Mens Health

Scabies: Ways of Infection, Symptoms, and Risks –

Introduction –

The easy mechanism of transmission of the infection in some infections in combination with asymptomatic transmission (infected persons do not suspect the presence of the disease due to the lack of visible and objective manifestations, but actively contribute to its spread) is one of the leading reasons for the problematic fight against them and the high frequency worldwide.

An example of such a disease, which is transmitted extremely easily, and often goes on for a long time without visible manifestations, is scabies. Although in the mass case the disease proceeds without the development of significant complications and serious health consequences for the patient, timely treatment for scabies is necessary and highly recommended in connection with the risk of infecting others.

In persons of an active age without underlying diseases and disabilities, the disease rarely leads to serious complications, but in patients with chronic diseases, in the elderly and small children, severe disabilities, a strong deterioration of the general state of health, and the need for complex measures to control the creatures are possible. situation.

If you suspect contact with a person with scabies or if you have symptoms similar to those typical of scabies, contact your doctor immediately to take the necessary measures to prove the disease and prescribe appropriate therapy.

Scabies: ways of infection, symptoms, risks –

The disease is caused by the small tick Sarcoptic scabies (the main representative of the Sarcoptidae family). A number of features in the biological cycle and morphology of the causative agent predetermine the mode of transmission of the infection and some of the features in the clinical course.

The main mechanism for the spread of the disease is through close contact, skin-to-skin contact, touch, and intimate relationships.

Infection is also possible through contact and the use of foreign (scabies) accessories, towels, clothes, and bed linen, although less often. This is due to the causative agent’s ability to survive in the external environment for up to 72 hours.

The disease occurs with a higher frequency in developing countries, socially poor areas and societies, places with poor household and public hygiene, in homes for the elderly and abandoned children, after natural disasters, and others.

The main predisposing factor is poor hygiene, close contact with many people, and unfavorable conditions.

The representatives of both sexes are equally affected, and no significant differences are described regarding the affected age groups. An important feature is that the course of the disease in young children, elderly persons, as well as patients with a compromised immune system is more severe and carries a risk of complications.

The main symptoms of the disease include discomfort and severe, constant itching, which worsens at night. The first manifestations of the disease are present, on average, after three to six weeks from the risky contact (this is how long it takes for the reproduction of the etiological agents).

In children, all parts of the body are affected, while in adults, involvement of the skinning process on the back, nape, and head is rarely observed, with the elbows, abdomen, chest, and the area between the fingers and toes being predominantly affected.

Characteristic of the infection is the so-called scabious courses, which are small (up to one centimeter in length) stripes with a grayish color and an irregular course, often accompanied by the appearance of various rash units such as vesicles, papules, and crusts.

Persons with compromised immunity as a result of an underlying neoplasm, HIV infection, AIDS, diabetes mellitus, severe metabolic and/or endocrine disorders, and others are at higher risk of infection and severe course of the disease. Risk groups include newborns and children up to 2 years of age, as well as patients over 65 years of age.

There are several main forms of the disease, which are differentiated from each other mainly by the type of character of the rash units and the severity of the course. Regardless of the form, timely and appropriate treatment in combination with hygiene measures reduces the risks of developing complications of varying severity.

The most frequently described complication in clinical practice is the development of secondary bacterial infection (additional infection, usually with bacteria, of existing skin lesions). Development of dermatitis and eczema, abscesses on the skin, and deterioration of the overall general condition are possible.

You can find useful and detailed information about the forms of scabies, the peculiarities of the course, and the diagnostic approach in the Diseases section:

» Scabies

Medicines used to treat scabies, including in children and pregnant women

Etiological treatment for scabies includes the use of specific preparations (scabicides) intended for use against the small ticks that cause the disease.

