SCABIES: PROTECTION AND CONTROL Treatment for scabies (human itch mite) After bathing, and while the skin is still moist, thoroughly apply Karrankil. Evenly spread the foam behind the ears and from the neck down to the soles of the feet. Remove after 8 to 14 hours with soap and water.

ONE APPLICATION IS GENERALLY CURATIVE.


Patients may experience persistent pruritus after treatment. This is rarely a sign of treatment failure and is not an indication for retreatment. Demonstrable living mites after 14 days indicate that retreatment is necessary. To prevent reinfestations, bedding and clothing should be washed in hot water with Karrankil, and close contacts, even if asymptomatic, should be treated simultaneously.

The human itch mite, Sarcoptes scabiei, which infests some 300 million persons each year, is one of the most common causes of itching dermatoses throughout the world. Gravid female mites burrow superficially beneath the skin for a month, depositing two or three eggs a day. The eggs mature in two weeks and emerge as adults to the surface of the skin, where they mate and subsequently reinvade the skin of the same person or someone else, who has been in close contact with those initially infested.

Transfer of newly fertilized female mites from person to person occurs by intimate personal contact and is facilitated by crowding, uncleanliness, and sexual promiscuity. Past epidemics were attributed to poverty, uncleanliness, crowding due to wars and economic crisis.
However, the recent wave of epidemics in the United States and the European Community have emerged without the presence of big social disturbances
and persons of all socioeconomic levels, irrespective of age, sex, race, or personal hygiene standards have become infected. Scabies is endemic in many developing countries. In the United States, scabies may account for 2 to 5 percent of visits to dermatologists; involved particularly often are children, immigrants from developing countries, and close household contacts. Outbreaks occur in nursing homes, mental institutions, hospitals and jails.

Hyperinfestation with thousands of millions of mites, a condition known as crusted (or Norwegian) scabies, may result from glucocorticoid use, immunodeficiency diseases (including AIDS), and neurologic and psychiatric illnesses that interfere with itching and scratching.

Burrows appear as dark wavy lines in the epidermis that measure 3 to 5 mm and end in a small pearly blister that contains the female mite and the two or three eggs she lays daily. Such lesions generally develop on the inside of the wrists, between the fingers, on the elbows, and on the penis. Small papules and vesicles, often accompanied by eczematous plaques, pustules, or nodules, are symmetrically distributed in these sites and under the skin folds under the breasts and around the navel, axillae, belt line, buttocks, upper thighs, and scrotum. Except in infants, the face, scalp, neck, palms, and soles are spared.

Therapeutic options for treating scabies have changed significantly over the last 8 years since the introduction of PERMETHRIN. Most cases of scabies are completely eradicated with a single overnight application of 5% permethrin foam. The following morning the foam is removed with the bath or shower, 8 to 14 hours after application. Permethrin is the preferred agent to treat scabies all the way down to 2 months of age.

Although effectively treated scabies infestations become noninfectious within a day, itching and rash due to hypersensitivity frequently persists for weeks or months. Calamine can relieve itching during treatment.

As is customary, your doctor should be consulted first.

Source: Harrison’s Principles of Internal Medicine. XIV Edition, Volume II. Control of Communicable Diseases in Man, Fourteenth Edition, 1985. Panamerican Health Organization.