Several things can be said about the human body, particularly in how the intricate system of organs and tissues within the body work together to produce life as we know it – giving humans the ability to navigate through several situations. The human body is a highly complex system that involves several mechanisms and parts to work correctly – making it essential that all parts involved in these processes are kept in a state of balance no matter what happens. While it is a crucial goal for humans to preserve the state of balance and ensure that all the processes in the body are working as they should, several events in the human world cause changes that might induce problems that sometimes could not be resolved by the natural mechanism of the human body to ward off such changes in the body. This process is called “homeostasis,” and effective as it might be, there are certain extents to its ability to revert changes to the body’s systems, mainly when these changes are massive or were caused by another external factor entirely, i.e., microorganisms.
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Microorganisms are essentially, well, tiny organisms, as indicated by the etymology of the root word “micro.” Microorganisms are found everywhere in our environment, and this is likewise found even in the human body, from the skin to the body’s digestive tract. These microorganisms tend to work in one of two ways – they could either work with the body and coexist to serve as an essential tool to maintain the healthy balance of the human body, or they could induce changes and imbalances that may result in problems that could then be construed as a “disease.” Microorganisms can be beneficial to the human body in such a way that they can perform processes that could replenish certain chemicals within the body or ensure that the body's environment is maintained at a certain point. However, negative responses are often expected when it comes to pathogenic microorganisms or those that tend to induce damage when it enters the human body. This results in specific manifestations, or sometimes non-specific, to the disease caused by that particular causative microorganism. In any case, external microorganisms, pathogenic microorganisms, or those not generally found within the human body, are bad news for a human’s internal system once it enters the body.
A specific type of microorganism behaves in such a way that it enters the human body, but it does not necessarily invade the internal structures of the body – mainly settling externally in the skin and causing manifestations within the outer layers of the body’s protective layer. These are typically known as infestations – one that can be caused by small insect-like creatures that tend to burrow under the skin and lay their eggs to cause itchiness, bruising, and the development of a rash specific to the microorganism that caused the infestation.
A typical example of an infestation is known as “Scabies” – caused by the human itch mite or Sarcoptes scabiei var. It is easy to mistake a scabies infestation with other rashes caused by varying factors due to how it likewise presents as an itchy rash typically located within the folds of the skin.
With this in mind, especially considering that the healthcare-seeking behavior of many communities worldwide is poor enough to discourage the prompt diagnosis of a simple rash, it is essential to disseminate knowledge regarding how one could identify a possible scabies infestation, and ensure its proper management following a diagnosis, as prompted by their prior identification of a potential condition. While this copy does not promote self-medication, particularly in such a condition that presents non-specific symptoms in its manifestation, it does provide the necessary and critical identifying factors that one could use to prompt a consultation with a qualified physician and obtain the required medication for this condition.
Scabies, as previously discussed, is an infestation caused by the microorganism known as Sarcoptes scabiei var., a microscopic mite (colloquially known as the human itch mite) that burrows into the upper layers of the skin and causes itchy manifestations within the external layers of the body. The mite tends to lay its eggs in the area of the skin that it burrows into – driving the development of rashes that may spread within site or transfer to another healthy individual following prolonged contact. It is a condition that is not endemic to any location and can be found worldwide – making it more important to understand the facts regarding this condition and how to handle potential cases to identify the need for any diagnosis or intervention from a qualified physician. Please do note, however, that while this copy provides most of the information needed to correctly identify an infestation and provide the necessary treatment strategies to resolve the condition, it does not promote self-management and the use of medications without a prior diagnosis from a physician and a prescription for the medicines to be used in the management of the condition.
Scabies is an infestation that is not limited geographically, or, in simpler terms, scabies infestations can be found anywhere within the globe as long as there is someone who serves as a carrier for the mite and someone who can get infested by the microorganism following contact. Scabies is a condition that does not distinguish race and social class – all individuals can be infected, and all types of individuals have the risk of being infected by the condition, provided that the conditions for transmission are present. Scabies is not necessarily a significant problem within most communities as the requirement for its transmission is mainly prolonged physical contact – making it harder to transmit the microorganism when two individuals are not, particularly in close quarters, or are open to random physical contact with other individuals, unlike how other communicable diseases tend to propagate. However, given that transmission through sharing personal belongings and bedding is likewise possible, it is still highly advisable for everyone to be extremely wary of the possibility of transmission when using the belongings of other individuals without any prior knowledge of their health status.
