Scabies is caused by the Sarcoptes scabiei mite. It is highly contagious and affects people worldwide, spreading through direct prolonged skin contact. Symptoms include intense itching and a pimple-like rash typically located in skin folds. Diagnosis is usually clinical based on symptoms and distribution of rash, but microscopes can be used to identify mites, eggs or feces from skin scrapings. Treatment involves topical creams or lotions.

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SCABIES
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INTRODUCTION
Sarcoptes scabiei
Sarcoptes scabiei, otherwise known as scabies, is a highly contagious infestation of microscopic
mites that affect humans and animals alike. Contracting scabies is more common then one may
think, and occurs worldwide. No one is safe from an infestation of scabies because it can affect
any race or social class. Scabies can also spread at a rapid pace, and this usually occurs in
crowded areas where there is a chance of prolonged contact. (Bandyopadhyay).
History of Scabies

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o Scabies dates back about 2500 years ago (Scabies Homepage),
and was documented all over Europe; however, it wasn’t known
as scabies to those who experienced it. In these eras it was
known as the “itch”. (Ramos).
o In earlier times scabies was commonly found among the poor
who exhibited bad hygiene, but some of the wealthiest people
also experienced encounters. In fact, Napoleon I was said to have suffered from the “itch”
his whole life. (Ramos).
o In 1687 an Italian man named Giovanni Cosimo Bonomo had finally discovered the mite
responsible for the inflictions. He came across a person who was itching a lot and broke
open one of the pustules. He then took the remnants of what was inside the pustule and
examined it under a microscope. He did this numerous times to different people, of
different ages, and different times of the year getting the
same result each time. (Ramos).
o Bonomo studied his findings until he was satisfied and
then wrote a letter to Francesco Redi who later published
in a book the discovery of scabies. (Ramos).
o Until Bonomo’s remarkable discovery of this flesh eating
mite, people suffered uncontrollable itching and much
distress.
o The treatment Bonomo found effective was a local therapy, sulphur, which was used up
until now. He also realized that the local treatment had to be applied for up to two or
three days after the itching subsided because un-hatched eggs could hatch and restart the
cycle. (Ramos).
Different Types of Scabies
o Clean Man’s Scabies: This is seen in individuals who bathe regularly, and keep very
clean. In this case, the lesions are minimal and hard to see. Itching tends to be not as
intense. (Babu, 2006).

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o Infant Scabies: This occurs in babies and young children, and is often misdiagnosed or
mistreated. Scabies will affect the whole body of the child, and there will be a large
amount of pustules. (Babu, 2006).
o Scabies Incognito: Normally, if a strong type of treatment, such as steroids, are applied
then the scabies are masked and the lesions are suppressed. (Babu, 2006).
o Norwegian Scabies: This is an intense case of crusted scabies. In this case, there can be
up to hundreds or thousands of mites within the lesions. This occurs commonly in
autoimmune deficient individuals, or people who are mentally challenged. (Babu, 2006).
o Animal Scabies: Animals are susceptible to scabies too. Domestic pets that contract
scabies are liable to pass it on to the other members of the household as well. (Babu,
2006).
Physical Features
o Scabies are a certain type of mite. Mites are related to the arachnid family the same as
ticks and spiders.
(Drisdelle).
o Scabies
are creamy white
with brown legs and
mouthparts. “Sarcoptes scabiei type hominis”, 2008.
o The adult female is about 0.4 mm long and 0.3 mm wide. The adult male
is smaller in both dimensions by one third. Also need a microscope to
actually see the mite itself. “Sarcoptes scabiei type hominis”, 2008.

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o They have no armor, no trachea, and no eyes. (Speare, 2008).
o Scabies mites have no respiratory system. They breathe through the skin. (Drisdelle).
o They can be very mobile when not inside a host. (Speare, 2008).
o They have 8 legs with the two in the front as walking legs. (Speare, 2008).
o Scabies have “suckers” that allow them to attach to surfaces to walk upwards. (Speare,
2008).

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Reproduction
o The female mite finds a host and burrows down into his or her skin.
o As the female is burrowing through the host’s skin she leaves a trail of eggs. She can
leave two to three eggs a day for up to two months. (Gould, 2009).
o The eggs will then hatch about four days after they are laid. The new larvae grow and
shed their outer coat about two times and then become adults. (Gould, 2009).
o After fully grown the adult mites burrow through the skin to the surface to find a mate.
(Gould, 2009).
o Males do not dig burrows. Instead, they stay on the skin’s surface waiting for females to
mate with. (Gould, 2009).
o After the females mate they return inside the skin where they continue to burrow and lay
eggs. Then the process starts all over again. (Drisdelle, 2007).
o The entire life cycle of the mites are 10-14 days, and usually
they live for about 30 days. (Gould, 2009).

