Pharmacy Practice IV

Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.

Scabies // Page 1 of 4
Scabies

1. Latin word scabere means scratch
2. Scabies is not the same as lice, although the treatment
may be the same
3. Infestation of the skin with the microscopic mite Sarcoptes
scabiei:
a. Eight-legged parasites
b. Tiny, just 1/3 millimeter long
c. Not visible with the naked eye, although sometimes they are
visible as a pinpoint of white
d. Visible with a magnifying glass or microscope
e. If not on human skin does not live long (few days)
f. On human skin live up to one month
4. Common worldwide, affects people of all races, social classes and personal hygiene

Signs and Symptoms

1. Symptoms may take 4 - 6 weeks to show
2. Intense, severe and continuous itchy
a. Because mites move within and on the skin. Female burrow into
the top layer of human skin to lay their eggs. Burrow is short S-
shaped track that indicates the mite's movement under the skin.
The presence of the eggs and waste produces a massive allergic
response which produces more itching. The eggs mature in 21
days, and the new mites work their way to the surface of your
skin, where they mature and can spread to other areas of your
skin or to the skin of other people
b. Clue, especially if several members of the same family have same signs
c. First weeks, the itch is subtle, gradually becomes more intense. After a month or two, sleep becomes
almost impossible
d. Worse at night, at least in part because there is not much going on to distract people from thinking
about it
3. Small insect-type bites. Lesions may look like pimples. It may also be red and crusty due
to scratching of the area
a. Over most part of body mostly webs between fingers or toes, the buttocks, the elbows, the genital
area, under the breasts in women, armpits, around the waist, along wrists, back elbows, groin, around
the male genital, knees, shoulder blades
4. Burrow may be visible
5. The face usually does not become involved in adults
Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Scabies // Page 2 of 4
How Infestation Occurs / Who At risk

1. Highly contagious. Transmitted readily if there is close skin-to-skin contact household
members, sexual contact, hugging
2. Prolonged contact. Quick handshake or hug will usually not spread infestation
3. Spreads rapidly under crowded conditions such as in hospitals, institutions, child-care
facilities, and nursing homes
4. Elderly and weakened people in nursing homes and similar institutional settings may
have scabies without significant itching or visible signs. Thus can lead to widespread
epidemics among patients and health workers. [Furthermore, in normal conditions, it
takes approximately 4-6 weeks to develop symptoms after initial infestation]
5. Spread by clothing, bedding, or towels is a less significant risk, though possible
6. Pets. Pets become infested with a different kind of scabies mite (mange). Can transiently
affect human. Mite dies in a couple of days and does not reproduce. Do not need to be
treated. Until your pet is successfully treated, mites can continue to burrow into your
skin and cause you to have symptoms

Diagnosis

1. Scabies is frequently misdiagnosed as intense pruritus before papular eruptions form.
Distinctive its relentless quality, at least after several weeks. Other itchy conditions like
eczema tend to wane
2. Most can be diagnosed by describing the symptoms and on examination of the skin
3. Finding the burrows. Burrows sometimes appear as short, wavy, reddish, or darkened
lines on the skin's surface, especially around the
wrists and between the fingers. Difficult because
they are scarce, because they are obscured by
scratch marks, or by secondary dermatitis
4. Skin scraped and placed under microscope and
looked for presence of mite or its eggs. Typically,
there are fewer than 10 mites on the entire body of
an infested person infestation can be missed
5. The suspicious area can be rubbed with ink from a
fountain pen or alternately a topical tetracycline solution which will glow under a special
light. The surface is then wiped off with an alcohol pad; if the person is infected with
scabies, the characteristic zigzag or S pattern of the burrow across the skin will appear
Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Scabies // Page 3 of 4

Treatment - Medicines

1. Scabies will not go away on its own
2. Anyone with scabies, sexual partners and persons who have close, prolonged contact to
the infested person should also be treated at the same time
3. Best solution - cream or lotion to kill the mites
a. Applied to the skin all over the body (neck down), not just the affected area
b. Must remain on the skin for 8 to 12 hours before it can be washed off
c. Do not apply to eyes, face, or mucous membranes
d. After applying it, don't wash your hands scabies mites love the area between the fingers
e. Repeat 7 10 days later
f. Permethrin (A-scabs): not carcinogenic and teratogenic (animals). This is safe for use in children as
young as two months
g. Malathion applied for 24 hours effective in killing adult mites and eggs
h. Crotamiton (Eurax)
i. Lindane. When others have failed or contraindicated
can cause seizures if absorbed through the skin. Lindane should be washed off with warm,
and not hot, water to avoid absorption through the skin
not very safe in children and may cause neurotoxicity (dizziness, seizures)
not be used in pregnant or nursing women
should not be used if skin is significantly irritated or wet, such as with extensive skin
disease, rash, or after a bath
4. A single dose of ivermectin (broad spectrum anti-parasites, not yet available in Malaysia)
has been reported to cure scabies
a. Study found no statistically-significant differences in effectiveness between lindane and ivermectin
b. Has not been shown to be superior to permethrin in eradicating scabies
c. Although more convenient than cream, ivermectin has a greater risk of toxic side effects than
permethrin
5. Antihistamine relieve the itching. Itching may continue for days or weeks, and does
not mean that you are still infested. If the treatment is effective there should be no new
rashes or burrows after 24 to 48 hours
6. Cream hydrocortisone, etc to relieve itching and help the rash go away faster
7. Lotion calamine lotion relieve mild itchiness
8. Pregnant women and children use milder scabies medications. 10% sulfur can be used
in pregnant women and infants under two months of age. (Effectiveness?)

Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Scabies // Page 4 of 4
Treatment Nonpharmacological / Prevention

1. Difficult to prevent or avoid scabies once someone close to you has scabies. Once a close
contact or family member has been diagnosed with scabies, everyone should be treated
at the same time
2. Mites surface at times, especially at night. They can be washed or scratched off (should
be done with a washcloth to avoid cutting the skin, therefore infection). Not a cure but
helps to keep the total population low
3. Cleaning should be done simultaneously. Should include:
a. Vacuuming floors, carpets, and rugs
b. Disinfecting floor and bathroom surfaces by mopping
c. Without a host, scabies mites can on average survive up to 48-72 hours away from human skin.
Therefore it is recommended to wash in hot water all material (such as clothes, bedding, and towels)
that has been in contact with all infested persons in the last three days
d. Overnight freezing, in a plastic bag: stuffed animals, brushes, combs, shoes, coats, gloves, hats,
robes, wetsuits, etc.
e. Dry cleaning: things that cannot be washed, hot dried or frozen or quarantined
f. Starve the mites by quarantining in a plastic bag for two weeks: things that cannot be washed, hot
dried, frozen or dry-cleaned
g. Cut your nails and clean under them thoroughly to remove any mites or eggs that may be present

When to seek medical advice

1. Vigorous scratching can break your skin and allow a secondary bacterial infection such as
impetigo - usually staph (staphylococci) bacteria or occasionally by strep (streptococci)
bacteria. Needs antibiotic:
a. Cream non-prescription
b. Oral - prescription
2. In persons with severely reduced immunity, such as those with HIV infection, or people
being treated with immunosuppressive drugs like steroids, a widespread rash with thick
scaling may result. This variety of scabies is called Norwegian scabies






This article is for educational purpose only. The writer welcomes any feedback, which may be sent to
ibrahim.lecturer@gmail.com