In different geographical latitudes, as well as depending on the severity and type of the disease, the general condition of the patient and some of his physiological features (childhood or advanced age, pregnancy), and underlying diseases, one of the following preparations is preferred:

Permethrin: a commonly used agent preferred as a first-line agent due to its high effectiveness, proven safety, and minimal risk of side effects, usually applied as a 5 percent cream. Topical application of permethrin results in a scabicide effect (killing ticks and their eggs). The medication is safe for all age groups, including small children, as well as during pregnancy

malathion: it is used in the form of a lotion most often in a concentration of 0.5 percent and is usually the option of choice in the absence of an effect from the application of permethrin or the impossibility of applying permethrin (lack of availability in pharmacy networks). Redness, rash, allergic dermatitis, and manifestations of hypersensitivity are possible as a result of the application of malathion.

Lindane:  lindane belongs to the chlorine-containing preparations and is applied only in cases of lack of effect from other standardly used therapeutic agents, the impossibility of their use, or in the presence of contraindications for their application. The preparation is not safe during pregnancy, during lactation, as well as in children and patients weighing less than 50 kilograms. Its use in the elderly is also carried out with caution due to the risk of neurotoxicity

benzyl benzoate: its topical application in scabies carries a risk of skin irritation (there is irritation of an already damaged skin surface) and the safety profile is not fully understood, therefore its application to the skin of pregnant women, children and the elderly are avoided. In Bulgaria, benzyl benzoate is available in the form of a lotion for topical application, and in the presence of skin injuries, its use is recommended only after consultation with a specialist (dermatologist). It is often applied in the form of a spray to clean contaminated surfaces in the presence of a heavy infestation

Ivermectin: the agent belongs to the preparations for the treatment of diseases caused by roundworms (nematodes), but, if necessary, it can also be used in the therapy of scabies. A single dose is sufficient for some patients, but two to three doses are often required. Its use is prescribed for persons with compromised immunity, and severe scabies, when many people are infected in closed societies (for example, in nursing homes), as well as in the absence of the desired effect from the application of other measures against scabies.  Ivermectin is administered orally (it is available in tablet form), and its use in children under 15 kilograms and pregnant women is not recommended. Although it results in effective deworming of the body, itching often persists for several weeks after treatment

Sulfur products: Sulfur products are usually not a first-choice option, but in young children under medical supervision, they can be used effectively to treat scabies. Various products are available, and it is recommended that they be prescribed by a specialist in the field and that the dose, percentage concentration, and type of additional ingredients be adjusted to the individual characteristics of the patient. Read more at: » Products containing Sulphur

It is recommended to apply the topical agents all over the body, and in adults, there is no need to apply to the head (the process does not affect the scalp), but in small children, it is necessary to cover this area as well (the disease can affect any part of the body in children).

In childhood and when infected during pregnancy or lactation, the only proven safe and effective option is treatment with permethrin.

Regardless of the type of disease, your individual characteristics, and the severity of the process, self-medication is not recommended. Be sure to consult your doctor, who can refer you to a specialist (dermatologist, for example) to prescribe an appropriate and effective therapy.

Many of the anti-scabies drugs are available only by prescription and there are certain peculiarities in their application, so skipping the consultation with a specialist is not recommended.

Additional measures to support successful scabies treatment

In addition to the specific therapy, including the application of scabicides, additional, symptomatic means are also applied to improve the comfort of patients and achieve favorable results of the treatment course.

As part of additional drug therapy, some of the following agents are also included:

Antihistamines: diphenhydramine, cetirizine, levocetirizine, and other representatives of the antiallergic agents of the antihistamine group are used in many patients as part of additional therapy in connection with complaints of severe and persistent itching. Since itching is a manifestation of an allergic reaction to small ticks, the application of antihistamines is completely appropriate and justified, and their use in small children deserves attention (selection of preparation with a good safety profile and in a lower dose is necessary), as well as and during pregnancy. Since itching can last for several weeks to about a month after successful treatment of the disease, antihistamines can be continued until the symptoms subside.

