Scabies – The itchy problem

Scabies is a contagious illness, causing much itching and embarrassment to the sufferer. It occurs commonly in the poor underprivileged people due to overcrowding. But the affluent people are not totally exempt. If exposed, they are also vulnerable to develop this sickness. People with reduced immunity like diabetic patients, those suffering from HIV/AIDS, renal failure or malignancy are more susceptible to develop scabies. Underlying cause for scabies is a tiny parasite called sarcoptes scabiei. Human beings and animals both are affected, though the species infecting people is different from that of animals. It burrows under the skin of the person and causes intense itching due to allergic reaction. This reaction occurs due to movement of the parasite under the skin, which occurs more in the night. Along with itching there may be small eruptions like mosquito bites. Once it starts, usually the infection becomes generalized and itching occurs all over the body, except the face and neck in adults. In young children even the face and neck become affected. Lesions are more on hairless parts of the skin like webs of fingers, below breasts, e.t.c. In immune depressed individuals, there are severe lesions with crusting called as, ‘Norwegian scabies”. Rarely a person may get only mild infection which manifests in the form of a localized lesion in some part of the body. High suspicion helps in diagnosis of this type of scabies.The intense itching causes a person to scratch with his nails. This carries the risk of causing superadded bacterial infection in the form of boils, which adds to the suffering of the affected person. Once super infection occurs, it can also lead to fever and sepsis. When an individual is infested by this parasite, symptoms develop after 2 to 4 weeks. The infection spreads from one person to another due to close physical contact. Many researchers have grouped scabies as one of the sexually transmitted diseases due to sexual contact also being one of the ways of spread of the disease. Infected mattresses, other bedding and shared clothes are other sources of infection. For this reason an entire family is liable to get affected by scabies at the same time. A person may get treated but if infection persists in his close contacts, he can easily get re-infected within 24 hours. Scabies is differentiated from other skin infections by the typical skin lesions. It is confirmed by microscopic demonstration of the parasite or its eggs and larvae from skin scrapings. Good personal hygiene is vital to prevent scabies. Treatment is by local application of agents which kill sarcoptes scabiei like permethrin, benzyl benzoate, gammexin, e.t.c. These topical agents have to be applied for 12 to 24 hours after a thorough bath. Bath should consist of a, “rub and scrub”, i.e. the skin should be scrubbed very well. This helps in destroying the parasites. One should avoid strong soaps and very hot water for bathing, as that would aggravate the irritation of the skin and increase discomfort of the person. Antiseptic soaps like sulphur or margosa soaps are beneficial. All the bed clothes should be washed thoroughly with warm water. Then it needs to be dried out in hot sun or ironed very well. This will disinfect it scrupulously. It is important that all family members or close contacts take treatment for scabies at the same time, otherwise treated members often get relapse of the illness. The sickness spreads from one family member to another and by the time this person is treated, the first member may again get infected. Thus like a ball game, the infection keeps on recurring. At times mass treatment may be done at community level to eradicate the infection spread in a close community. Educating the public about scabies, and emphasis on importance of good hygienic measures will go a long way in reducing the prevalence and spread of scabies in the community. rachna212002@yahoo.co.uk