Scabies
Scabies is a contagious human skin infestation by the tiny mite Sarcoptes scabiei, variety hominis. The word is from. It is a particular public health problem in crowded settings such as care homes, schools, refugee camps, prisons, and hospitals. The most common symptoms are severe itchiness and a pimple-like rash. Occasionally, tiny burrows may appear on the skin from eggs that are about to hatch. In a first-ever infection, the infected person usually develops symptoms within two to six weeks. During a second infection, symptoms may begin within 24 hours. These symptoms can be present across most of the body or just in certain areas such as the wrists, between fingers, or along the waistline. The head may be affected, but this is typically only in young children. The itch is often worse at night. Scratching may cause skin breakdown and an additional bacterial infection in the skin.
Various names have been given to this condition and the name 'seven year itch' has been recorded in many documents from the 1800s. Although the 1952 play The Seven Year Itch and modern treatment methods have generally changed this name to refer to human relationships, the condition was historically very difficult to treat.
Scabies is caused by infection with the female mite Sarcoptes scabiei var. hominis, an ectoparasite. The mites burrow into the skin to live and deposit eggs. The symptoms of scabies are due to an allergic reaction to the mites. Often, only between 10 and 15 mites are involved in an infection. Scabies most often spreads during a relatively long period of direct skin contact with an infected person such as that which may occur during sexual activity or living together. Spread of the disease may occur even if the person has not developed symptoms yet. Crowded living conditions, such as those found in child-care facilities, group homes, and prisons, increase the risk of spread. Areas with a lack of access to water also have higher disease rates. Crusted scabies is a more severe form of the disease, not essentially different but an infestation by huge numbers of mites that typically only affects those with a poor immune system; the number of mites also makes them much more contagious. In these cases, the spread of infection may occur during brief contact or by contaminated objects. The mite is tiny and at the limit of detection with the human eye. It is not readily obvious; factors that aid in detection are good lighting, magnification, and knowing what to look for. Diagnosis is based either on detecting the mite, detecting typical lesions in a typical distribution with typical histological features, or detecting atypical lesions or atypical distribution of lesions with only some histological features present.
Several medications are available to treat those infected, including oral and topical ivermectin, permethrin, crotamiton, and lindane creams. Sexual contacts within the last month and people who live in the same house should also be treated at the same time. Bedding and clothing used in the last three days should be washed in hot water and dried in a hot dryer. As the mite does not live for more than three days away from human skin, more washing is not needed. Symptoms may continue for two to four weeks following treatment. If after this time symptoms continue, retreatment may be needed.
Scabies is one of the three most common skin disorders in children, along with ringworm and bacterial skin infections. As of 2015, it affects about 204 million people. It is equally common in both sexes. The young and the old are more commonly affected. It also occurs more commonly in the developing world and tropical climates. Other animals do not spread human scabies; similar infection in other animals is known as sarcoptic mange, and is typically caused by slightly different but related mites.
Signs and symptoms
The characteristic symptoms of a scabies infection include intense itching and superficial burrows. Because the host develops the symptoms as a reaction to the mites' presence over time, typically a delay of four to six weeks occurs between the onset of infestation and the onset of itching. Similarly, symptoms often persist for one to several weeks after successful eradication of the mites. As noted, those re-exposed to scabies after successful treatment may exhibit symptoms of the new infestation in a much shorter period—as little as one to four days.Itching
In the classic scenario, the itch is made worse by warmth and is usually experienced as being worse at night, possibly because distractions are fewer. As a symptom, it is less common in the elderly.Rash
The superficial burrows of scabies usually occur in the area of the finger webs, feet, ventral wrists, elbows, back, buttocks, and external genitals. Except in infants and the immunosuppressed, infection generally does not occur in the skin of the face or scalp. The burrows are created by the excavation of the adult mite in the epidermis. Acropustulosis, or blisters and pustules on the palms and soles of the feet, are characteristic symptoms of scabies in infants.In most people, the trails of the burrowing mites are linear or S-shaped tracks in the skin, often accompanied by rows of small, pimple-like mosquito or insect bites. Lesions are symmetrical and mainly affect the hands, wrists, axillae, thighs, buttocks, waist, soles of the feet, areola, and vulva in females, and penis and scrotum in males. The neck and above are usually not affected, except in cases of crusted scabies and infestations of infants, the elderly, and the immunocompromised. Symptoms typically appear two to six weeks after infestation for individuals never before exposed to scabies. For those having been previously exposed, the symptoms can appear within several days after infestation. However, symptoms may appear after several months or years.