Much like any other condition or infestation, the transmission of the microorganism is not necessarily guaranteed once contact occurs, especially considering that transmission is triggered once the mite jumps from one person to another. However, similar to how most diseases work, certain activities and individuals tend to increase their risk of contracting the condition compared to others. Do note, however, that while these activities presumably increase the risk of transmission, it does not guarantee that you will be infected, nor will the opposite of this scenario be likewise true – not being a high-risk candidate for scabies does not mean that you will no longer contract the condition in all situations. The transmission always occurs on a case-to-case basis, and only certain activities tend to tip the scales toward a particular outcome.
As previously discussed, prolonged skin contact is the primary mechanism through which the human itch mite is transferred from one person to another. This is because the causative microorganism for a scabies infestation is a parasite that would have to jump from an infected individual to another healthy person, then burrow within the skin to lay eggs and induce the typical manifestations of this condition. When two individuals are in prolonged skin contact, even through hugging, this activity provides an avenue for the mite to transfer from one host to another, and the length of contact gives the parasite enough time to burrow into the skin and go through the process of laying their eggs underneath the upper layer of the skin. Suppose you are an individual who is particularly fond of hugs, cuddling, or any form of prolonged physical contact with any individual. In that case, you might be at an increased risk of contracting the condition from someone else. This risk may be severely diminished by the fact that prolonged skin contact only typically occurs between individuals who are somehow familiar with each other and might therefore be aware of each other’s health status, but prolonged contact, in essence, increases the risk of transmission nonetheless.
As a form of prolonged physical contact, sexual contact with an individual who has scabies is likewise a significant risk factor for transmitting a scabies infestation. While such sexual contact does not necessarily imply the need for contact with bodily fluids, unlike the case in most sexually transmitted conditions, it is still vital to be likewise careful when engaging in sexual intercourse with an individual whose health status you are not familiar with as sexual intercourse provides an avenue for prolonged physical contact – the primary risk factor for scabies transmission.
Apart from the risk of transmission when there is direct contact between two individuals, it is likewise possible for a scabies infestation to be transferred to another healthy individual when personal belongings are shared. Scabies mites tend to live on a person for as long as 1-2 months, but the human itch mite can live on other surfaces for around 48-72 hours, no matter how short it may seem. When this happens, the mite can burrow into the skin of the person that used the infested item – resulting in an indirect transmission that can still induce a full-blown infestation and manifestation of the condition. Considering that the human itch mite can survive on these surfaces for quite some time, sharing personal belongings such as clothes, underwear, and even beddings or blankets could result in transmission if the source of these items has an ongoing infestation, whether they are aware of the condition or not.
Scabies is typically transmitted through prolonged physical contact to allow the human itch mite to transfer from one person to another and burrow through the skin to induce its respective manifestations. However, one type of scabies, known as “crusted scabies” or “Norwegian scabies,” is a specific variation commonly found within immunocompromised individuals. The issue with crusted scabies is how highly contagious the condition is compared to the common scabies variation – translating to higher transmission rates when exposed to someone with crusted scabies. The transmission pathway remains the same, i.e., through prolonged direct contact and sharing of personal belongings. However, the infestation requires significantly less contact time to infect another individual – making it a significant risk factor to be exposed to someone with this type of scabies manifestation.
Prison inmates are often cramped together in tightly closed spaces in jails – making it almost inevitable to have direct physical contact with another individual, especially within sleeping quarters. In such an instance where prolonged physical contact is almost a given at all times, the risk for transmission of such infestations, along with many other conditions, skyrockets to the point where transmission is practically guaranteed once an individual becomes infected by the condition within the facility.
Assisted living situations are often running under a tight budget – resulting in certain limitations regarding the supplies being distributed throughout the facility. In the case of home care centers, the availability of bedding and materials are often quite limited to the point where it is almost a must to rotate out items, after proper washing, of course. Despite this protective measure in place to somehow still maintain sanitation, there are certain instances wherein parasites such as human itch mites can survive the washing process, mainly when the temperatures are not high enough to kill the microorganism living within the material. When this happens, and the bedding is used again by another individual, it then introduces the possibility that transmission of the condition may occur – generally resulting in an increased risk of contracting a scabies infestation from these materials. In addition to this issue, home care centers are sometimes prone to overcrowding – a contributing factor to close physical contact, which is subsequently considered the primary risk factor for scabies infestation transmission.
