings such as hospitals, day care centers,
and nursing homes.  Symptoms usually appear 2-6 weeks after exposure and often affect
the entire family.

Signs and Symptoms:

Here's where it gets REALLY gross: After exposure to the itch mite by an infected person,
the itch mites then burrow into your skin.  The proteins and feces (YES, feces!!) of the
itch mites then cause an allergic response in your skin, causing intense itching that is
usually worse at night.  A pimple-like rash then begins to form.  This rash is unique
compared to other rashes because it forms a linear pattern, almost as if you can see the
itch mite's path. Some doctors compare the bumps to pencil marks in appearance.  The
rash can cover most of the body or it can be concentrated to only certain areas, most
notably the webbing of the fingers, inside skin folds such as armpits, writs, knees, and
elbows, and around the waist.  In young children, the rash is usually present on the soles
of the feet and palms.

Source

Source

We have all the symptoms: now what?

A trip to the pediatrician/family doctor is definitely in order.  A definitive diagnosis can
be made by scraping a small area of the skin and examining it under a microscope.  The
mites and their eggs are then visible and a proper diagnosis can be confirmed.  The
entire household will need to be treated as scabies is highly contagious and its symptoms
do not show up until several weeks after exposure.

Treatment:

Your doctor will most likely prescribe you a topical cream called Permethrin.  This cream
has been found to be the most effective form of treatment as it kills the itch mites and the
eggs they have burrowed into the skin as well.  The cream should be applied from the
neck down to the toes and should be kept on the skin for 8-12 hours.  After this
prescribed time, shower, clean the cream off, and put on clean clothes.  The CDC
recommends repeating this treatment one week later to ensure that any eggs left behind
are finished off.  The cream may cause very mild irritation to the skin but is overall gentle
and odorless.  Again, everyone in the infected household should be treated whether they
are showing symptoms are not.  This skin disease is very contagious!!!  

What else can we do?

Wash all bed linens, blankets, towels, and recently worn clothes in hot water.  Vacuum
the carpets and upholstered furniture.  Place pillows, stuffed animals, and anything else
you are not able to wash in the dryer for 30 minutes: the heat will blast those suckers
away.  You can also place items too large to wash in a sealed plastic bag for 7 days.  Itch
mites do not live for very long away from the human body so cleaning the house and
washing all linens is sufficient in eradicating them: no pesticides needed. 

Complications:

This rash is very itchy so kids will of course scratch intensely to relieve themselves.
The problem is that kids have lots of germs in their little fingernails and these germs can
then be spread to the skin, causing a bacterial infection.  The most common complication
of scabies is MRSA, also known as "Staph".  This bacteria will often present itself by
infecting the scabies bite marks, forming boils and/or sores, sometimes accompanied by
fever.  If you notice any increased swelling, redness, areas of tenderness or increased
pain, drainage from the skin, foul odor, or red streaking in the skin, notify your
doctor immediately.  A topical triple antibiotic cream should be applied to the skin and
an oral antibiotic, such as Bactrim, may be necessary.  

Wrapping it up:

Because this rash is attributed to an allergic response, you may experience itching for
several weeks after treatment.  Oral antihistamines such as Claritin and Zyrtec may
be prescribed to help with this.  Witch Hazel and oatmeal bathes are also great
natural remedies for itch relief.  Remember to encourage frequent hand washing and
change bed linens regularly. 

Great resources:

CDC

Bed Bugs or scabies?

Identifying childhood rashes

Scabies

Have a question you'd like to ask a nurse?  Leave me a comment and I will address it in a future 

post.  Or, email me at vasqueztribe@yahoo.com.