Scabies

Dear Lisa,

My son just got back from camp and told me that one of the kids at camp had scabies. What does a scabies rash look like and how do I know if my son caught it?

“Scabies at Camp”

Dear “Scabies at Camp”,

Scabies is a skin infestation caused by a parasite, a female itch mite called Sarcoptes scabiei. The disease is spread through close personal contact and is usually found in more than one person in the family. Younger Children tend to develop Scabies after a sleep over at a friend’s house or after attending sleep away camp. In teenagers and adults, scabies can be transmitted during sexual contact and is considered a sexually transmitted disease. (1)

Many times scabies is not suspected because there is a long span of time from the time of exposure to the initiation of symptoms. The incubation period is usually 4 to 6 weeks in a child that has not previously been exposed. (2) By the time a child gets a rash, the parents many times forget that there was a sleep over or that the child was in contact with a person with a rash.

The rash that develops as a result of Scabies is caused by a hypersensitivity reaction to the proteins of the mite. (2) The symptoms are very similar to a wide spread case of contact dermatitis and many times is mistaken for eczema. The difference is that a patient with scabies has burrows in the skin which appear as gray or white threadlike lines.

A burrow is formed when the adult female mite burrows through the skin leaving behind this characteristic rash. Many times the burrows cannot be appreciated because of damage to the skin inflicted by repetitive scratching. In an attempt to identify the burrows Doctors or Nurse Practitioners may use a black permanent marker. Writing on the patient’s skin with the marker makes the burrows easier to see.

The symptoms of Scabies include intense itching which occurs especially at night. (2) In older children the rash is typically distributed on the skin between the fingers, around the belly button area, the wrists, the buttocks, the belt line, thighs and the penis. Occasionally, 2-5 mm red-brown nodules can be found that persist for weeks or even months after a person is treated. These nodules are formed in response to the dead mites that remain on the skin after treatment. Infants younger than two years old typically do not present with the classic “Scabies” rash. The rash on younger children appears more like vesicles and is likely to occur on the head, neck, palms of the hands and soles of the feet.

The important thing to remember about Scabies is that the rash is wide spread throughout the body and intensely itchy. The rash due to Scabies is not limited to one part of the body. Because it is highly contagious, many times it is found in family members at the same time. Therefore if a child has a new rash that looks like a wide spread case of contact dermatitis, plus other members in the family members have a similar rash, Scabies should be suspected.

In order to determine if your son has Scabies, you should inspect his skin 4 to 6 weeks from his initial exposure. Look for the characteristic rash that is widespread and found between the fingers, at the beltline, on the thighs and around the belly button area.(1) If your son develops such a rash it would be a good idea to you bring him to his Pediatrician to confirm the diagnosis.

The treatment for Scabies includes the application of a scabicide cream or lotion over the entire body. A 5% Permethrin crème such as Elimite is commonly used in children over 2 months old. (2,3) The crème should be washed off of the body 8 to 14 hours after the application. It is common for a child’s symptoms of itching to persist for a couple of weeks after treatment since Scabies is due to a hypersensitivity reaction to the mite. After the mite dies the protein that causes the reaction remains on the skin and continues to cause symptoms for a couple of weeks. (2,3) Antihistamines may be used during this time to alleviate symptoms. (4)

Whenever there is open lesions on a child’s skin, especially when there is scratching involved, there is a chance of developing a bacterial skin infection. If your child has Scabies and develops a fever, increased redness, warmth or induration at the site of a lesion, oozing discharge or pain, an evaluation by a health care professional is necessary. In order to prevent your child from developing a bacterial skin infection it is important to keep your child’s nails clean and cut short.

To prevent scabies from spreading to other members in the household you should wash all clothing and bedding that came into contact with an infected child for the four days previous to the initiation of therapy. The clothes should be laundered on the hot cycle of the washing machine since the heat kills the mites. The mites cannot live for more than 3 to 4 days off of the body, therefore you can put stuffed animals or non-washable items in a plastic bag for 4 days in order to kill the mites too. (2)

References:
(1) Monroe J. DermaDiagnosis. Clinician Reviews. 2006;16(2):54.
(2) American Academy of Pediatrics. Scabies. In: Peter G, ed. 1997. Red Book: Report of the Committee on Infectious Disease. 24th ed. Elk Grove Village, IL: American Academy of Pediatrics; 1997:387-390:468-470.
(3)Physician’s Desk Reference. 2004. Montville, NJ. Thomson PDR at Montville:552-553.
(4) Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984: 620-621.


Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Advice about Pediatric Infectious Diseases