Scabies is an itchy, highly contagious skin disease and is caused by an infestation by the itch mite Sarcoptic scabiei. The mites that infest humans are female; the males are about half this size of female mites. Scabies mites can be seen with a magnifying glass or microscope. The scabies mites crawl but are unable to fly or jump. They are immobile at temperatures below 20 C, although they may survive for prolonged periods at these temperatures.

Scabies is an ectoparasitic skin infection with the mite Sarcoptes scabiei var. humanus and is caused by the female mite.

It is spread by skin to skin, via both sexual and nonsexual contact, and in some cases as fomites, which means that scabies is mostly transmitted by direct contact with the infected person or things of his/her personal use.

The most commonly affected areas are the interdigital web spaces, axillae, genital area, buttocks, and breasts. it usually takes four to six weeks (incubation period) for the symptoms to start showing.

In cases where scabies have occurred earlier, it takes one to four days for the symptoms to appear, after exposure.

Norwegian scabies (first described in Norway), or crusted scabies, is a severe form of scabies.

Crusted scabies almost always affects people with a compromised immune system and is observed most frequently in the elderly, those who are mentally or physically disabled, and patients with AIDS, lymphoma, or other health conditions that decrease the effectiveness of the immune response. Due to the poor function of the immune system, an individual may become infested with hundreds of thousands of mites.

The lesions of this distinctive form of scabies are extensive and may spread all over the body. The elbows, knees, palms, scalp, and soles of the feet are most commonly the original sites of involvement, and the scaly areas eventually take on a wart-like appearance. The fingernails can be thickened and discolored. Interestingly, itching may be minimal or absent in this form of scabies.

A particular danger of crusted scabies is that these lesions often predispose to the development of secondary infections, as with Staphylococcus or Streptococcus bacteria, including impetigo, a common skin infection in children.

Pets are infected by different types of mites than those that infect humans. Animals are not a source of the spread of human scabies. Scabies on dogs is called mange and is sometimes referred to as sarcoptic mange. When canine or feline mites land on human skin, they fail to thrive and produce only a mild itch that goes away on its own.

Symptoms

The main symptoms of scabies are severe itching accompanied by superficial burrows and skin rashes, itching may be more severe at night. The superficial burrows and skin rashes appear mostly on the feet, wrist, fingers (especially web of fingers), elbow, back, and hips.

The severe itchiness compels the person to scratch constantly which may lead to the breakdown of the skin, leaving it open to further infection.

The female mite burrows under the skin and produces eggs and scybala. Acarus scabiei has four pairs of legs.

Acarus scabiei undergoes its life cycle on the skin surface. The male mite fertilizes the female and dies.

The adult female, after impregnation, burrows into the skin at the rate of 1 to 5 mm per day and forms and a tunnel in the horny layer (stratum corneum).

Two days after fertilization, it starts laying two to three eggs per day along her course in the burrow.

Acarus lays a total of 10 to 25 eggs during her life span of 30 days and then dies at the end of the burrow. The egg hatches in 3 to 4 days producing a larva that moves to the skin surface.

It then molts through various stages of octopod nymph into an adult mite in 10 to 14 days.

A type 4 delayed hypersensitivity reaction occurs after approximately 1 month in unsensitized patients or within hours in sensitized patients. This leads to the severe itching that is characteristic of scabies infection.

GENERAL MANAGEMENT of SCABIES

• Maintain personal hygiene.
• Change clothes, bed sheets/linens daily.
• Regular/daily bath.
• Clothes & bed linens to be washed in hot water, dried in sun & ironed.
• Thorough scrubbing with soap & water.

A 2019 meta-analysis reports that no single agent ranked most effective with respect to cure and control of adverse effects from the scabies infection. Curing scabies is not easy with the administration of prescription scabicide drugs. There are no approved over-the-counter preparations that have been proven to be effective in eliminating scabies (home remedies are not effective). Since scabies is a parasitic infestation, antibiotics used to treat bacterial infections are not effective.

Permethrin, oral ivermectin, and synergized pyrethrins were deemed most effective for cure and symptomatic relief but huge segment of the population is at increased risk for ivermectin toxicity.

