Which primary clinical manifestation would the nurse expect to assess in a child with scabies?

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Scabies is a skin infestation caused by a mite known as the Sarcoptes scabiei. Untreated, these microscopic mites can live on your skin for months. They reproduce on the surface of your skin and then burrow into it to lay eggs. This causes an itchy, red rash to form on your skin.

There are approximately 200 million cases of scabies in the world at any given time. It’s a highly contagious condition that can easily be passed from one person to another through direct skin contact.

Scabies isn’t a sexually transmitted disease, although it can be transmitted through intimate contact, sharing clothing, or sharing bedding.

Although scabies can be bothersome, the mites can usually be eliminated. Treatment often consists of medications that kill the mites and their eggs. Since scabies is so contagious, doctors usually also recommend treatment for the people who are in frequent contact with the person who has scabies.

Recognizing scabies bites and the distinctive red rash can help you find treatment faster.

After the initial exposure to scabies, it can take 2 to 5 weeks for symptoms to appear. The symptoms usually develop more quickly in people who’ve had scabies before, often as soon as 1 to 4 days after exposure.

The hallmark symptoms of scabies include a rash and intense itching that gets worse at night. Continuous scratching of the infected area can create sores that become infected. If this occurs, additional treatment with antibiotics for the skin infection may be recommended.

Common sites for scabies in older children and adults include the:

• wrist
• elbow
• armpit
• nipple
• penis
• waist
• buttocks
• area between the fingers

Scabies in babies and toddlers, and sometimes the very elderly or immunocompromised, can show up on the:

• head
• face
• neck
• hands
• soles of the feet

The rash itself can consist of:

• tiny bites
• hives
• bumps under the skin
• pimple-like bumps

The burrow tracks of the mite can sometimes be seen on the skin. They may appear as tiny raised or discolored lines.

Scabies is the result of an infestation of tiny, eight-legged mites. These bugs are so small you can’t see them on your skin, but you can certainly see their effects.

The mites burrow into the top layer of your skin to live and feed. Female mites lay eggs. Your skin reacts to the mites and their waste, and you develop a red, itchy rash.

These mites are easily passed between people. Direct skin-to-skin contact is the most common way the infestation is spread. The mites can also be spread through infested:

• furniture
• clothes
• bedding

Facilities where people live in close contact with one another often see infestations spread easily. These may include nursing homes or extended care facilities.

Can you get scabies from animals?

According to the Centers for Disease Control and Prevention (CDC), animals don’t spread the type of scabies that affects people. A different type of scabies mite can affect your pets, which causes a condition called “mange.”

If you come into contact with an animal with mange, the mites can cause temporary itching and irritation of your skin. However, the mites won’t be able to reproduce on your skin and will eventually die.

It’s important to treat a pet with mange since you and your pet will continue to come into contact with these mites until they’re treated.

There’s only one type of mite that causes a scabies infestation in humans. This mite is called Sarcoptes scabiei. However, these mites can cause several types of infestations.

Typical scabies

This infestation is the most common. It causes an itchy rash on the hands, wrists, and other common spots. However, it doesn’t infest your scalp or face.

Nodular scabies

This type of scabies may develop as itchy, raised bumps or lumps, especially around your genitals, armpits, or groin.

Norwegian scabies

Some people with scabies may develop another form of infestation known as Norwegian scabies or crusted scabies. This is a more severe and extremely contagious type of scabies. People with crusted scabies develop thick crusts of skin that contain thousands of mites and eggs.

Crusted scabies can also appear:

• thick
• gray
• easy to crumble when touched

Crusted scabies usually develops in people with weakened immune systems. This includes people who are:

• living with HIV
• using steroids or certain medications (such as some for rheumatoid arthritis),
• undergoing chemotherapy

In immunocompromised people, the scabies mites can overpower the immune system more easily and multiply at a quicker rate. Crusted scabies spreads the same way as normal scabies.

