Dermatology

Scabies:
Crusted scabies is a severe form of scabies that occurs in some people with weakened immune systems. Those infected develop thick crusts of skin containing large numbers of scabies mites and their eggs. Those infected with it can spread the infection easily as they may not show the usual signs and symptoms of scabies (Such as skin rash or itching).

Causes:
Scabies occurs due to transmission of a parasite called “Sarcoptera scabiei” (a small parasite or mite that cannot be seen with the naked eye and does not live for more than two to three days outside the human body) from an infected person to another person. After infection, the female mite penetrates the upper layers of the skin and digs tunnels to live inside it, feed, and lay eggs. The eggs hatch within three to four days and develop into adult mites within one to two weeks, and the life cycle repeats.

Methods of transmission:

• It is easily transmitted by direct contact with the skin of an infected person for a long period (skin-to-skin contact).
• It is transmitted indirectly by sharing objects (such as clothes, towels, bedding, etc.) used by an infected person.
• It is transmitted through sexual contact because of physical contact.

A quick handshake or hug usually doesn't spread scabies.

The incubation period:
If a person has never had scabies before, symptoms may take 4-6 weeks to appear, and it is important to remember that an infected person can spread the infection during this time even if he or she does not have symptoms.

The most vulnerable groups:
Anyone can get scabies, as skin-to-skin contact is the most common way of infection, however, some people are particularly susceptible to it:

• Children and the elderly.
• Patients in hospital.
• Residents of nursing homes and extended care facilities.
• People with a weak immune system usually develop crusted scabies.

Symptoms:
Symptoms occur as an allergic reaction of the body to mites and eggs and appear in the form of:

• Severe itching that gets worse at night (the most common symptom).
• Thin, visible lines on the surface of the skin that cause intense itching resulting from mites burrowing under the skin.
• A skin rash that includes red bumps or blisters.
• Scratches due to itching.
• The child may suffer from a severe red rash, especially on the palms of the hands, soles of the feet, ankles, and scalp.
• Thick crusts on the skin that form when a person is infected with a severe type of scabies (crusted scabies).

Areas of the body most affected by scabies:

• Fingers (especially between the fingers).
• Skin folds around the wrists, elbows, and knees.
• Folds under the arms (armpits).
• Around the breasts (especially in women).
• Waist
• Genital organs
• Lower buttocks and upper thighs.
• Sides and bottoms of the feet.

Usually, neither the back nor the head is affected (except occasionally in infants or young children).

When to see a doctor:

• When you notice signs and symptoms indicating scabies infection.
• If the itching continues 4 weeks after the end of treatment.

Treatment:
People who have close contact with the infected person will need to receive treatment at the same time, even if they do not have any signs or symptoms, as treatment is in the form of topical creams or oral medications in more severe cases, and take the following steps:

• Before applying the medicine to the skin, you should take a shower, then apply the medicine to clean, dry skin.
• The medicine should be left on the skin for 8-14 hours and then washed off. The medicine can also be applied before bed and then washed in the morning.
• The medicine should be reapplied to the hands after washing them, especially between the fingers because moths prefer these places.
• The itching gets worse for one to two weeks after starting treatment, and this is normal, but the skin usually heals within 4 weeks.
• These medications are applied to all of the skin from the neck down the body, and infants and young children often need treatment of the scalp and face.

Doctor's instructions should be followed and care should be taken to complete the treatment period. Patients can also return to work or school the day after the start of treatment (after applying the treatment once).

Scabies infection in schools:

• When it is confirmed that a child is infected with scabies, treatment must begin for the child immediately, and all members of the household should be treated, but classmates and teachers often do not need treatment unless they show signs and symptoms of infection.
• The child returns to school after applying the treatment to the skin once, and returns immediately the next day without absence.

Prevention:
Home tips:

• Avoid close contact with an infected person, especially if he or she has an itchy rash.
• On the day the treatment is started, you should ensure that the victim’s clothes and bed linen are washed independently from others, in a washing machine, rinsed with hot water, and dried at high temperatures.
• Vacuum entire house carpets and furniture, especially for those infected with crusted scabies.
• Avoid sharing clothes, towels, etc. with the infected person.
• Maintain good cleaning of rooms using designated household cleaners.

School tips:

• Avoid crowding and close contact with skin for a long time.
• Avoid exchanging clothes or sharing personal items belonging to the infected person.