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ScabiesIndicationsInfectious diseasesSexually transmitted diseases Scabies is a parasitic skin disease caused by mites that burrow into the skin, multiply and cause allergic and eczematous skin reactions. Unpleasant itching occurs, especially when it is warm in bed. Treatment is primarily with permethrin, benzyl benzoate, crotamiton or ivermectin. Permethrin is the drug of choice and can also be used in children.
Scabies is a parasitic skin disease caused by mites that dig into the skin and multiply. The primary lesion is a comma-shaped reddish duct up to one centimeter long, at the end of which the mite can be seen as a black point. Due to an allergic reaction to type IV mites, the so-called scabies rash with redness, papules, vesicles and crusts occurs three to four weeks after the initial attack. The strong and uncomfortable itching is typical, which gets worse when the bed is warm because warmth lowers the threshold for itching. Scratching will make the rash worse.
Scabies mainly occurs on warm skin areas between the fingers and toes, on the wrist, on the ankle, in the genital area, on the buttocks, on the breasts, on the elbows, armpits and on the navel. The head is usually spared, but in babies the face and the soles of the hands and feet are also affected.root cause
The cause of the disease is the itch mite between 0.2 and 0.5 mm in size Sarcoptes scabiei var hominis, a mite from the arachnid class. The mites cannot fly or jump, but can crawl on the skin relatively quickly (2.5 cm per minute).
Their life cycle begins with the fertilization of the female on the surface of the skin. The males die in the process. Only the female digs into the stratum corneum of the skin, where it survives between 30 and 60 days and lays 2 to 4 eggs daily. The eggs develop into larvae within a few days, which work their way back to the surface of the skin and mature into sexually mature mites over a period of two weeks at most. If the immune status is normal, there are only about 5 to 15 buried mites on the skin at the same time.transmission
Once on the skin, the mites can dig in within minutes. They are mainly transmitted from person to person through close and long (possibly repeated) skin contact, for example when cuddling, during sexual intercourse, when breastfeeding or in care (retirement and nursing home). Scabies is therefore also counted among the sexually transmitted diseases. A handshake or a quick hug is not enough. Transmission via objects, clothing and bedding is possible, but is considered rare. This is because the mites are only viable to a limited extent outside the body and die after just 24 to 36 hours. Immunosuppressed people with scabies norvegica (see under complications) are highly contagious and can lead to greater spread in a group.Complications
With the immune reaction, the body restricts the infestation and sometimes also prevents reinfection. If this reaction does not occur in immunosuppressed persons, it can lead to a massive multiplication with millions of mites (Scabies norvegica). Other complications are skin damage and secondary bacterial infections.Risk factors
- Bad hygienic conditions
- Poverty, overpopulation
- Close physical contact with other people
- Retirement and nursing homes
- Cool season
Some clues can already be obtained from the anamnesis (nocturnal itching, itchy skin disease, simultaneous infestation of family members). The clinical picture also provides information, but the mite ducts are often no longer clearly recognizable due to the rash. Due to the small size of the mites, the tissue is examined with light and dermatoscopy. Numerous skin diseases can be used as differential diagnoses and must be excluded in medical treatment. Pubic lice can produce a similar picture in the genital area. Pubic lice do not live in the skin, but in the pubic hair.Non-drug treatment
Scratching can remove the mites mechanically, but it can also worsen the skin disease at the same time. Without medication, it can take years for the immune system or scratching to eliminate all pathogens.Medication
So-called antiscabiosa, i.e. agents effective against itch mites, are used for drug treatment of the scabies. The information in the relevant package inserts should be followed exactly. In general, the agent is spread over the whole body from the lower jaw downwards and left on overnight. It is best to have a partner or a family member to help, as otherwise not all positions can be reached. For some drugs, a single application is sufficient, others are applied every evening for 3 to a maximum of 5 days. After 10-14 days, the treatment can be repeated if a persistent infestation is suspected. Close contact persons should also be treated if possible, even if no infestation is proven. It should be noted that the skin affections and itching can persist for weeks to months after the successful treatment. This is not due to a therapy failure.
According to the literature, permethrin (Scabi-med®) is the drug of choice. The cream is applied to dry skin in the evening and left on overnight for at least 8 hours. A single treatment is usually sufficient. The application can be repeated after one to two weeks. See under permethrin cream.
Benzyl benzoate is a possible alternative to permethrin and is approved in Germany. The emulsion is applied all over the body from the neck downwards for three consecutive days and is only washed off on the 4th day. It is also not available in Switzerland. In Germany it is available under the brand name Antiscabiosum® (10% or 25%).
Crotamiton (Eurax®) is also said to be effective against itching and bacteria and was approved for treatment in adults in Switzerland. The entire surface of the skin (excluding the face and scalp) is rubbed in in the evening. The duration of treatment is 3-5 days. According to some sources, it is significantly less effective than permethrin. Eurax® has been out of trade in Switzerland since 2012.
Ivermectin is given internally as a single dose and is another possible treatment alternative. It is used, for example, in the highly contagious Scabies norvegica, as there is a large-scale infestation there. Ivermectin is not approved as a medicinal product for human use in Switzerland and must be imported from abroad (Stromectol®, e.g. from France).
The anti-inflammatory topical glucocorticoids and, in the case of secondary infections, antibiotics are used to treat skin affections. Various remedies are available against itching (see the article Itching).
Other options: allethrin, mesulfen, sulfur (10% in petroleum jelly), Peru balsam and tea tree oil are effective against scabies, but are not first or second choice. Further (also herbal) treatments are conceivable, but so far insufficiently investigated.
Lindane (Jacutin®) is out of trade and should no longer be used due to the possible undesirable effects. Malathion (Prioderm®) is also no longer available in Switzerland.see also
Mange of the dogsliterature
- Medicinal product information (CH, D)
- Chosidow O. Clinical practices. Scabies. N Engl J Med, 2006, 354 (16), 1718-27 Pubmed
- Hengge U.R. et al. Scabies: a ubiquitous neglected skin disease. Lancet Infect Dis, 2006, 6 (12), 769-79 Pubmed
- Hafner C. Scabies. Dermatologist, 2009, 60 (2), 145-59 Pubmed
- Hicks M.I., Elston D.M. Scabies. Dermatol Ther, 2009, 22 (4), 279-92 Pubmed
- Johnston G., Sladden M. Scabies: Diagnosis and Treatment. BMJ, 2005, 331 (7517), 619-22 Pubmed
- Leaflet Robert Koch Institute: http://www.rki.de
- Mumcuoglu K.Y., Gilead L. Treatment of scabies infestations. Parasite, 2008, 15 (3), 248-51 Pubmed
- Strong M., Johnstone P.W. Interventions for treating scabies. Cochrane Database Syst Rev, 2007, CD000320 Pubmed
- Sunderkötter C. et al. Scabies. J Dtsch Dermatol Ges, 2007, 5 (5), 424-30 Pubmed
Conflicts of Interest: None / Independent. The author has no relationships with the manufacturers and is not involved in the sale of the products mentioned.
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