Scabies mites aren’t visible to the human eye and reach a maximum length of about 0.45 millimeters (1/56th of an inch), or about the size of a pin tip.

Scabies is highly contagious and can easily lead to a community outbreak. Sores can become infected with bacteria. In rare cases, usually in people who are immunocompromised, bacterial infections can cause serious complications like:

• chronic kidney disease
• septicemia, a bacterial infection of your bloodstream
• heart disease

Persistent itching from scabies may lead to insomnia.

Your doctor will likely be able to diagnose scabies simply by performing a physical exam and inspecting your affected area of skin. In some cases, your doctor may want to confirm the diagnosis by removing a mite from your skin with a needle.

If a mite can’t easily be found, your doctor will scrape off a small section of skin to obtain a tissue sample. This sample will then be examined under a microscope to confirm the presence of scabies mites or their eggs.

A scabies ink test (or Burrow Ink Test) can help spot burrowed paths in your skin created by the mites. To do this test, your doctor can drop ink from a fountain pen onto an area of the skin that appears to be infested. They then wipe away the ink.

Any ink that fell into the burrowed tunnels will remain and be obvious to the naked eye. That’s a good indication you have an infestation.

Treatment for scabies usually involves getting rid of the infestation with prescription ointments, creams, and lotions that can be applied directly to the skin. Oral medications are also available.

Ointments, creams, and lotions for scabies

Your doctor will probably instruct you to apply the medication at night when the mites are most active. You may need to treat all of your skin from the neck down. The medication can be washed off the following morning.

Make sure you follow your doctor’s instructions very carefully. You may need to repeat the topical treatment in 7 days.

Some common medications used to treat scabies include:

• 5 percent permethrin cream
• 25 percent benzyl benzoate lotion
• 10 percent sulfur ointment
• 10 percent crotamiton cream
• 1 percent Lindane Lotion

Medications for scabies itch

Your doctor may also prescribe additional medications to help relieve some of the bothersome symptoms associated with scabies. These medications include:

• antihistamines, such as diphenhydramine (Benadryl) or pramoxine lotion to help control the itching
• antibiotics to kill any infections that develop as a result of constantly scratching your skin
• steroid creams to relieve swelling and itching

More aggressive treatment may be needed for severe or widespread scabies. An oral tablet called ivermectin (Stromectol) can be given to people who:

• don’t see an improvement in symptoms after initial treatment
• have crusted scabies
• have scabies that covers most of the body

Sulfur is an ingredient used in several prescription scabies treatments. You can also purchase sulfur over the counter and use it as a soap, ointment, shampoo, or liquid to treat scabies.

It’s important to note, however, that no over-the-counter scabies treatments have been approved by the Food and Drug Administration (FDA).

During the first week of treatment, it may seem as if the symptoms are getting worse. However, after the first week, you’ll notice less itching, and you should be completely healed by the 4th week of treatment.

Skin that hasn’t healed within a month may still be infested with scabies mites. It’s important to remember that “post-scabies itch” can last up to 1 month.

Contact your doctor right away if you find that symptoms continue after 4 weeks of treatment.

Some traditional scabies treatments can cause unwanted side effects, such as:

• a burning sensation on the skin
• redness
• swelling
• numbness or tingling

While these side effects are typically temporary, they may be uncomfortable.

Common natural treatments for scabies include:

Tea tree oil

Small studies show tea tree oil may treat scabies while also easing itching and helping eliminate the rash. However, it won’t work well on mites that are burrowed in your skin.

Aloe vera

Aloe is thought to have antibacterial and antifungal properties and is well known for its ability to ease skin irritation and burning. One small study from 2009 found that aloe vera was just as successful as a prescription treatment at treating scabies.

Be sure to buy pure aloe vera, not an aloe vera-infused product.

Capsaicin cream

Capsaicin has pain-relieving properties and has long been used as a home remedy for burning pain. Though it will not kill the mites, creams made with capsaicin from cayenne peppers may relieve pain and itching by desensitizing your skin to the bothersome bites and bugs.

