Scabie Ladies

Scabie Ladies – An Ode to Scabies

In general, my goal is to make memorable videos that answer questions that I get each day in practice.  However, this isn’t one of those videos. . .

The story: An anonymous relative acquired scabies from an unnamed source and then gave it to some undisclosed family members.  When my wife asked me to look at the rash (I love when she does that), I actually initially missed the diagnosis because I don’t see the rash very frequently and there were no markings early on.  Eventually when the marks showed up and other family members developed the same symptoms, the rash was diagnosed as scabies.  The Ultimate G – my wife’s younger brother – was not one of those family members who acquired “the itch”; however, he was inspired enough by the experience to forever memorialize it with the line:

Scabie ladies lay their babies
In your skin
It’s a little bit crazy

Yes, I know, “scabie” isn’t a word.  But it flows so much more nicely in the song, doesn’t it?   Together we made the song into a video, allowing me to learn how to use “the Brady Bunch effect” (simultaneous videos) while trying to get my kids to lip synch something approximately similar to the line above (you may notice my daughter singing “itchy, itchy, scratchy, scratchy” in the audio).

Here is the rap – also written by the Ultimate G:

Hey these scabies been cravin’ me lately
Matin’ and making babies and making me crazy
Yeah, it does faze me, itchin’ all day,
Seems that there here to stay,
Eek, oh no, go away please,
Scabies

Anyway, on to the education. . .

The word “scabies” is actually derived from latin for “the itch or scratch.”   It refers to a really itchy rash caused by sarcoptes scabeiei, a mite so small that it is scarcely visible.  The females like to burrow into the skin, lay a few eggs a day for while, then die.  The larvae hatch in 3-4 days to continue the circle of life – in your skin!

The symptoms usually emerge about 3-6 weeks after the initial contact (the amount of time that it takes your body to build up an immune response) – although if you’ve had it before, you can have symptoms within 1-3 days.  The intense itchiness – often worst at night – is caused by your body’s immune response to the mite, its feces and its eggs.  The response to the scabies is similar to your body’s response to poison ivy.

The rashes can present in various forms (feel free to google “scabies” for all sorts of gross pictures).  Classically, a person will have small, red bumps and scratches – sometimes with crusting and a little bit of discharge from scratching.  More difficult to find are the mite’s burrows – a thin gray/red/brown line from 2 to 15 mm long.  More rarely people can have blisters, pustules and bacterial infections overlying the initial lesions.  The lesions are classically found in skin folds (in the groin/armpits/sides and webs of fingers) and arms, legs and feet; they can be found almost everywhere although the back and head are usually spared (except in infants).

Usually, you get it from contact with the people you live with; the casual contacts in school and work are usually insufficient for transmitting scabies.   It is rare, but not impossible, to contract scabies from sheets or clothing – usually when the quantity of mites is rather high.   Animal lovers will be happy to know that the species of mite that infests dogs and cats rarely causes significant infection in humans – however, my veterinarian friend tells me that the species that infects some larger animals (such as goats) can cause significant itchiness in humans.

Usually, the diagnosis can be made simply based on the presence of a very itchy rash, often with itchiness that is more severe than the actual rash that can be seen, the classic findings of the rash (skin fold involvement etc.) and/or other family members with similar symptoms.  Occasionally, a clear diagnosis may require a microscopic examination of the marks on the skin, a scraping of the skin or a sample of skin removed with clear adhesive tape.  Sometimes, the rash may appear similar to fungal rashes, eczema, seborrheic dermatitis or other rashes – so the diagnosis may require further questioning and examination for clarification.

The treatment is usually 5% permethrin cream applied to the entire body (especially under the nails; usually the head can be spared in toddlers and above) before bed and then washed off in the morning.   A second application in 1-2 weeks can increase the likelihood of eradication.  Other treatments include oral ivermectin or other creams.  More severe scabies (crusted scabies) requires more complex treatment regimens and a non-internet pediatrician (so I will avoid that topic for now).  To avoid a vicious cycle of infection and reinfection – all family members shall be treated to eliminate any scabies that they may not know about.

Because the mites can only live for 2-3 days away from human skin – the only items that require cleaning are those that have been used in the previous 2-3 days.  They can be put in a plastic bag for a few days (until the mites die), washed and dried (hot!) or dry-cleaned.  Otherwise, no intensive cleaning is needed.

So there you go.   Hopefully, you will never need this knowledge.  But if you do, I’m glad I was here for you!

This information was primary derived from the www.uptodate.com article on Scabies – obtained on March 9, 2012.  The images are from the www.wikipedia.org article on Scabies – obtained March 10, 2012.  The image on the homepage is from http://www.dermeducation.com/Scabies.html – thanks Dr. White!

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