The following steps should be included in the medical treatment of scabies:

1. Apply a mite-killer like permethrin. These creams are applied from the neck down, left on overnight, then washed off. This application is usually repeated in seven days. Permethrin is approved for use in patients 2 months of age and older and is considered (not proven) to be the safest and most effective treatment for scabies.
2. An alternative treatment is 1 ounce of a 1% lotion or 30 grams of cream of lindane, applied from the neck down and washed off after approximately eight hours. Since lindane can cause seizures when it is absorbed through the skin, it should not be used if the skin is significantly irritated or wet, such as with extensive skin disease, rash, or after a bath. As an additional precaution, lindane should not be used during pregnancy or in nursing women, the elderly, people with skin sores at the site of the application, children younger than 2 years of age, or people who weigh less than 110 pounds. Lindane is not a first-line treatment and is only recommended if patients cannot tolerate other therapies or if other therapies have not been effective. Resistance to this medication has also been frequently reported.

Over the counter and prescription medications to treat scabies include:

• Ivermectin, an oral medication, is an antiparasitic medication that has also been shown to be an effective scabicide, although in many countries it is not approved for this use. The recommended dosage is 200 micrograms per kilogram body weight as a single dose, followed by a repeat dose two weeks later. Although oral ivermectin has a greater risk of toxic side effects than permethrin and is not superior to permethrin in eradicating scabies. It is typically used only when topical medications have failed or when the patient cannot tolerate them.
• Crotamiton lotion 10% and cream 10% is another allopathic drug that has been approved for the treatment of scabies in adults, but it is not approved for use in children. However, treatment failures have been documented with the use of crotamiton.
• Sulfur in petrolatum (herbal/ayurvedic and Homeopathic) applied as a cream or ointment is one of the earliest known treatments for scabies (sulfur is safe for use during pregnancy and in infants).

Itching may persist for up to a month, even following successful allopathic treatment. Pruritus may be partially alleviated with an oral antihistamine, such as hydroxyzine hydrochloride (Atarax), diphenhydramine hydrochloride (Benadryl), or cyproheptadine hydrochloride (Periactin, Prirtan). Rarely, individuals with a history of atopy may require a tapered dose of prednisone for the treatment of severe pruritus. Intramodular injection of dilute corticosteroids may be necessary in cases of nodular scabies. Lindane, benzyl benzoate, crotamiton, and ivermectin could be advise; a new option is albendazole.

If available, video dermatoscopy can be used to enhance the monitoring of clinical response to scabies treatment and allows for optimal timing of drug application. This may minimize the risk of overtreatment, reduce the potential for side effects, and enhance patient compliance. This is not a widespread technique. With video dermoscopy, a handheld device is used to illuminate, magnify, and record video of the skin.

A second course of treatment is often recommended 7-10 days later because of some developing larvae that may survive the initial treatment.

Crusted scabies

Patients with crusted scabies or their caregivers should be instructed to remove excess scale in order to allow penetration of the topical scabicide agent and decrease the burden of infestation. This can be achieved with warm water soaks followed by application of a keratolytic agent, such as 5% salicylic acid in petrolatum or Lac-Hydrin cream. (Salicylic acid should be avoided if large body surface areas are involved because of the potential risk of salicylate poisoning or it’s better to use a Homeopathic forlmula – Acidium Salicylicum which is absolutely harmless).

Because of their heavy mite burden, patients with crusted scabies may require repeated applications of topical scabicides or treatment that simultaneously uses oral ivermectin and a topical agent, such as permethrin.

Pruritus can be treated with an oral antihistamine, such as hydroxyzine hydrochloride (Atarax), diphenhydramine hydrochloride (Benadryl), or cyproheptadine hydrochloride (Periactin, Piritan). More severe symptoms may require a short course of topical or oral steroids.

Secondary infections may require antibiotics, which should be prescribed based on culture and sensitivity data.

Mupirocin

This agent is used to treat infection with Staphylococcus species, beta-hemolytic streptococci, or Streptococcus pyogenes. It inhibits protein and ribonucleic acid (RNA) synthesis by inactivating transfer-RNA synthetase.

Antiparasitic Agents

Homeopathic treatment for Scabies

Homeopathic medicines for scabies stimulate the disease-fighting mechanism (immune system) of the body to fight scabies and secure organism in future for disease like this one (treated) and treatment duration is amazingly short that is from 10 – 15 days only.