Like home care centers are often considered a high-risk area for scabies infestation transmission, living in crowded areas where physical contact, particularly those within proximity, is considered inevitable, the transmission of the condition is easier compared to areas where there are sufficient distances between each living quarters. Living in crowded areas where close contact is imminent, especially when sleeping next to each other in a limited space, could increase the risk of transmission as contact between a healthy individual and another carrier could quickly occur, and the microorganism could likewise easily penetrate the skin of its new host.
With children, it is essential to note that physical contact is a recurring event throughout the day, mainly when they are playing around and trying to engage in several activities with each other. Considering that younger children are often not yet aware of their actions, touching each other and sharing each other’s belongings is almost a norm that anyone could observe in any childcare facility. In instances where a child is a carrier of scabies, similar to how lice infestations are relatively more prominent among children, it is easy for a scabies infestation to increase within this environment – showing that being in a childcare facility significantly increases the risk of transmission for your children.
Currently, there are several available options to treat scabies cases in the market, but it is essential to understand that these medications are only available with a prescription from a qualified physician before you can safely buy and use these items. These treatment options are known as scabicides, and these medications kill mites and the eggs deposited when these parasites have burrowed under your skin. There are no available over-the-counter medications for scabies, but with the proper diagnosis and prescription order from your physician, it is easy to have yourself treated for scabies and their subsequent manifestations.
As previously discussed, sexual contact with an individual unaware of their health status is a significant risk factor for the transmission of a scabies infestation. This is because sexual intercourse employs close physical contact, which is the perfect venue for the human itch mite to jump from an infected individual to another healthy person – causing an infestation and its subsequent manifestations following proliferation.
However, while this might seem as if the condition itself can be transferred through sexual contact, scabies itself does not necessarily qualify under the definition of a sexually transmitted condition as this type of contact is not the primary mechanism through which the infestation is transferred. Sexual contact serves as a perfect complimentary avenue to the transmission pathway of scabies infestations and is in no way the cause of infestation during transmission. Do note that scabies cannot be transmitted via bodily fluids produced during sexual intercourse, nor can it be transmitted with exposure to the blood of the infected individual – indicating that the transmission of scabies primarily relies on the ability of the parasite to transfer from one host to another instead of relying on specific bodily mechanisms to infect another individual.
Considering that scabies is primarily caused by a parasite that essentially jumps from one person to another and then burrows underneath the upper layer of the skin to lay its eggs and increase, there are specific preventive measures that one can employ to disrupt this process and prevent its transmission pathway from completing its course. In most cases, the primary preventative measure is relatively straightforward, especially considering there needs to be a direct transfer of the parasite from one person to another to entail transmission: distance. Distance is all it ultimately takes to prevent the transmission of the parasite – no contact, no transmission. However, considering that the parasite may likewise live on specific surfaces and still induce transmission once another person encounters these items, other preventive measures may be integrated to mitigate and minimize the risk of transmission fully.
As previously discussed, the human itch mite can survive on surfaces for up to 3 days, and this may include beddings, linens, and clothing that an infected individual has used. If you are currently living with someone who has a scabies infestation or knows someone who is now suffering from such a condition, it might be wise to advise them to wash all their linens and clothing regularly to ensure that no accidental transmission incidents will occur. In addition, periodically washing your linens, mainly if you are frequented by several visitors whose health statuses are pretty vague, will lower the risk of accidental transmission caused by an infected individual’s contact with the items you use.
If you have encountered certain hard-to-wash items or those that cannot be dry cleaned which were previously used or touched by someone with a known case of a scabies infestation, it might be wise instead to follow the lifecycle of a human itch mite and wait for it out instead before using the item again. In this case, you may put the things in a sealed plastic bag and allow the item to wait out around 3-4 days to ensure that even if the human itch mite indeed infested the items, the parasites are already dead by the time the item is put to use once again.
As a rule of thumb, infestations such as scabies and other conditions caused by a specific parasite are sometimes an issue of sanitation within your home. Having these mites live within some commonly used items or those you typically come into contact with is a considerable risk factor for contracting the condition indirectly. To ensure that this risk is further mitigated, it is efficient to maintain your home's cleanliness and vacuum dirt-accumulating items such as your carpet and couches.
Scabies infestations are caused by the parasite known as the human itch mite or Sarcoptes scabiei var. hominis. The human itch mite variation that causes a scabies infestation is the female mites, which then burrow into the upper layer of the skin following transmission. When this happens, the mites then live within their burrowed hole and deposit their eggs into the skin layer, where they can then grow, replicate, and proliferate to later on cause itchy manifestations, primarily in the form of pimple-like blisters that are typically found within the folds of the skin.
