Page updated 30 September 2007
Ectoparasites - Scabies (Sarcoptes scabiei)
Introduction
The itch mite burrows and lays eggs in the skin, often causing a rash on wrists, elbows, axillae and sometimes waist and thighs. This rash represents an allergic reaction and may not correspond to the sites of burrowing. Burrows are characteristically seen around the wrists but adults are not visible to the naked eye. Each burrow contains a fecund female which lays eggs which eventually emerge on the skin. A simple scrape and examination under low power microscopy will reveal the adult and eggs. The illness reflects allergy to the mite faeces.
Transmission
By prolonged personal contact or sharing clothes or bedding. Extensive scabies (the "Norwegian" or crusted variety) is common in AIDS, though by no means unique to immunocompromised patients and may infect health workers who do not observe simple hand hygiene. Transmission is most likely to occur before the diagnosis is made.
Treatment
If sores are seen, inform the doctor before treatment. Read "Cautions and Instructions" on the prescribed lotion container. Use gloves and apron for all direct contact with patient until cured.
Equipment Required
- Disposable plastic gloves and apron
- Clean towel and disposable washing cloth
- Receiver and gauze swabs
- Prescribed lotion with instructions
- Yellow disposable bag and a clear plastic bag for clothing to be laundered
Procedure
- Explain procedure to patient
- Don plastic apron and gloves
- Take patient to bathroom, remove clothing into plastic bag, put patient into a warm bath and wash with soapy cloth. NB A bath is not essential for effective treatment
- Pour lotion into a receiver and with gauze swabs paint over the entire body surface except the face and scalp. Include palms, soles and external genitalia. Include the face and scalp for Norwegian scabies
- Allow to dry in air
- Apply fresh lotion sparingly to hands and wrists after each hand wash
- Leave lotion on skin for 12 hours then bathe thoroughly
- Dress patient in clean nightwear
- Clean bath or washbowl with cream cleanser
- Dispose of washing cloth, plastic apron and gloves, in a yellow bag, and send towel in laundry bag. List clothing items, and close clothing bag with rubber band or tape ready for storage, laundering or other disinfestations
- Clothing and bedding should be laundered
- The itch may persist for two weeks after treatment and can be relieved by antipruritics. Do not retreat simply because of itching.
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