First of all, stop using antibacterial and/or medicated soaps as they are the main cause of lowering immune system said Dr Qaisar Ahmed, after that, advice your patient from medicines described below, I (Dr Qaisar Ahmed) prefer combination therapy.

Alternative or Homeopathic therapy includes precipitated ointment of sulfur 6% in petrolatum.

Sulphur

The symptoms to look out for include intense itching and scratching which worsen with washing and heat, especially during the night. The condition is characterized by unhealthy skin with pimply eruptions which are painfully sensitive to air, wind, and water.

Arsenic Album

Scabies with violent itching along with great restlessness, the skin peels off in large scales and is very sore to touch in such cases. Dry, rough, scaly, dirty skin like parchment burns intensely, Over-sensitiveness skin.

Kali Sulphuricum

Kali Sulphuricum is suitable medicines for scabies where the symptoms include dry and harsh skin with extreme itching, Peeling and flaking of the skin, worsens with heat are observed.

Kali Sulphuricum is a best medicine for removal of scabs (desquamation of the skin) after skin infections.

Sepia

Sepia is best when complains of itching vesicles not relieved by scratching. The skin turns pinkish from scratching. The condition gets worse in the open air while better in a warm room.

Scabies which is present mostly at the bends of the elbows and knees.

Carbo Vegetabilis

Sensation of tingling of the skin, throughout the body, itching all over the body in the evening, and on becoming warm in bed. Burning sensation in different parts of the skin. Eruption of small pimples like miliary scabies.

Causticum

Soreness in folds of skin, back of ears, between thighs. Warts large, jagged, bleeding easily, on tips of fingers and nose.

Selenium

Frequent tingling in circumscribed parts of skin, with great provocation to scratch. Miliary eruption. Red rash on region of liver. Prolonged oozing from parts which have been scratched. Flat ulcers. Itching in folds of skin, between fingers and about joints, esp. ankle joint. Hair falls off head, whiskers, and other parts.

Antimonium Crudum

Eczema with gastric derangements. Pimples, vesicles, and pustules. Sensitive to cold bathing. Thick, hard, honey-colored scabs. Urticaria; measle-like eruption. Itching when warm in bed. Dry skin. Dry gangrene. Scaly, pustular eruption with burning and itching, worse at night.

Kreosotum

Skin soft, unnatural feel of skin, with pegged teeth. Violent itching all over body, esp. towards evening with burning sensation in arms and legs, after scratching. Burning itching at night, and heat over whole body.

Nettle-rash. Eruption, like bug-bites, with violent itching especially in evening; Large, greasy looking, pox like/shaped pustules over whole body. Mealy and pustular, dry or humid tetters (on backs of hands and fingers, in palms, on ears, elbows, knuckles, and malleoli), with violent itching in almost every part of body.

Phosphoricum Acidum

Insensibility of skin. Crawling tingling under skin. Formication of skin. Red and burning spots on limbs. Eruption like scarlatina. Erysipelatous inflammations. Eruption of small pimples, and of miliary pimples collected in clusters and red. Eruption of pimples with burning pain, or pain as from excoriation.

Scabious vesicles. Humid and dry tetters, squamous; variola. Corns with shootings and burning pain. Chilblains. Wens, Warts: large, jagged, often pedunculated, exuding moisture and bleeding readily; indented. Condylomas. Furunculi. Flat, indolent ulcers, with secretion of a dirty-looking pus, and having a serrated bottom. Itching ulcers.

Zincum Metallicum

Itching in bends of joints. Itching, with violent lancinations, especially in evening in bed, disappearing immediately on being touched. Tingling between the skin and the flesh. Chronic eruptions, Eczema of back of right hand with terrible irritation, little oozing and fissuration feels better in cold weather while excited by rubbing.

Manganum

Skin burning all over skin, in evening, and when rising from bed. Itching tetters. The skin does not heal easily; every injury tends to ulceration. Excoriation and fissures in bend of the joints. Voluptuous itching worse by scratching.

Itching in hollow of knee and on shin (Psoriasis). Suppuration of skin around joints.

