SCABIES, previously known as the SEVEN-YEAR ITCH, is a contagious
skin infestation by the mite
Sarcoptes scabiei . The most common
symptoms are severe itchiness and a pimple -like rash. Occasionally,
tiny burrows may be seen in the skin. In a first ever infection a
person will usually develop symptoms in between two and six weeks.
During a second infection symptoms may begin in as little as 24 hours.
These symptoms can be present across most of the body or just 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 of the skin.
Scabies is caused by infection with the female mite Sarcoptes scabiei
var. hominis . 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
Scabies is most often spread during a relatively long
period of direct skin contact with an infected person (at least 10
minutes) such as that which may occur during sex. Spread of 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 rates of disease. Crusted scabies is
a more severe form of the disease. It typically only occurs in those
with a poor immune system and people may have millions of mites,
making them much more contagious. In these cases, spread of infection
may occur during brief contact or by contaminated objects. The mite
is very small and usually not directly visible. Diagnosis is based on
the signs and symptoms.
A number of medications are available to treat those infected,
including permethrin , crotamiton , and lindane creams and ivermectin
pills. 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 (2.8% of the world population). 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 . The word scabies is from Latin :
scabere, "to scratch". Other animals do not spread human scabies.
Infection in other animals is typically caused by slightly different
but related mites and is known as sarcoptic mange .
* 1 Signs and symptoms
* 1.1 Itching
* 1.3 Crusted scabies
* 2 Cause
* 2.2 Transmission
* 3 Pathophysiology
* 4 Diagnosis
* 5 Prevention
* 6 Management
* 6.3 Others
* 6.4 Communities
* 7 Epidemiology
* 8 History
* 9 Society and culture
* 10 Other animals
* 11 Research
* 12 References
* 13 External links
SIGNS AND SYMPTOMS
Commonly involved sites of rashes of scabies
The characteristic symptoms of a scabies infection include intense
itching and superficial burrows. The burrow tracks are often linear,
to the point that a neat "line" of four or more closely placed and
equally developed mosquito-like "bites" is almost diagnostic of the
disease. 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.
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
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 excavation of the adult mite in the
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. These signs are often found in
crevices of the body, such as on the webs of fingers and toes, around
the genital area, in stomach folds of the skin, and under the breasts
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
Acropustulosis , or blisters and pustules on the palms and
soles of the feet, are characteristic symptoms of scabies in infants.
Scabies of the foot
Scabies of the arm
Scabies of the hand
Scabies of the finger
Crusted scabies in a person with
The elderly, disabled, and people with an impaired immune system ,
HIV , cancer , or those on immunosuppressive medications , are
susceptible to crusted scabies (formerly called Norwegian 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; however, they are much more numerous (up
to two million). People with crusted scabies exhibit scaly rashes,
slight itching, and thick crusts of skin that contain the large
numbers of scabies mites. Due to being infected thusly, persons with
crusted scabies are more contagious to other persons. Such areas
make eradication of mites particularly difficult, as the crusts
protect the mites from topical miticides/scabicides, necessitating
prolonged treatment of these areas.
Sarcoptes scabiei Play media Video of the
Sarcoptes scabiei mite Life cycle of scabies
In the 18th century, Italian biologist
Diacinto Cestoni (1637–1718)
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 (
Arachnida ) as spiders and ticks.
S. scabiei mites are under 0.5 mm in size, but are sometimes visible
as pinpoints of white. Gravid females tunnel into the dead, outermost
layer (stratum corneum ) 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 noncrusted 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 (wheals) have been elicited in infected persons, but not in
healthy persons; immediate hypersensitivity of this type is thought to
explain the observed far more rapid allergic skin response to
reinfection seen in persons having been previously infected
(especially having been infected within the previous year or two).
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 only survive
for 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
Healthcare workers are at risk of contracting scabies from patients,
because they may be in extended contact with them.
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 from the gut, in mite feces, which
are deposited under the skin. The allergic reaction is both of the
delayed (cell-mediated) and immediate (antibody-mediated) type, and
IgE (antibodies, it is presumed, mediate the very rapid
symptoms on reinfection). The allergy-type symptoms (itching)
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 were negatively related to temperature and
positively related to humidity.
