Scabies
Symptoms
Scabies presents with intense itching, especially at night, and small red bumps or burrows in finger webs, wrists, armpits, waistline, and genital areas. Scratching leads to open wounds and secondary infection. Nodular scabies produces firm reddish nodules on the scrotum or axillae. Crusted (Norwegian) scabies features thick hyperkeratotic crusts and minimal itching in immunocompromised hosts. Household members often report similar symptoms.
Cause
Infestation with the mite Sarcoptes scabiei var. hominis occurs through prolonged skin contact or shared bedding and clothing. Mites burrow into the skin, laying eggs and triggering a hypersensitivity reaction. Symptoms manifest after a 2‑6 week incubation in first infections. Crowded living conditions facilitate outbreaks. Crusted scabies contains a heavy mite burden, increasing contagion.
Treatment
Topical permethrin 5% cream applied overnight from neck to toes and repeated in one week is first‑line. Oral ivermectin treats crusted or refractory cases and facilitates institutional outbreak control. All close contacts should be treated simultaneously, even if asymptomatic. Bedding and clothing must be washed in hot water or sealed for 72 hours. Antihistamines and topical steroids relieve residual itch after mite eradication.
Dr. Beth Schulz-Butulis
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