Scabies - Scabies

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-08-25 11:04

Scabies (scabies)

Scabies is an infectious, severely itchy parasitic skin disease ("scabere", Latin for scratching) caused by the grave mite or itch mite (Sarcoptes scabiei variatio hominis). The scabies mite belongs to the group of arachnids (arachnida). The female scabies mites are 0.3 to 0.5 mm in size (barely visible as a point with the human eye), the male mites 0.21 to 0.29 mm. Mating takes place on the surface of the skin. The male mites then die. Only the fertilized females dig fine tunnel-shaped passages in the upper layer of the skin. There they lay several eggs every day and excrete plenty of balls of feces. They live about four to six weeks. After two to three days, larvae hatch from the eggs, swarm to the surface of the skin and settle there in folds, hair follicles, etc.develop into sexually mature mites after two to three weeks.

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• How is the scabies transmitted?
• What are the symptoms?
• How is the diagnosis made?
• How is scabies treated?
• What can I do myself?
• Duration of the risk of infection
• Whom can I ask?
• How are the costs going to be covered?

How is the scabies transmitted?

Scabies are transmitted from person to person (skin-to-skin contact), so there is no intermediate host. Infection usually occurs through intensive physical contact (including during sexual intercourse). Since itch mites move very slowly, there is usually no transmission through brief handshakes, hugs, etc. An exception is the crustaceans (scabies crustosa). It is one of the highly contagious form of scabies with strong crust formation. Since the number of itch mites on the skin is very high in scabies, even a short skin contact can lead to infection. This means that the risk of colonization increases with the number of mites on the patient's skin surface.

Since the itch mite can live without a host for a short time (approx. Two days), transmission via textiles such as bed linen, clothing, soft toys, etc. is in principle possible. Due to the rapidly decreasing infectiousness outside the skin and with a low number of mites, this transmission route is rather rare. The risk of infection is greatest where people live very closely together (e.g. kindergartens / schools, hospitals, nursing homes, etc.).

Risk factors for transmission are:

• high number of mites
• frequent, long-lasting body contact
• Community facilities (kindergarten, school, home, etc.)
• lack of hygiene
• poor immune status

What are the symptoms?

Burning skin and itching (especially at night) are common early signs of scabies. The itching can also spread to areas of the skin that are not directly affected by mites.

If infected, it can take several days before symptoms appear. During this time, the infection can spread to other people. Therefore, people who come into contact with cases of suspected scabies are usually treated as well.

Common scabies (Sarcoptes scabiei variatio hominis)

The first symptoms appear after two to five weeks at the initial infestation. Scabies mites prefer areas with high temperature and a thin layer of skin. Popular places therefore include the spaces between the hands and feet, the extensor side of the elbows, anterior armpits, areola, umbilical region, anal folds, groin region, penile shaft, etc. The back is rarely affected. The head and neck are mostly left out.

Typical signs are fine, dark, irregularly twisted or streaked lines (mite ducts) in the upper layer of the skin. These can hardly be seen with the naked eye. After a while, small bubbles may form at the end of these lines. In addition, areas of skin injured by scratching can become inflamed with pus.

Krustenskabies (Scabies crustosa, Borken dross)

Krustenskabies occurs mainly in immune-weakened (immunosuppressed) people on which the mites multiply uninhibited. Often up to several million mites can be found on and in the skin. The signs of the crustaceans differ from the common scabies. Typical is an extreme crust formation, which mainly affects the palms and feet, elbows and knees. Often parts of the body are also affected that are not affected by ordinary scabies (e.g. face).

Note Due to the high number of mites, the Krustenskabies is highly contagious. Even brief skin contact can lead to infection.

Scabies in infancy and toddlerhood

Infants and toddlers have very pronounced skin changes. Mostly the feet, especially the soles of the feet, scalp and face are affected. Blisters, vesicles, and pustules often appear.

Scabies does not cause pain. Symptoms, such as itching, are a reaction of the body's own immune system to the scabies mites and their waste products (e.g. dung balls).

How is the diagnosis made?