Calamine lotion: the local application of Calamine lotion has a good effect in terms of alleviating the manifestations of itching, local irritation, and inflammation in connection with its good anti-allergic and anti-itching properties. It is usually applied several times a day to the affected skin areas, and due to the lack of sufficient studies on its safety during pregnancy, breastfeeding and in children under 6 months, its use in these groups of patients is not recommended

Corticosteroids: topical or oral corticosteroids are discussed only in patients with very severe disease, intolerable itching, and severe skin irritation. They are appointed by the attending physician and are usually taken (or applied) according to a scheme in connection with the risk of exacerbation of the condition in the event of sudden termination of therapy. Using them locally (in the form of cream, gel, or lotion) leads to rapid relief of itching, inflammation, and skin irritation. Oral administration is prescribed very rarely, usually in the absence of the desired effect from the application of standard preparations

Anti-inflammatory agents: the local application of anti-inflammatory agents leads to relief of skin manifestations and limitation of the inflammatory process, reducing the risks of additional complications and secondary infection from severe skin irritation (for example, with severe itching, patients tend to injure the skin, which opens an entrance door for secondary bacterial infection)

Antibiotics: in case of secondary bacterial infection, appropriate antibiotics are prescribed. In case of doubts about the choice of an appropriate antibiotic, it is recommended to examine secretions from an affected skin area, isolate the specific bacterial agent and determine its sensitivity to standard antibiotics. Antibiotic therapy includes both local application of means containing appropriate concentrations of the appropriate antibiotics, and oral administration (especially in persons with reduced immunity)

Herbs and medicinal plants: in addition to the etiological therapy, some herbs and medicinal plants can be applied in order to relieve itching, redness, and irritation of the skin. One of the most popular (some of which are often included in the composition of anti-scab preparations) herbs and medicinal plants against scabies include tea tree (tea tree oil is distinguished by its anti-inflammatory, antibacterial, antiseptic, and anti-parasitic effects, further supporting the healing processes on wounds), neem (neem oil and leaves), turmeric, aloe vera, lavender, and others. Useful and detailed information on the subject can be found in the Alternative Medicine section (Useful herbs against scabies)

Although there is no specially developed nutritional regimen for scabies, following some rules regarding the daily menu can support recovery processes, and strengthen the immune defense and regenerative abilities of the skin.

It is recommended to consume foods rich in fat-soluble vitamins (vitamin A, vitamin D, vitamin E) in relation to their antioxidant and anti-inflammatory potential, as well as foods rich in water-soluble vitamins (vitamin C, group B vitamins) in relation to their beneficial effects on the skin and immune system.

Useful information on the subject can be found in the Nutrition section:

»Nutrition for scabies

Additional measures include thorough disinfection and treatment of the surfaces with which the patient has been in contact, for which purpose various disinfectants or a solution of bleach in hot water can be used.

All clothing, towels, and linens must be washed at a hot temperature and dried at a hot temperature (using a dryer for at least 30 minutes is recommended).

Another option for clothes, towels, and bedding is to store them in vacuum bags for three days and then wash them at high temperatures (ticks can survive for up to three days in the outdoor environment, away from the hospitable human skin).

Thorough cleaning of the home reduces the risks of re-infection and deterioration of the applied therapy.

How to protect yourself from contracting scabies?

Although there is no specific prevention against scabies (for example, the use of certain drugs or the administration of vaccines), following some basic tips can help you minimize the risk of contracting the insidious infection.


strict personal and household hygiene: thorough hand washing and maintaining high hygiene at home reduces the risk of infection limiting contact with sick people and limiting close contact in general: infection occurs through close skin-to-skin contact, and keeping a distance from others and avoiding close contact minimizes the risk of contracting scabies and other communicable diseases transmitted by contact increasing health culture and awareness

Avoiding risky behavior: risky behavior is considered, for example, frequent change of sexual partners, use of prohibited narcotic substances, excessive alcohol consumption, and others

a timely visit to the attending physician in case of suspicion of an underlying disease caution when it is necessary to use other people’s towels and bedding: for example, when staying overnight in a hotel, motel, bungalow, etc., in the event that the person who left before you were infected with scabies and the staff did not change the sheets and towels in the bathroom, it is possible to infections.

Active prevention reduces the risks of infection and subsequent treatment for scabies. If you need advice, do not hesitate to contact your doctor.

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