By Martha A. Simpson, D.O., M.B.A.
Associate Professor of Family Medicine
Ohio University College of Osteopathic Medicine

COLOSSAL ITCHING OF SCABIES CAUSED BY EXTREMELY TINY MITE

Question: I read your column on chiggers, but it sounded to me as though the person had "The Itch" and not chiggers. My mother went from her home in Kentucky to Ohio once and got "The Itch" and came back and we all got it from her. It produces a little rash and the worst itch you've ever had. It's highly contagious. I think it's caused by a little insect. Could you do a column on "The Itch"?

Answer: You must be talking about scabies. This disorder is caused by a tiny, insect-like creature called a mite. It is so small that under good light it is just barely visible to the human eye. The female mite burrows under the skin, lays eggs and dies. The eggs hatch, and in about a month they mature into adults. Then this new generation of mites can continue the infestation cycle as the females burrow into the skin and lay more eggs. Your mother is correct; a scabies infestation is highly contagious.

This disorder has several names besides scabies and “The Itch.” It is also -- with some considerable exaggeration -- often called the “7-year-itch.” Itching, the primary symptom of this problem, is caused by an “allergic” reaction to the mites, eggs or the feces of the mites. The itching is extremely intense and seems to be worse at night, but usually spares the head and face, except in young children and infants. The relentless itching -- rather than concern for the accompanying rash -- is usually what causes the sufferer to seek medical attention.

Scabies is sometimes called the great imitator because the rash has no “classic” presentation and can mimic other skin disorders. It is most common in children and young adults, but an infestation can happen at any age. It occurs in all races and both genders with equal frequency and intensity.

The good news is, once the diagnosis is made, scabies are usually responsive to treatment. The diagnosis can be made by looking at a skin scraping under a microscope and seeing a mite, egg or feces. Treatment with a scabicide lotion that kills the mites will usually do the job. Use of an antihistamine to help with the itching is also in order. Some patients have crusted lesions from their scabies, a condition called Norwegian scabies. The crusts need to be removed before the scabicide can work.

All family members should be treated at the same time, even if they have no symptoms. Since these little critters can live for up to a week without a meal, it’s important to kill them not only on the body, but elsewhere. For instance, bed linens, clothing and towels should be washed in hot water and then placed in a drier using the hot cycle. Overstuffed furniture and carpeting can be sprayed with commercial sprays to kill any mites that might be hiding there. Both the house and the people should be treated again one week after the first treatment.

The itching may persist for a couple of weeks after the rash is gone. If it lasts much longer than that, you need to have a follow-up visit with your physician. Infants, pregnant women, and those with compromised immune systems need to have special attention, because the treatment guidelines for this fairly common, very itchy rash are different for them.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701, or via e-mail to readerquestions@familymedicinenews.org. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnose and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.