Nosocomial outbreaks of scabies have occurred in a variety of health care settings, including intensive care units, rehabilitation centers, long-term care facilities, hospital wards, a dialysis unit, and a health care laundry, according to the Centers for Disease Control and Prevention (CDC).1 The CDC cites the following Q&A information to assist with scabies education of patients and health care workers.
Question: What are the signs and symptoms of scabies infestation?
Answer: Symptoms and signs include:
• Pimplelike irritations, burrows, or rash of the skin, especially the webbing between the fingers; the skin folds on the wrist, elbow, or knee; the penis; breasts; or shoulder blades.
• Intense itching, especially at night and over most of the body.
• Sores on the body caused by scratching. These sores sometimes can become infected with bacteria.
Question: How did I get scabies?
Answer: By direct, prolonged, skin-to-skin contact with a person already infested with scabies. Contact must be prolonged (a quick handshake or hug will usually not spread infestation). Infestation is spread easily to sexual partners and household members. Infestation may also occur by sharing clothing, towels, and bedding.
Question: Who is at risk for severe infestation?
Answer: People with weakened immune systems and the elderly are at risk for a more severe form of scabies, called Norwegian or crusted scabies.
Question: How long will mites live?
Answer: Once away from the human body, mites do not survive more than 48-72 hours. When living on a person, an adult female mite can live up to a month.
Question: Did my pet spread scabies to me?
Answer: No. Pets become infested with a different kind of scabies mite. If your pet is infested with scabies (also called mange), and they have close contact with you, the mite can get under your skin and cause itching and skin irritation. However, the mite dies in a couple of days and does not reproduce. The mites may cause you to itch for several days, but you do not need to be treated with special medication to kill the mites. Until your pet is successfully treated, mites can continue to burrow into your skin and cause you to have symptoms.
Question: How soon after infestation will symptoms begin?
Answer: For a person who has never been infested with scabies, symptoms may take four to six weeks to begin. For a person who has had scabies, symptoms appear within several days. You do not become immune to an infestation.
Question: How is scabies infestation diagnosed?
Answer: Diagnosis is most commonly made by looking at the burrows or rash. A skin scraping may be taken to look for mites, eggs, or mite fecal matter to confirm the diagnosis. If a skin scraping or biopsy is taken and returns negative, it is possible that you still may be infested. Typically, there are fewer than 10 mites on the entire body of an infested person; this makes it easy for an infestation to be missed.
Question: Can scabies be treated?
Answer: Yes. Several lotions are available to treat scabies. Always follow the directions provided by your physician or the directions on the package insert. Apply lotion to a clean body from the neck down to the toes and left overnight (eight hours). After eight hours, take a bath or shower to wash off the lotion. Put on clean clothes. All clothes, bedding, and towels used by the infested person two days before treatment should be washed in hot water and dried in a hot dryer. A second treatment of the body with the same lotion may be necessary seven to 10 days later. Pregnant women and children often are treated with milder scabies medications.
Question: Who should be treated for scabies?
Answer: Anyone who is diagnosed with scabies, as well as his or her sexual partners and those who have close, prolonged contact to the infested person also should be treated. If your health care provider has instructed family members to be treated, everyone should receive treatment at the same time to prevent reinfestation.
Question: How soon after treatment will I feel better?
Answer: Itching may continue for two to three weeks, and does not mean that you still are infested. Your health care provider may prescribe additional medication to relieve itching if it is severe. No new burrows or rashes should appear 24-48 hours after effective treatment.
1. Centers for Disease Control and Prevention. Guide-lines for infection control in health care personnel, 1998. Am J Infect Control 1998; 26:289-354.