Scabies is a condition characterized by itching of the skin, especially at night. This itching is accompanied by the appearance of a spotted rash that resembles pimples or small scaly blisters. This condition occurs due to mites that live and nest in the skin.

Scabies or scabies is a disease that is easily transmitted, either through direct or indirect contact. This disease is very easy to spread, especially if there is close contact between people in an environment.

In Indonesia, scabies can be found in densely populated areas, slum areas, and Islamic boarding schools. Because it is easily transmitted, scabies treatment needs to be carried out thoroughly in groups exposed to this disease.

Causes of Scabies

Scabies is caused by the mite  Sarcoptes scabiei . These mites secrete saliva, eggs and feces. This triggers a response from the immune system, causing itching.

The development cycle of the mite parasite begins when the female mite burrows into the human skin, then makes a hole that resembles a tunnel to become a nest. Furthermore, the male mites will enter the nest to mate with the female mites.

After mating, the male mites will die and the female mites will start laying eggs in the nest. The eggs will hatch 3–4 days later. After hatching, the young mites will emerge onto the surface of the skin for the next 1–2 weeks until they grow into adults.

As adults, male mites will settle on the surface of the skin. Meanwhile, the female mites will enter the skin again to make a new nest and repeat the same cycle.

Please note, the scabies mite is a parasite that lives in the deep layers of the skin. This makes it impervious to soap and hot water, and won't come off if you just rub your skin. Without proper treatment, the mites will continue to reproduce and the mite development cycle will continue.

Sarcoptes scabiei mites cannot fly or jump, so transmission can only occur in two ways, namely:

Direct contact

Mites can be transmitted easily through direct contact with a person with scabies, such as holding hands for a long time or sexual intercourse. However, brief physical contact, such as shaking hands or hugging, has little potential to transmit mites.

Indirect contact

Although rare, mites can also be transmitted through indirect contact, for example when sharing clothing, towels, or bedding with people with scabies. This can happen because mites can stay for 2–3 days on certain objects.

Scabies can also affect animals, such as dogs and cats. However, the scabies parasite from animals cannot be transmitted to humans because of the different types of mites between the two. Mites from animals cannot develop on human skin and will only cause mild symptoms on the skin.

Everyone can catch scabies. However, there are several groups that have a high risk of contracting this disease, namely:

  • People living in densely populated neighborhoods
  • Babies and children
  • Older people, especially those living in nursing homes
  • Sexually active adults
  • Someone who is in hospital
  • Health care worker treating a patient with scabies
  • Someone who has a weak immune system, such as  people with HIV/AIDS or cancer

Symptoms of Scabies

Symptoms of scabies or scabies first appear 4–6 weeks after the skin is exposed to mites. However, in people who have previously had scabies, symptoms usually develop more quickly, around 1–2 days after exposure to the mites.

Scabies is characterized by intense itching of the skin, especially at night, causing sufferers to wake up at night. In addition, there will be a  rash of spots  resembling pimples that form a line, or it can also be in the form of small and scaly blisters.

In adults, the rash is most often found between the fingers, wrists, armpits, breasts and nipples, and buttocks. In addition, a rash can also appear in the following areas:

  • Elbow
  • Penis
  • Waist
  • Knee

Meanwhile, in infants and toddlers, symptoms may appear in the following areas:

  • Head
  • Face
  • Neck
  • Palm
  • Sole

When to see a doctor

Check with your doctor if you experience skin complaints that are suspected to be signs of scurvy. Apart from scabies, these complaints can also be caused by other skin conditions. Therefore, the doctor will help find the exact cause as well as determine the right treatment for you.

If you have had close contact with a scabies sufferer , consult a doctor even if no symptoms appear on the skin. Early examination and treatment can help relieve symptoms that may appear later.

Scabies Diagnosis

The doctor will first ask for a history of symptoms and factors that are suspected of causing the patient to contract scabies. Next, the doctor will carry out a physical examination.

After that, the doctor will carry out a series of examinations to rule out the possibility that the symptoms are caused by other conditions, such as drug allergies, eczema , and dermatitis. Some of these checks are:

Ink test

This test is done by applying special ink to the problem area of ​​the skin. After that, the skin will be washed with cotton containing alcohol. If there are mite nests, the ink will remain on the skin and form small streaks.

Microscopic examination

This examination is done by scraping a small area of ​​problematic skin, to be examined under a microscope. The goal is to detect mites that are invisible to the naked eye.

Scabies Treatment

Treatment of scabies aims to eradicate mites, relieve itching and inflammation, and treat secondary infections, as described below:

Eliminate mites

To eradicate mites and their eggs, the doctor will prescribe scabies medication which is usually applied at night. Topical medications prescribed by doctors include:

  • Permethrin Cream 5%
  • Crotamitone Cream 10%
  • Benzyl benzoate lotion 25%
  • Sulfur precipitate (5–10%)
  • Indane lotion (1%)

Reduce itching and inflammation

The doctor will prescribe a mild steroid cream that can relieve itching and inflammation on the patient's skin. Patients can also be given oral antihistamines, which can reduce itching while improving the patient's sleep quality.

Overcome secondary infections

Itching from scabies can encourage patients to scratch the skin, thereby risking open sores. This can cause a bacterial infection in the skin. In these conditions, the doctor will prescribe antibiotics, for example mupirocin .

Do self-handling

Patients can also perform simple treatments at home to reduce itching caused by scabies , including:

  • Soak in cold water or apply a wet cloth to the problem area of ​​the skin, to reduce itching
  • Apply calamine lotion to reduce pain and itching, consulting your doctor first

Clean up the surroundings

Because scabies spreads so quickly, it's important to clean your home and surroundings. The goal is to kill mites that may be present on objects around the patient. Efforts that need to be made include:

  • Clean items at home, such as toys, dolls, floors, and clothing with disinfectant
  • Wash clothes, bed sheets and pillowcases in hot water
  • Cleaning carpets and footwear
  • Submerge the mites that are still alive in a closed container filled with alcohol
  • Wrap clothing, blankets, bed sheets and pillows in airtight plastic when not in use

Scabies complications

Some of the complications that can occur due to scabies, especially if not treated properly, are:

Bacterial infection

The intense itchiness caused by scabies will make it difficult for sufferers to refrain from scratching their skin. However, excessively scratching the itchy areas of the skin can cause open sores. This can make it easier for bacteria to enter the layers of the skin and cause an infection, such as impetigo .

Crusted mange ( Norwegian scabies )

People who suffer from scabies generally only have 10-15 mites on their bodies. Whereas in crusted scabies, mites on the sufferer's body can reach millions.

This condition is characterized by hard and scaly skin, as well as the spread of the scabies rash to other parts of the body. Once scabies has progressed to this stage, it can be more difficult to treat.

Scabies Prevention

The most effective way to prevent scabies is to protect yourself from being exposed to the  Sarcoptes scabiei mite , either through direct or indirect contact. If you have just had close contact with a person with scabies, you should do an examination so that you can get treatment immediately.

Meanwhile for people with scabies, efforts that can be made to avoid spreading scabies to others are:

  • Clean bed linen, clothes, towels and other personal items using soap and warm water, then dry them in hot air.
  • Wrap items that are potentially exposed to mites but cannot be washed in plastic, then place them in a place out of reach.
  • Do not have sex or have close physical contact with other people until the scabies treatment is complete.
  • Avoid sharing bedding, clothes and towels with other people.
  • Clean floors, carpets, sofas and footwear with a vacuum cleaner and disinfectant regularly.
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