In most instances, the transmission of the human itch mite is facilitated by prolonged and direct physical contact between an infected individual and another healthy patient to allow the physical transfer of the mites and provide enough time for the parasite to burrow underneath the skin. However, remember that while physical contact is the common transmission pathway of scabies, transfer through inanimate surfaces is still possible for around 48-72 hours following an infected person’s contact with these items.
Scabies is an infestation caused by the human itch mite – a parasite that causes intense itching, particularly at night, in specific body areas. The manifestations caused by this infestation may be non-specific in certain instances – making it more important to properly recognize the symptoms caused by a scabies infestation to seek appropriate help from a qualified physician.
Among adults, the most common areas affected by the rash manifestation of a scabies infestation include:
The aforementioned areas are the common sites that are often showing itchiness along with the presence of pimple-like rash, but in infants and younger children, the commonly affected areas are as follows:
Once the human itch mite has been able to burrow underneath the upper layer of the skin, specific manifestations tend to appear that are commonly misconstrued as either a presentation of another condition or a typical rash caused by an irritation or reaction with a particular substance. However, in the case of a scabies infestation, the patient may present with intense itching at night and a pimple-like rash that could either be blistered or scaled over. Once the rash is scratched, it can often develop painful sores, mainly when bacteria infect the open area.
The burrows caused by the human itch mite may appear grayish-white in color, often described as tiny, raised, and crooked areas within the skin surface. They are typically hard to find due to their small sizes and the limited number of burrowing mites for every infestation, but they are usually located within skin folds such as on the wrist, elbow, knee, penis, breast, or shoulder blades.
Rashes caused by scabies are nearly identical to other rash types, particularly those caused by acne and mosquito bites. However, the distinguishing factor in a scabies infestation is the sensation of intense itching that is magnified at night – a symptom even more severe in the case of children and the elderly.
For most diagnosticians, the testing procedure for a scabies infestation is typically composed of identifying and adequately examining the appearance and distribution of the rash, along with confirming the presence of burrows. However, to produce an entirely conclusive test result, human itch mites must be carefully removed from the burrows through skin scraping, then analyzed and identified to identify the microorganism underneath the skin.
Scabies can typically be treated using scabicides or substances meant to kill the human itch mite along with the eggs that these parasites were able to lay on your upper skin layer. These require a prescription to dispense – meaning that a proper diagnosis and confirmation from your physician are necessary for you to use these medications for your infestation.
The application of topical scabicides may vary depending on the medication prescribed, but most physicians recommend applying the topical substance to your whole body and leaving it on for 8 to 14 hours. The following are the commonly prescribed agents for this particular condition:
It is known as a scabicide skin cream that is generally safe for adults, those who are pregnant or breastfeeding, and children over two months old.
It is a scabicide cream typically left on overnight, followed by a rinse, then a reapplication for five nights in a row. It is likewise considered safe for pregnant women and children under two months old.
Ivermectin is an oral medication indicated for those not responding to topical medications. However, this medication is not recommended for pregnant women, breastfeeding children, or children who weigh less than 33 pounds.
Considering that only about 10-15 mites live in the skin of an infected individual, there is a low chance for the human itch mite to emerge underwater, mainly since this would entail treading through wet skin. As such, it is improbable to observe any transmission due to sharing a pool with an infected individual, except perhaps in cases where the patient may have crusted or Norwegian scabies, which is significantly more contagious than the typical variation of the infestation.
The human itch mite, or the Sarcoptes scabiei var. hominis, is a specific variation of the Sarcoptes scabiei species that tends only to infect humans and can only, therefore, be sourced from other humans. As such, obtaining the disease from your pets is impossible.
It may take 4-8 weeks for symptoms to appear among those who have never had a scabies infestation, but it may only take 1-4 days for those who have had a past infestation.
The usual treatment plans are typically prescribed for around 2-4 weeks.
After 2-4 weeks, if you are still experiencing intense itching and can still observe the appearance of rashes all over your body, it might be wise to consult your doctor regarding potential retreatment.
World Health Organization
Written by Mark Riegel, MD
Yes. Products used to treat scabies are called scabicides because they kill scabies mites; some also kill eggs.
Scabies is not an infection, but an infestation.
Permethrin and malathion lotion are the drugs of choice for the treatment of scabies.
Marks on the skin from scabies usually go away in 1 to 2 weeks.
No. Don't have sex until the scabies has been treated. Advise your sexual partner/s to seek treatment for scabies.
Yes. If you previously had scabies, the rash may appear from 1-4 days after being reinfected.