A photomicrograph of an itch mite (S. scabiei)
Scabies may be diagnosed clinically in geographical areas where it is
common when diffuse itching presents along with either lesions in two
typical spots or itchiness is present in another household member.
The classical sign of scabies is the burrow made by a mite within the
skin. To detect the burrow, the suspected area is rubbed with ink
from a fountain pen or a topical tetracycline solution, which glows
under a special light. The skin is then wiped with an alcohol pad. If
the person is infected with scabies, the characteristic zigzag or S
pattern of the burrow will appear across the skin; however,
interpreting this test may be difficult, as the burrows are scarce and
may be obscured by scratch marks. A definitive diagnosis is made by
finding either the scabies mites or their eggs and fecal pellets.
Searches for these signs involve either scraping a suspected area,
mounting the sample in potassium hydroxide and examining it under a
microscope, or using dermoscopy to examine the skin directly.
Symptoms of early scabies infestation mirror other skin diseases,
including dermatitis , syphilis , erythema multiforme , various
urticaria -related syndromes, allergic reactions, ringworm-related
diseases, and other ectoparasites such as lice and fleas .
Mass-treatment programs that use topical permethrin or oral
ivermectin have been effective in reducing the prevalence of scabies
in a number of populations. No vaccine is available for scabies. The
simultaneous treatment of all close contacts is recommended, even if
they show no symptoms of infection (asymptomatic ), to reduce rates of
recurrence. Since mites can survive for only two to three days
without a host, other objects in the environment pose little risk of
transmission except in the case of crusted scabies, thus cleaning is
of little importance. Rooms used by those with crusted scabies
require thorough cleaning.
A number of medications are effective in treating scabies. Treatment
should involve the entire household, and any others who have had
recent, prolonged contact with the infested individual. Options to
control itchiness include antihistamines and prescription
anti-inflammatory agents. Bedding, clothing and towels used during
the previous three days should be washed in hot water and dried in a
Permethrin is the most effective treatment for scabies, and remains
the treatment of choice. It is applied from the neck down, usually
before bedtime, and left on for about eight to 14 hours, then washed
off in the morning. Care should be taken to coat the entire skin
surface, not just symptomatic areas; any patch of skin left untreated
can provide a "safe haven" for one or more mites to survive. One
application is normally sufficient, as permethrin kills eggs and
hatchlings, as well as adult mites, though many physicians recommend a
second application three to seven days later as a precaution. Crusted
scabies may require multiple applications, or supplemental treatment
with oral ivermectin (below).
Permethrin may cause slight
irritation of the skin that is usually tolerable.
Oral ivermectin is effective in eradicating scabies, often in a
single dose. It is the treatment of choice for crusted scabies, and
is sometimes prescribed in combination with a topical agent. It has
not been tested on infants, and is not recommended for children under
six years of age.
Topical ivermectin preparations have been shown to be effective for
scabies in adults, though only one such formulation is available in
the United States at present, and it is not FDA-approved as a scabies
treatment. It has also been useful for sarcoptic mange (the
veterinary analog of human scabies).
Other treatments include lindane, benzyl benzoate , crotamiton ,
malathion , and sulfur preparations.
Lindane is effective, but
concerns over potential neurotoxicity have limited its availability in
many countries. It is banned in
California , but may be used in
other states as a second-line treatment.
Sulfur ointments or benzyl
benzoate are often used in the developing world due to their low cost;
Some 10% sulfur solutions have been shown to be effective, and
sulfur ointments are typically used for at least a week, though many
people find the odor of sulfur products unpleasant.
been found to be less effective than permethrin in limited studies.
Crotamiton or sulfur preparations are sometimes recommended instead of
permethrin for children, due to concerns over dermal absorption of
Day 8 (treatment begins)
Day 12 (under treatment)
Scabies is endemic in many developing countries, where it tends to
be particularly problematic in rural and remote areas. In such
settings, community-wide control strategies are required to reduce the
rate of disease, as treatment of only individuals is ineffective due
to the high rate of reinfection. Large-scale mass drug administration
strategies may be required where coordinated interventions aim to
treat whole communities in one concerted effort. Although such
strategies have shown to be able to reduce the burden of scabies in
these kinds of communities, debate remains about the best strategy to
adopt, including the choice of drug.
