Scabies is a skin condition caused by tiny mites that burrow into the skin, leading to intense itching and a noticeable rash. This article outlines effective ways to address a scabies infestation and manage its symptoms.
Understanding Scabies
Scabies is an infestation caused by the human itch mite, Sarcoptes scabiei var. hominis. These microscopic mites burrow into the top layer of human skin, where female mites lay eggs. The condition primarily spreads through prolonged, direct skin-to-skin contact. Transmission can occur through contact with contaminated items like bedding or clothing.
The primary symptom of a scabies infestation is intense itching, which often worsens at night. A pimple-like rash may also develop. If a person has never had scabies before, symptoms appear within two to six weeks after the initial infestation. If someone has been previously exposed, symptoms can emerge more quickly, within one to four days.
Prescription Treatments
The most effective way to eliminate scabies mites involves prescription medications. Permethrin cream 5% is a first-line topical treatment. This cream kills both scabies mites and their eggs.
When applying permethrin cream, it should be massaged into all areas of the body from the neck down, including the soles of the feet, hands, and all skin folds. For infants or older adults, application should also extend to the scalp, neck, and face. The cream should remain on the skin for eight to fourteen hours before being washed off with a bath or shower. While a single application is often effective, a second application one to two weeks later may be necessary to ensure any newly hatched mites are eliminated.
Oral ivermectin is another option, used for severe cases, crusted scabies, or when topical treatments are impractical. While not specifically approved by the U.S. Food and Drug Administration for scabies, it is effective. Dosage is 200 micrograms per kilogram of body weight, taken with food, with two doses seven to fourteen days apart. This medication is not recommended for children weighing less than fifteen kilograms or for individuals who are pregnant or nursing.
Other topical treatments include crotamiton cream or lotion, approved for adults, and sulfur ointment, which is considered safe for pregnant individuals and infants under two months of age. Benzyl benzoate lotion is also used. Newer options like spinosad topical suspension are available. All treatments for scabies require a medical diagnosis and a prescription from a healthcare provider.
Managing Symptoms During and After Treatment
Even after scabies mites are eliminated by treatment, itching can continue for several weeks, typically two to four weeks, sometimes up to six. This persistent itching results from the body’s allergic reaction to mite proteins, feces, and dead mites remaining in the skin. New skin lesions may also appear for a few days following treatment.
Continued itching does not necessarily indicate treatment failure or re-infestation. To help manage these lingering symptoms, several strategies can provide relief.
Oral antihistamines can help reduce the itching sensation. Topical corticosteroids may be prescribed to alleviate inflammation and redness. Applying cool compresses to affected areas can also offer comfort.
Additionally, emollients can address skin dryness, and crotamiton can help with mild itching that is not accompanied by significant inflammation. If symptoms persist or worsen beyond four weeks after treatment, or if new burrows or a rash develop, it is advisable to seek further medical evaluation.
Preventing Spread and Re-infestation
Preventing the spread of scabies and avoiding re-infestation is important for lasting results. All close contacts of an infested individual, including household members, should be treated simultaneously, even if they do not show symptoms. This synchronized treatment helps prevent a cycle of re-exposure.
Environmental measures are also necessary to eliminate mites that may have fallen off the body. All clothing, bedding, and towels used by the infested person and their close contacts during the three days prior to treatment should be machine washed. Washing these items in hot water (exceeding 50°C/122°F for at least ten minutes) and then drying them on a high heat setting effectively kills mites and their eggs.
Items that cannot be washed or dry-cleaned, such as stuffed animals or non-washable rugs, should be sealed in a plastic bag for at least 72 hours (three days) or up to a week. This duration is effective because scabies mites do not survive for more than two to three days away from human skin. Vacuuming carpets, rugs, and upholstered furniture is recommended, especially in cases of crusted scabies, and vacuum bags should be disposed of afterward.