Question:
I am 38 years old, married, and have four children. My sister who lives in Miami called and informed me her son has scabies, and she is treating her entire family. In addition, she was given instructions on cleaning clothes and her house. I have not seen my sister or her family since the Christmas holidays. Should I be concerned for my family?
Answer:
Scabies, or the “itch mite”, is a tiny, microscopic skin mite which burrows into the skin. The mite does not fly, which means it requires very close personal contact with a person who has scabies to be contagious.
The mite prefers intertriginous areas (web spaces between the fingers and toes, under the breast and breast area, armpits, waist and navel area, and the genital area) as its initial site of attack. After a few weeks of infestation (3-4 weeks), a person begins to develop an allergic reaction to the mite, its eggs, and its excretions. The rash usually begins near the site of the initial infestation, which includes the hands, wrists, breasts, armpits or genital area. In severe cases, the allergic reaction rash can spread to most of the body.
This does not mean that there are mites in all areas of the rash. They tend to stay in the skin crease areas mentioned above. The physician will try to identify mite burrows in skin crease areas. A skin scraping for a microscopic exam from these burrows will allow the doctor to identify the mite, which confirms the diagnosis. Most itchy rashes are not scabies; and it is very important to make an accurate diagnosis, as all close personal contacts, family members in the same household, and sexual partners should be treated at the same time.
Treatment consists of applying a mite killing medication to the skin, cleaning all clothing worn within the last 24-48 hours, and striping all bed linens for cleaning as directed by your doctor. The mite requires human skin for survival. That means the mite cannot live for more than 24-48 hours without a human host. Any clothes and furniture not used for 24-48 hours do not require washing or fumigation.
The topical medications for scabies should be applied no longer than the time directed by your doctor, as the medication can irritate the skin, causing a rash and itching. The rash and itching may continue even though the mite has been killed, since the rash and itch represent an allergic skin reaction to the mite and its excretions. The residual rash and itch can be treated with anti-itch cortisone creams and oral anti-itch pills.
The itchy rash of scabies usually clears up in 2-6 weeks with an accurate diagnosis and treatment program. Obviously, treatment of an itchy, scaly, red rash that is not scabies with anti-scabetic medication will only aggravate the rash and cause other family members and close contacts to get unnecessary treatment that may cause them to get a rash from the topical anti-mite medication. An accurate diagnosis prior to treatment is mandatory.
Your contact with your sister’s family has been several months. If no family members are itching and there is no rash, it is most likely that you have no reason for concern and should not treat yourself and your family. You might ask your sister if the doctor actually scraped the skin of her child and identified the mite, as doctors see a lot of cases which get treated without an accurate diagnosis.