Scabies - Requires Prescribed Care

October 29, 2018


Scabies bites on an arm

Scabies mites are so small that you cannot see them on skin, but the rash they leave behind can be a big problem.

“Scabies is a skin condition caused by scabies mites,” Beth Keth RN, BSN, Organizational Performance Improvement/Patient Safety officer at Penn Highlands Brookville, said. “The mites burrow into the top layer of skin to live, feed on and lay eggs. When the skin reacts to the mite’s intrusion, an extremely itchy rash occurs.”

“The pimple-like rash can affect any area of the body,” Rhonda Chilson, RN, director of Quality and Infection Control at Penn Highlands Elk said. “It is contagious and can spread quickly.”  Scabies can show up between fingers, on wrists, elbows, armpits, genitals, chest or waist. It can show on heads, faces, necks, palms and soles of children and infants.

“Scabies is spread through skin-to-skin contact,” Sue Stiner, MSN, RN, director of Infection Prevention and Control at Penn Highlands DuBois, said. “But it can be spread through shared items, such as clothing, towels, bedding or furniture.” It is easily passed in households by families and roommates, in dorms, in workplaces and in skilled-care facilities.

Someone who never had scabies before usually notices symptoms about four to six weeks after contact with the mites. Those who have had scabies before may notice them sooner – maybe within a few days or a week.

Though scabies is annoying, it is does not pose any complications to generally healthy people. Yes, it can lead to infected sores from scratching. And sometimes, a bacterial skin infection can lead to an inflammation of the kidneys.

However, a severe form of scabies can affect the elderly, people who have weak immune systems or people that have conditions that prevent them from itching, such as those with paralysis, loss of sensation or mental disabilities. This severe form is known as crusted or Norwegian scabies.

Crusted scabies occurs when thick crusts of skin contain large numbers of scabies mites and eggs. The mites are the same as those in non-severe cases, but they spread to others faster because there are so many more. They are spread through limited skin-to-skin contact faster, and the eggs fall off the body to spread from clothing, bedding and furniture to people faster.

How is it treated?  Scabies is diagnosed by looking at the rash or by taking a scraping of skin for testing. The sooner it is diagnosed, the easier it is to treat.

“The treatment for scabies is a topical cream available only by prescription from a healthcare provider. No over-the-counter medications have been approved to treat scabies,” Lisa Rorabaugh, director of Patient Safety, Risk Management and Customer Service at Penn Highlands Clearfield, said.

After a shower, the cream is applied from head to toe – even on areas without a rash. It is left on for the recommended time then washed off. Clothing worn during and after treatment, and all bedding should be washed in hot water and dried in a hot dryer before use.

Other clothing and items that cannot be laundered should be stored in a closed plastic bag for one week. Rooms should be cleaned thoroughly. Furniture and rugs that cannot be washed with disinfectant should be vacuumed well.

Unlike other diseases, those with no symptoms still need to be cautious. Someone who lives with or works around those with scabies should be treated, too. They must follow the same routine as someone with the rash. Pets will be fine. They do not get or spread human scabies.

Will the rash clear up immediately? How fast the rash clears up depends upon the person’s sensitivity to the mites, their eggs and their feces.  Even after all the mites and eggs are gone, a person could still have an itch and rash. If it is present longer than two weeks or if it is crusted scabies, the mites may have burrowed and a second treatment is needed.

Sometimes at Penn Highlands, we have patients who come in with scabies. We follow policy to protect our staff and other patients.

Those with scabies are in private rooms, and the staff and all visitors wear protective gowns and gloves while in the room. If the patient has crusted or Norwegian scabies, the staff - along with visitors - will wear covers on their shoes in addition to gloves and protective gowns. Those gowns, shoe covers and gloves will be disposed of properly as the staff/visitor leaves the room so the mites and eggs don’t go out into the hall/public.

The hospital staff will treat patients with the necessary creams, and crusted scabies will be treated twice, a week a part. The patient’s clothing will be sent home for family to wash in hot water and dry in a hot dryer. Other items will be placed in a sealed plastic bag for patients.

All bedding from the room will be changed daily and placed in sealed bags. All furniture will be cleaned and vacuumed in the room.