If you suspect scabies, you should consult a doctor (general practitioner or dermatologist).

The suspected diagnosis can be secured by means of:

• microscopic detection of itch mites, mite eggs or mite excrement from a skin scraping ("skin scraping"). For this, skin is scraped off with a sharp spoon or scalpel in order to examine it microscopically.
• Tesafilm tear-off: for this, an adhesive strip is pressed firmly onto the affected area of the skin, pulled off suddenly and examined under the microscope.
• Dermoscopy: If a mite duct can be seen well, the doctor can look at it with a special microscope and possibly see the mites directly.

Note In the case of scabies, the numerous mites present can already be detected in individual flakes of skin.

How is scabies treated?

Special drugs are available for treating scabies - so-called sabicides. They are usually applied to the skin as creams, ointments or sprays. Sometimes they are also given orally.

The primary goal of treatment is to kill the scabies mites and their larvae and eggs. Symptoms, in particular the often pronounced itching and inflammatory skin areas, are also treated.

The following active ingredients are available:

Permethrin: In Europe, the active ingredient permethrin is the first choice for treating scabies. It is applied to the skin as a cream. For common scabies, a single treatment (8-14 hours, preferably overnight) with the active ingredient permethrin is usually sufficient

Note Permethrin is highly effective against scabies mites, is well tolerated and can be used in a lower dose for children.

• Benzyl benzoate: This active ingredient is usually only used if a previous therapy with permethrin was unsuccessful. Benzyl benzoate is highly effective against the scabies mites, but is rarely administered due to its relatively complicated application.
• Oral Ivermecitin: Ivermecitin is taken orally (swallowed as a tablet). Similar in effectiveness to permethrin.

Which side effects can occur?

Studies have shown that common drugs for treating scabies rarely cause side effects. Rash, diarrhea, or headache are very rare. Itching and eczema can persist for a few weeks after successful treatment, but they decrease in intensity.

What can I do myself?

In order to protect other people from infection, sick people should temporarily limit contact with other people and, in particular, avoid direct skin contact. To prevent further infections, the following measures have a supportive effect:

• Wear gloves: People who treat people with scabies should wear gloves. In particularly severe cases (e.g. bark scabies) a protective gown should also be worn.
• Cutting fingernails: Sufferers should trim their nails as much as possible and carefully brush out the areas underneath.
• Topically applied anti-mite agents work better if they are applied to the skin after a full body bath (approx. 60 min.).
• During the medication exposure time, patients should wear cotton gloves (and plastic gloves if necessary).
• After washing off the drug, clothes should be completely changed.
• Bed linen, clothing, etc., which the affected person has been using for a long time, should be washed at 60 degrees.
• Beds should be freshly made. Mattresses only need to be decontaminated for scabies crustosa.
• Upholstered furniture, carpets, etc. can be vacuumed with a vacuum cleaner. The filter should be disposed of after vacuuming.

Note All contact persons should be checked regularly for symptoms of scabies, even if all hygiene measures are observed.

Duration of the risk of infection

After completing the first proper treatment, children can go to a community facility (school, kindergarten, etc.) and adults can go back to work. This does not apply to patients with crustaceans. An inpatient stay in the hospital is usually required here.

Whom can I ask?

If you suspect scabies, you should contact a dermatologist immediately.

You can find doctors in your area under Search for a doctor

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services.

You can obtain detailed information from your social security agency. Further information can also be found at:

• Right to treatment
• Visit to the doctor: costs and deductibles
• What does the hospital stay cost?
• Prescription fee: This is how drug costs are covered
• Rehabilitation & cure
• Medical aids & aids
• Health Professions AZ

and via the online guide to reimbursement of social insurance costs.

When hospitalization is required

Inpatient treatment is not necessary for common scabies. In the case of severe mite infestation (eg crustaceans, a hospital stay may be necessary. In this case, the hospital stay will be billed to the hospital costs. The patient has to pay a contribution per day. Further medication at home is provided by the general practitioner on a prescription) the general practitioner or specialist, you can find

further information under What does the hospital stay cost?