Scabies Diagnosis And Treatment
Scabies (“The Itch”) is especially prevalent among people who live in crowded conditions such as old age homes, hospitals and army bases. The nursing staff which takes care of older people in homes or family members of patients are highly likely to become infected. Scabies can affect anyone at any time in his or her life, from infancy to old age. The disease is caused by tiny mites, less than one millimeter in length, which burrow into the skin and lay their eggs. The presence of these mites and their eggs in the skin causes an intense itch which worsens at night. At the place of penetration small red nodes can be seen, similar in form to mosquito bites.
The mites which cause scabies prefer to penetrate the skin folds and places where the skin is thin, with the result that scabies rashes are most often found between the fingers, in the folds of the waist, at the wrist, under the arms, around the nipples and on the head of the male sex organ. In infants the rash can be seen on the face and on the palms of the hands and the soles of the feet. The marks left by the mites as they burrow into the skin are not prominent, and as a result several weeks usually pass before the disease can be diagnosed.
The treatment of scabies must be strictly adhered to and must include all members of the family, whether or not they have been diagnosed. In its early stages scabies does not itch, and therefore members of the family who have been infected can reinfect those who have already received treatment.
The most effective treatment includes the use of fat-based ointments containing sulfur and salicylic acid. The ointment is applied to the skin from the neck down for three consecutive nights, then suspended for a week, and then the ointment is once again applied for three nights. During the time the ointment is applied it is advisable to change the bedclothes every night. During the day I advise the use of an ointment containing crotamiton (brand name: Eurax), which eases the itching. It is applied only to the rash. Other products can be used but they are usually less effective.
LICE
Lice are small, wingless insects, 1-2 mm in length, parasites which have accompanied man from time immemorial. They are divided into groups according to the part of the body they infest: head lice, which infest the scalp, body lice, and crab lice, which infest the genitalia. In all three groups the female lice feed on blood they suck from the skin of the host. The saliva of the female louse remains on the skin and causes an intense itching, one of the most easily recognizable symptoms of the disease.
HEAD LICE
Head lice are prevalent among kindergarten and elementary school children. Once they have infested the scalp they cause itching not only of the scalp but of the sides and back of the neck as well. Children frequently scratch the area with dirty fingers leading to secondary bacterial infections, which in turn cause fever and inflamed lymph nodes in the neck. On examination, large numbers of silvery louse eggs (nits) can be seen stuck to the hair about 1 cm (1/2) from the scalp.
Head lice are transmitted by direct contact. The hair of an uninfected person comes into contact either with the hair of an infected person or with infected objects such as hats, combs, pillows, hair ribbons and towels. When one member of the family has head lice there is a good chance that other members will also have them, as will other children in the child’s class or kindergarten. There is a simple treatment for head lice: in most cases one shampooing with a product specially formulated to kill lice is sufficient. Unfortunately, it has recently become apparent that some lice have developed immunity to certain kinds of shampoos, but in most cases an additional shampooing with a product with a different active ingredient will solve the problem.
Even when the treatment has proved effective, the louse eggs will remain stuck to the hair. Despite the fact that they are dead, they should be removed with a fine toothed comb, which can be bought in any pharmacy.
BODY LICE
Body lice lay their eggs on the fibers of clothing, leaving the nest to bite the skin of the host. Since they only infest people who do not change their clothing for long periods of time (days and weeks), they are common among the homeless and people who are ill. Meticulous washing of the clothes and frequently changing clothes will solve the problem.
CRAB LICE
Crab lice infest pubic hair, the hair of the underarms and sometimes the eyelashes. They are transmitted by sexual contact and are common in patients between the ages of fifteen and twenty-five. Infrequently they are transmitted by non-sexual contact, for instance by wearing another person’s underpants or by using someone else’s towel. The most prominent symptom of crab lice is an intense itch which worsens at night. When the pubic hair is examined, clusters of eggs can be seen, appearing as small scales. The treatment for crab lice is identical with the treatment for head lice.
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