The resources required to implement such large-scale interventions in
a cost-effective and sustainable way are significant. Furthermore,
since endemic scabies is largely restricted to poor and remote areas,
it is a public health issue that has not attracted much attention from
policy makers and international donors.
Scabies is one of the three most common skin disorders in children,
along with tinea and pyoderma . As of 2010, it affects about 100
million people (1.5% of the population) and is equally common in both
genders. The mites are distributed around the world and equally
infect all ages, races, and socioeconomic classes in different
Scabies is more often seen in crowded areas with unhygienic
living conditions. Globally as of 2009, an estimated 300 million
cases of scabies occur each year, although various parties claim the
figure is either over- or underestimated. About 1–10% of the
global population is estimated to be infected with scabies, but in
certain populations, the infection rate may be as high as 50–80%.
Wax figurine of a man with Norwegian scabies
Scabies has been observed in humans since ancient times.
Archeological evidence from Egypt and the Middle East suggests scabies
was present as early as 494 BC. The first recorded reference to
scabies is believed to be from the
Bible – it may be a type of
"leprosy " mentioned in
Leviticus c. 1200 BC or be mentioned among
the curses of Deuteronomy 28. In the fourth century BC, Aristotle
reported on "lice" that "escape from little pimples if they are
pricked" – a description consistent with scabies.
The Roman encyclopedist and medical writer
Aulus Cornelius Celsus (c.
25 BC – 50 AD) is credited with naming the disease "scabies" and
describing its characteristic features. The parasitic etiology of
scabies was documented by the Italian physician Giovanni Cosimo Bonomo
(1663–1696) in his 1687 letter, "Observations concerning the
fleshworms of the human body". Bonomo's description established
scabies as one of the first human diseases with a well-understood
In Europe in the late 19th through mid-20th centuries, a
sulfur-bearing ointment called by the medical eponym of Wilkinson's
ointment was widely used for topical treatment of scabies. The
contents and origins of several versions of the ointment were detailed
in correspondence published in the British Medical Journal in 1945.
SOCIETY AND CULTURE
The International Alliance for the Control of
Scabies was started in
2012, and brings together over 70 researchers, clinicians, and
public-health experts from more than 15 different countries. It has
managed to bring the global health implications of scabies to the
attention of the
World Health Organization
World Health Organization . Consequently, the WHO
has included scabies on its official list of neglected tropical
diseases and other neglected conditions.
Sarcoptic mange and
Acariasis A street dog in
Indonesia , suffers from sarcoptic mange .
Scabies may occur in a number of domestic and wild animals; the mites
that cause these infestations are of different subspecies from the one
typically causing the human form. These subspecies can infest animals
that are not their usual hosts, but such infections do not last long.
Scabies-infected animals suffer severe itching and secondary skin
infections. They often lose weight and become frail.
The most frequently diagnosed form of scabies in domestic animals is
sarcoptic mange, caused by the subspecies
Sarcoptes scabiei canis,
most commonly in dogs and cats.
Sarcoptic mange is transmissible to
humans who come into prolonged contact with infested animals, and is
distinguished from human scabies by its distribution on skin surfaces
covered by clothing. Scabies-infected domestic fowl suffer what is
known as "scaly leg". Domestic animals that have gone feral and have
no veterinary care are frequently afflicted with scabies and a host of
other ailments. Nondomestic animals have also been observed to suffer
from scabies. Gorillas, for instance, are known to be susceptible to
infection by contact with items used by humans.
Moxidectin is being evaluated as a treatment for scabies. It is
established in veterinary medicine to treat a range of parasites,
including sarcoptic mange. Its advantage over ivermectin is its longer
half life in humans and, thus, potential duration of action. Tea tree
oil appears to be effective in a
Petri dish .
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