It could be scratching

scabies

A scabies infestation can be treated well. The goal of treatment is to kill the scabies mites as well as their larvae and eggs. Since the mites create their passages in the uppermost horny layer of the skin, they can in most cases be killed by antidotes that are usually applied externally (antiscabiosa). It is also important to alleviate the symptoms of scabies and promote skin healing.

The problem is the long incubation period (that is, the time from infection to the outbreak of an illness) when it is first infected. The first signs of scabies appear after two, usually four to six weeks at the earliest. This period of time passes until the animals have reproduced so much that the body recognizes them as intruders and its immune system triggers defense reactions: itching and inflammation. Without these symptoms, a scabies infection is not noticeable. If the infection is repeated, the immune system reacts after just a few days.

Treat scabies properly

Those who suffer from common scabies can usually do the treatment at home. A hospital stay is only necessary for babies (infants), in exceptional cases toddlers and scabies crustosa patients. Older children and adults only need hospital treatment if the skin damaged by the scabies is severely inflamed by bacteria or if the therapy does not work.

After completing the first scabies treatment, those affected are no longer contagious and no longer have to stay away from others. Children can go to school and adults to work. Those affected should avoid closer contact, such as intimate intercourse, until both partners have been adequately treated. Longer isolation is only necessary for scabies crustosa (usually two weeks).

Which medication - also for babies and children?

For the treatment of scabies, there are various means to choose from, depending on the shape, severity, situation and patient preferences:

  • Permethrin is applied to the skin and is considered the first choice in Europe for many forms of scabies. It is easy to use and well tolerated - for adults and children. Permethrin works against both mites and their eggs. In the case of uncomplicated scabies, a single treatment with eight to twelve hours of exposure is often sufficient. Permethrin in a five percent concentration in a cream base is approved for scabies therapy from the age of three months. Babies and toddlers can also be treated with such an ointment.
  • Benzyl benzoate is also effective against itch mites and their eggs. It is approved in Germany in the form of a 25 percent (from the age of twelve) and ten percent emulsion (for children from the age of one). Benzyl benzoate must be applied on three consecutive days and should not be washed off until the fourth day. Benzyl benzoate is unsuitable for treating babies with scabies.
  • Crotamiton is available in Germany in a ten percent concentration as a lotion, cream and ointment and in a five percent concentration as a gel. To successfully treat scabies, crotamiton must be applied for three to five consecutive days and must not be washed off. The remedy is also approved for babies.
  • Oral ivermectin is a pill-type scabies medication. The remedy is mainly used in the event of failure of the externally applied remedies and in immunocompromised people. If many of those affected live in a confined space, for example in collective accommodation or homes, therapy with ivermectin is best implemented in practice. With common scabies, a single intake of 200 micrograms per kilogram of body weight is usually sufficient. The scabies tablets are sure to work after 24 hours. Ivermectin can damage the liver and nervous system. Pregnant women are not allowed to take the product. Ivermectin should not be used on children weighing less than 15 kilograms.

The right approach

When applying a scabies ointment or something similar, it is best to have a second person reach out to all parts of the body. They should wear disposable gloves, and a protective gown for patients with scabies crustosa.

Before the product is spread on the skin, scabies sufferers should trim their nails and shower or bathe thoroughly. The drug may only be used on dry, preferably flaky skin and at normal body temperature (reached after about 60 minutes of rest).

Anyone who suffers from severely inflamed skin areas can, after consultation with the attending physician, also apply an agent for skin care or for disinfecting the wound surfaces (antiseptic) before or during the scabies therapy. Sometimes an antibiotic is also needed.

The entire body must be evenly covered with the drug from the lower jaw down, including all skin folds. In case of doubt, the scalp and face should also be treated against scabies. For babies (infants) and toddlers up to the age of 3, for scabies crustosa and for patients with a weakened immune system, the entire head should always be thoroughly applied. The external scabies remedies must not come into contact with mucous membranes. Areas of skin around the eyes and mouth must be spared.

Cotton gloves prevent you from accidentally rubbing the ointment or lotion into your eyes or mouth during the exposure time. After each hand washing, the scabies medication must be reapplied immediately after drying.

Pay attention to the times and inform the environment

The exposure time varies depending on the preparation. It is stated on the package insert and must be strictly adhered to in order to safely kill the itch mites. When it is over, the patient should wash or shower thoroughly and put on new clothes and change bedding.

After one to two weeks, the skin will be checked by the doctor. He decides whether and how the scabies therapy has to be continued. For scabies crustosa, the treatment is repeated at least once after a week. Itching and eczema can persist for a few weeks even after successful treatment (especially in allergy sufferers), but they become weaker.

People affected by scabies should urgently inform everyone with whom they have had close physical contact. Treatment is also recommended for them because the symptoms of a scabies infection show up after two weeks at the earliest, but often only after four to six weeks. People who live in the same household as the infected person should be treated on the same day.

Pregnancy, Breastfeeding and Infants

Scabies in pregnancy is a particular problem. None of the drugs are approved for pregnant women. Permethrin, benzyl benzoate or crotamiton can therefore only be used after careful consideration and comprehensive information from the doctor.

During breastfeeding, if it is not clearly affected, the breast area is spared during the treatment (permethrin, benzyl benzoate or crotamiton).

For infants and newborns, five percent permethrin or crotamiton preparations are the only scabies remedies that are not strictly advised against in Germany. However, treatment should be carried out in a specialist clinic.

Home remedies for scabies

Anyone who suspects they may have contracted scabies should see a doctor. They will make a correct diagnosis and recommend therapy if necessary. Frequently recommended home remedies and herbal medicine alternatives such as tea tree oil, vinegar, oil and sugar cannot kill the itch mites, their larvae or eggs. So they don't work against the cause. Tea tree oil and vinegar in particular tend to irritate the damaged skin. Improper and inadequate treatments prolong the scabies infestation and delay the healing of the affected areas of the skin. In addition, other people are at risk of becoming infected as well.

Avoid retransmission

In order to get rid of itch mites completely, the following must be observed:

  • Change clothes, bed linen and towels immediately after the scabies treatment, daily for scabies crustosa.
  • Wash all textiles and other objects with prolonged body contact (e.g. blood pressure cuffs, slippers, soft toys) at at least 50 degrees Celsius for at least ten minutes or decontaminate them with the help of a hot steam device to kill the itch mites.
  • If cleaning at a high temperature is not possible, the objects and textiles can be tightly wrapped in plastic and stored for 72 hours at 21 degrees Celsius (as constant a temperature as possible). A longer period is necessary for scabies crustosa, at least seven days.
  • With common scabies it is enough to make fresh beds. Mattresses only need to be decontaminated for scabies crustosa.
  • If you want to be on the safe side, you can vacuum up upholstered furniture, pillows and carpets (on which the scabies patient has lain with bare skin) with a vacuum cleaner (dispose of the filters afterwards) or not use them for at least 48 hours. This measure is not absolutely necessary because of the low risk of infection - except for scabies crustosa. The following applies here: Avoid objects for at least seven days!