Magazine article Drug Topics

The Scourge of Scabies: Some Ways to Treat It

Magazine article Drug Topics

The Scourge of Scabies: Some Ways to Treat It

Article excerpt

You hear a lot about lice outbreaks when school starts. Less well known are scabies attacks.

Scabies is an infestation caused by Sarcoptes scabiei, a tiny mite that burrows into the skin, causing a rash and a great deal of itching. It is spread by skin-to-skin contact or by sharing an infected person's clothing or bedding. It is common in people living in crowded conditions and has cropped up in day care centers.

"The problem is that the itching doesn't occur right away, so people who are not itching may be harboring this condition, and they may not start to itch for perhaps as long as a month," explained Mervyn Elgart, M.D., clinical professor, department of dermatology, George Washington University. "That gives the scabies time to set up shop. Therefore, by the time the itching breaks out, it can be more severe than if it were immediate itching. That also means people in contact with someone who has a diagnosis of scabies are most likely infest ed, although they may not show any itching or signs. So, it's important that everybody in the immediate contact of an individual with scabies be treated."

Richard J. Pollack, PhD., entomologist at the Harvard School of Public Health, agreed that it is important to evaluate others in the home. "If one person in the family has scabies, it's more likely to spread to others. Some people may be carriers and may or may not be symptomatic. It's difficult to diagnose under the best of conditions," said Pollack.

Elgart said a scabies diagnosis is made on the basis of clinical observation, either by seeing lesions that look like the condition or by microscopic examination of scraped lesions. Scabies mites are the size of a pinpoint.

In adults, scabies doesn't occur above the neck, and itching worsens at night, according to Elgart.

He also said there was a U.S. epidemic of scabies in the 1970s and 1980s. He attributed the outbreak to an increase in sexual permissiveness. But because of awareness of AIDS and safer sex practices, the incidence of scabies has decreased, he added.

Lindane was the preferred method of treatment for scabies in the 70s and '80s. "It was a useful medication, but if it was overused, it produced some side effects," said Elgart He cautioned that lindane should not be used after a bath because the drug penetrates wet skin more easily than dry skin "You don't want lindane to penetrate, because there have been cases of seizures. …

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