Essential oils

Clove oil and some other essential oils are thought to have potential insecticide properties that could help remedy scabies.

In a 2016 in-vitro study, meaning it was performed in a test tube or culture dish, researchers examined the effectiveness of various oils for killing scabies mites. The researchers found that the most efficient oils in order were:

• clove oil
• palmarosa oil
• geranium oil
• tea tree oil
• lavender oil

More research is needed to evaluate the effectiveness in humans.

Soaps

Active components from the bark, leaves, and seeds of the neem tree may kill the mites that cause scabies. Soaps, creams, and oils made with the tree’s extract may help kill the mites.

Home remedies for scabies show some promise for both relieving symptoms of an infestation and killing the mites that are causing the uncomfortable symptoms. Learn more about these natural scabies treatments so you can decide if one is right for you.

Scabies is highly contagious. It can be spread in the following ways:

• prolonged skin-to-skin contact, such as holding hands
• intimate personal contact, such as having sexual intercourse
• sharing clothing, bedding, or towels that have been used by someone with a scabies infection

Since scabies is mostly transmitted through direct physical contact, the infestation can easily be passed on to family members, friends, and sexual partners. The infestation may also spread quickly in:

• schools
• nursing homes
• rehab facilities
• sports locker rooms
• prisons

The best way to prevent getting scabies is to avoid direct skin-to-skin contact with a person known to have scabies. It’s also best to avoid unwashed clothing or bedding that’s been used by a person with scabies.

Scabies mites can live for 2 to 3 days after falling off your body, so you’ll want to take certain precautions to prevent another infestation. Make sure to wash all of the following in hot water that reaches 122°F (50°C):

• clothing
• bedding
• towels
• pillows

These items should then be dried in the dryer on very high heat for at least 10 to 30 minutes.

Anything that can’t be washed should be thoroughly vacuumed. When you’re finished vacuuming, throw out the vacuum bag and thoroughly clean the vacuum with bleach and hot water.

Bleach and hot water can also be used to clean other surfaces that may contain scabies mites.

Anyone can get scabies. The mites don’t distinguish between gender, race, social class, or income level. Getting mites also doesn’t have anything to do with your level of personal hygiene or how often you bathe or shower. Skin is skin to a mite looking for a place to burrow.

People who live in close, crowded environments, like college dormitories, may be more likely to get scabies. That’s because the infestation is very contagious and can be shared through infested surfaces like furniture.

The contagious factor is also why toddlers and young children may be more susceptible to scabies. Close contact in a child care center is a fast way for the infestation to spread.

Older adults, and people with weakened immune systems, are more likely to develop crusted or Norwegian scabies.

Scabies and bedbugs feed off the human body. One does it from outside your body (bedbugs), while the other does it from inside (scabies).

Scabies are microscopic mites that burrow into your skin to live and lay eggs.

Bedbugs are tiny as well, but you can see them without special viewing equipment. They usually come out at night‚ while you’re asleep, to feed on your blood. They then scurry away to your mattress, headboard, or other soft nearby furniture and hide.

When bedbugs bite, you often see clusters of bites. Each cluster usually contains three to five bites that appear in a zigzag pattern. The area may look red and blotchy. You may even notice a bit of blood. Scabies often appears more widespread and makes scaly or lumpy bumps.

It’s possible to treat bed bugs and scabies, but both will likely require treating other people in your house as well as your physical surroundings. Bedbugs are particularly hardy and difficult to kill. You may need to call a professional exterminator.

Scabies, on the other hand, don’t live long without human contact. Treatment for your body and your home is typically successful.

Scabies mites can live on a person for 1 to 2 months.

If you’re treating scabies, you can expect the itching and burning caused by the rash to last for several weeks after treatment begins. That’s because the eggs and mite waste are still in your skin, even if the mites are dead.

Until your skin grows new layers, you may continue to have a rash and irritation.

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