Crusted scabies
The elderly, disabled, and people with impaired immune systems, such as those with HIV/AIDS, cancer, or those on immunosuppressive medications, are susceptible to crusted scabies. On those with weaker immune systems, the host becomes a more fertile breeding ground for the mites, which spread over the host's body, except the face. The mites in crusted scabies are not more virulent than in noncrusted scabies but are much more numerous, sometimes up to two million. People with crusted scabies exhibit scaly rashes, slight itching, and thick crusts of skin that contain large numbers of scabies mites. For this reason, persons with crusted scabies are more contagious to others than those with typical scabies. Such areas make eradication of mites particularly difficult, as the crusts protect the mites from topical miticides/scabicides, necessitating prolonged treatment of these areas.Cause
Scabies mite
In the 18th century, Italian biologists Giovanni Cosimo Bonomo and Diacinto Cestoni described the mite now called Sarcoptes scabiei, variety hominis, as the cause of scabies. Sarcoptes is a genus of skin parasites and part of the larger family of mites collectively known as scab mites. These organisms have eight legs as adults and are placed in the same phylogenetic class as spiders and ticks.S. scabiei mites are under 0.5 mm in size; they are sometimes visible as pinpoints of white. Gravid females tunnel into the dead, outermost layer of a host's skin and deposit eggs in the shallow burrows. The eggs hatch into larvae in three to ten days. These young mites move about on the skin and molt into a "nymphal" stage, before maturing as adults, which live three to four weeks in the host's skin. Males roam on top of the skin, occasionally burrowing into the skin. In general, the total number of adult mites infesting a healthy hygienic person with non-crusted scabies is small, about 11 females in burrows, on average.
The movement of mites within and on the skin produces an intense itch, which has the characteristics of a delayed cell-mediated inflammatory response to allergens. IgE antibodies are present in the serum and the site of infection, which react to multiple protein allergens in the body of the mite. Some of these cross-react to allergens from house dust mites. Immediate antibody-mediated allergic reactions have been elicited in infected persons, but not in those not infected; immediate hypersensitivity of this type is thought to explain the observed far more rapid allergic skin response to reinfection seen in persons who have been infected previously, especially within the previous year or two.
Transmission
Scabies is contagious and can be contracted through prolonged physical contact with an infested person. This includes sexual intercourse, although a majority of cases are acquired through other forms of skin-to-skin contact. Less commonly, scabies infestation can happen through the sharing of clothes, towels, and bedding, but this is not a major mode of transmission; individual mites can survive for only two to three days, at most, away from human skin at room temperature. As with lice, a latex condom is ineffective against scabies transmission during intercourse, because mites typically migrate from one individual to the next at sites other than the sex organs.Multiple transmission factors allow scabies to achieve very high prevalence rates in institutional outbreaks, including crowded living conditions with high host density, social interactions involving prolonged skin-to-skin contact, sharing of bedding and clothing, frequent manual handling, limited access to laundry services, and immunocompromised populations. Healthcare workers are at risk of contracting scabies from patients, because they may be in extended contact with them.
Pathophysiology
The symptoms are caused by an allergic reaction of the host's body to mite proteins, though exactly which proteins remains a topic of study. The mite proteins are also present in the gut, and in mite feces, which are deposited under the skin. The allergic reaction is both of the delayed and immediate type, and involves IgE. The allergy-type symptoms continue for some days, and even several weeks, after all mites are killed. New lesions may appear for a few days after mites are eradicated. Nodular lesions from scabies may continue to be symptomatic for weeks after the mites have been killed.Rates of scabies are negatively related to temperature and positively related to humidity.