Graphites

Obstinate dryness of the skin, and absence of perspiration. Ephelides. Red spots on the skin, like fleabites. Erysipelatous inflammations. Vesicular erysipelas, like zona, on the abdomen and on the back.

Itching of the varices on the lower limbs. Itching-stinging on the surface of a mole. Eruptions oozing out a thick honey-like fluid. Tetters, and other humid or scabby eruptions, sometimes with secretion of corrosive serum, or with itching in the evening, and at night.

Eruption of pimples and nodules (principally under hair and on covered parts) which itch very much. Swelling and induration of the glands. Excoriation of the skin (in the bends of the limbs, groins, neck, behind the ears), esp. in children. Unhealthy skin, every injury tending to ulceration. Proud flesh, and fetid pus, in ulcers, with tearing pains, burning, and shooting. Scrofulous and syphilitic ulcers. Burning pain in an old cicatrix.

Mezereum

Sensitiveness to touch. General desquamation of skin of body; usual liver spots on chest and arms become dark and desquamate. Red rash, itching violently better in bed, from touch; burning and change of place after scratching. Cutaneous ulcers form over bony protuberances. Ulcers with thick, whitish, yellow scabs, under which thick, yellow pus collects.

Skin covered with elevated white scabs. Itching, esp. at night (when in bed), more violent and painful (and changed to burning) after scratching the parts, and sometimes with swelling of the part that has been scratched. Gnawing itching as from vermin. Miliary eruptions, sometimes chronic. Furunculi with gnawing pain of excoriation.

Ulcers: with an areola, sensitive and easily bleeding when removing the linen, which sticks, painful at night, the pus tends to form an adherent scab, under which a quantity of pus collects, burning and stinging with inflammation. Vesicles around the ulcers, itching violently and burning, like.

Psorinum

Rash, beginning with sticking. Burning like heat-rash, burning after scratching, and feeling sore (in a herpetic patient); and ulcers, from which watery fluid oozed for hours after being opened. Nodules on face, neck, and legs. Pimples on forehead; on neck and mammae; with black points in center, painful when scratched; on external throat.

Pustules, with sticking. Boils, with burning itching, soon disappearing, leaving crusts. Itch-like eruption, and agglutination of eyes. Vesicles: quickly filling with yellow lymph, sore to touch, some forming itching papules. Crawling sensation on all limbs, with falling asleep of them. Itching: on forehead; tip of nose; l. arm; biceps of l. arm; r. elbow; soles in evening after a glass of Muscat wine, with tickling and heat; of face, neck, and hands on touch; over whole body after rubbing papules and vesicles; between fingers, and vesicles filled with lymph; on r. carpus, with red spots; voluptuous, where a flea had bitten, with white, hard blisters on a red base. Of the itching, which he had had for years on knees, and the herpetic eruption begins to become pustular.

Taraxacum Officinale

Unhealthy, pimply, sycotic skins. Stinging on skin. Eruption over body and limbs itching severely and appears to be a mixture of lichen and urticaria. Biting in skin with sweat.

Antimonium Tartaricum

Itching in the skin. Itching pimples, and miliary eruption. Eruptions like scabies. Eruption of pustules, like varioloids, as large as peas, filled with pus, with red areola (like smallpox), and which afterwards form a crust, and leave a scar. Itching round inveterate ulcers. Pustular eruption on different portions of the body, leaving a bluish-red mark.

P. S: This article is only for doctors having good knowledge about Homeopathy and allopathy, for learning purpose(s).

For proper consultation and treatment, please visit our clinic.

None of above-mentioned medicine(s) is/are the full/complete treatment but just hints for treatment; every patient has his/her own constitutional medicine.

Dr. Sayyad Qaisar Ahmed (MD {Ukraine}, DHMS), Abdominal Surgeries, Oncological surgeries, Gastroenterologist, Specialist Homeopathic Medicines.

 Senior research officer at Dnepropetrovsk state medical academy Ukraine.

Location:  Al-Haytham clinic, Umer Farooq Chowk Risalpur Sadder (0923631023, 03119884588), K.P.K, Pakistan.

Find more about Dr Sayed Qaisar Ahmed at:

https://www.youtube.com/Dr Qaisar Ahmed

https://www.facebook.com/ahmed drqaisar

https://www.drqaisarahmed.com.