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Transmission
Scabies can be picked up by several different ways.
o Most commonly is direct prolonged body-to-body contact. This occurs in homes between
family members. Even more commonly between people who share beds or are sexual
partners. “Scabies Frequently Asked Questions”, 2010.
o Sharing clothing or bedding is another form of transmission, but not as common. (Gould,
2009).
o An individual who has scabies, but isn't exhibiting symptoms can still spread them
without knowing. “Scabies Frequently Asked Questions”, 2010.
o Most common place to contract scabies is:

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Signs and Symptoms
o Most common symptom is severe itching also known as pruritus. The itching tends to get
worse at night or after hot showers. “Sarcoptes scabiei type hominis”, 2008.
o May have a pimple-like rash that can affect most of the body or be limited to common
sites such as:

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o The head, face, neck, palms, and soles are
common sites for infants that contract
scabies. “Scabies Frequently Asked
Questions”, 2010.
o Symptoms don’t usually show up until two to
six weeks after contracted; however, if
someone has been re-infested then symptoms
can show up in a week. (Gould, 2009).
o In individuals with weakened immune
systems mites tend to be present in large
amounts, which is commonly known as
Norwegian Scabies. “Scabies Frequently
Asked Questions”, 2010.
Pathogenesis
o F (within 20 min) burrows into the stratum corneum (traverses at a rate of 0.5 - 5
mm/day)
o avoid areas with a high density of pilosebaceous follicles
o Mating takes place once, and the female is fertile for the rest of her life (1 mo),
o Copulation in a small burrow---------the male, falls off the skin & perishes---------
Fertilized female enlarges the burrow using proteolytic enzymes to dissolve the stratum
corneum of the epidermis ----- begins egg laying (3 eggs a day each)
o Six-legged larvae emerge from the eggs after 3-4 days
o 90% of the hatched mites die
o Escape from the burrow by cutting through its roof------then dig short burrows called
moulting pouches & transform into nymphs-------------After further moult into larger
nymphs , adult males and females develop(in 2-3 weeks)

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Clinical features
o IP- 2-6 weeks
o immediate symptoms –in re infection
o Triad`s
o Pruritic papular lesions,
o Excoriations, and
o Burrows
o Site- The circle of Hebra ~ an imaginary circle intersecting the main sites of involvement
- axillae, elbow flexures, wrists & hands, & crotch
Pruritis
o accentuate at night & exacerbated by a hot bath or shower

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 Primary lesions of scabies
o burrows, papules, pustules, nodules, occasionally urticarial papules and plaques
 interdigital webbing of the hands,
 flexural aspect of the wrists, behind the ears, axilla, waist, ankles, feet, buttocks & belt
area
 penile & scrotal in men, areola, nipples & genital area in women
 In very young children, infants, elderly and immunocompromised hosts, a widespread
eczematous eruption primarily on the trunk is common , scalp & face can also be
affected.

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The burrow
 pathognomonic sign and represent the
 intraepidermal tunnel created by the
 moving female mite.
 a 1-10 mm tunnel
 serpiginous, greyish-white
 thread-like elevations
 At the end of it a vesicle/pustule containing
 the mite may be noted, especially in infants & children
 at entry, slight scale
In infants, commonly located on
 the palms & soles : F
 To identify burrows quickly:
 apply a drop of India ink or
gentian violet to the infested area,
 remove it with alcohol
 Thin threadlike burrows retain
the ink
Erythematous Papules & Vesicles (filled with serous fluid) rarely contain mites and most likely
are due to a hypersensitivity reaction
 Papules= on the shaft of the penis & scrotum in men
 & on nipples in women
Vesicles= on the palms & soles
Animal Scabies: Zoonotic scabies
o affect humans who come in close contact with the animal
o incubation period is shorter, the symptoms are transient

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o usually manifests with vesicles & papules with atypical distribution
o Burrows are usually absent
o runs a self-limited course, require no treatment
o Mites from animals are not a source of human infestation, but they can
produce bite reactions
Asymptomatic infestation
o not uncommon
o considered ‘carriers’

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Complications
o Secondary impetiginization
o Lymphangitis & septicemia ~ particularly in crusted scabies
o Post-streptococcal glomerulonephritis
o 'post-scabietic pruritus‘
a. represent the body's response to dead mites that are eventually sloughed off
(within 4 wks) along with natural epidermal exfoliation
b. Tx- antihistamines or a short course of topical or oral corticosteroids
Diagnosis
o Mainly clinical
a. Pruritus with typical lesions & distribution
b. Contact Hx
o Microscope
a. Skin scrapings obtained from the finger webs, wrists, or ankles is most likely to
be positive
b. In Norwegian scabies, scraping of the thick scales will often yield several viable
mites(100)
c. Excoriated lesions are often negative
Dermoscopy
PCR
Biopsy

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H/p
 A patchy to diffuse infiltrate with eosinophils is noted in the reticular dermis
 On transection, a scabies mite may occasionally be seen within the epidermis
o fragments of the adult mite exoskeleton
o serve as a clue to the Dx when mites, scybala or eggs are not identified
Treatment
 Age
 cost
 severity
 previous treatment status
 In infants with extensive involvement, several re treatments a week apart occasionally
be required
 second application of topical medication.......
 Treat simultaneously all household contacts (even with no symptoms)

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