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What is scabies?
Scabies is a skin irritation caused by an infestation of tiny parasitic mites that burrow under the skin. The bumpy rash you see is actually an allergic reaction to the eggs and feces the mites leave behind. The name comes from a Latin word meaning "to scratch," and if your child has scabies, he's likely doing lots of that.
Your child can contract scabies through skin-to-skin contact with someone who has it. Scabies is extremely contagious, and anyone can get it – even if they're scrupulously clean. It often shows up in more than one family member or in groups of children in daycare or school. There's no particular time of year when scabies is more prevalent.
A severe form of scabies, called crusted or Norwegian scabies, sometimes develops in people with a compromised immune system. In this case, thick crusts of skin containing large numbers of scabies mites and eggs develop. These mites are not stronger than other mites, but there are many more of them.
What are the symptoms?
If your child gets scabies, he'll develop a severely itchy rash of scattered, pimply red bumps, usually between the fingers. In young children, it also typically shows up on the head, neck, shoulders, palms, and soles. In older children and adults, the rash appears on the hands, wrists, genitals, and abdomen.
You may see curvy or razor-thin red lines where the mites have burrowed under the skin. Your child may also develop little pustules (inflamed areas filled with pus, like little pimples) or small, water-filled blisters.
© Dr. P. Marazzi / Science Source
The itching is usually most intense after a hot bath or at night, and it may keep your child awake. Nasty-looking scabs may form over the areas your child has scratched, and a bacterial infection (like impetigo) or a staph infection) could develop.
If this is your child's first bout of scabies, four to six weeks may pass between when the mites latch onto him and when he begins to itch. If he's had scabies before, his reaction time will be much shorter – only one to three days.
Why does scabies itch so much?
Female scabies mites burrow under the skin, where they lay eggs and deposit feces. The eggs and feces trigger an allergic reaction, which causes the nearly intolerable itching.
How can I be sure my child has scabies? Should I call the doctor?
You should always call the doctor if your baby has an unidentified rash. The sooner he's treated, the sooner he'll be more comfortable.
The doctor will take a look at the rash and possibly do a painless test that involves scraping off a small sample of skin and looking at it under a microscope. (Or she might refer you to a dermatologist to do the skin scraping and confirm the diagnosis.) Scabies mites and their eggs are visible when magnified. Mites can be easy to miss, though, because there are usually only ten or fewer on an infected person.
How is scabies treated?
Your doctor will prescribe a topical medication. Permethrin cream is the most common treatment. Other treatments include benzyl benzoate, sulfur in petrolatum, crotamiton, lindane, and malathion. (Some of these are not used on babies.) Permethrin cream is thought to be the safest of these remedies. Talk with your child's doctor if you have concerns about whether the product she recommends is safe to use on your child.
You'll need to spread the cream over every inch of your child's body from the neck down. Even parts of the body that don't seem to be infected must be treated. Don't forget to put the cream between your child's toes and fingers, under his arms, in his navel, and on his genitals. If you see the telltale rash on your child's scalp or face, apply the cream along his hairline, as well as on his forehead, scalp, and temples.
Follow the directions for leaving the cream on the skin (it may be for eight hours or more), and then wash it off.
Young children tend to put their hands in their mouth a lot when they're awake, so it's best to put the cream on at bedtime and wash it off first thing in the morning. If your child tends to suck on his hands or fingers while he sleeps, cover his hands with mittens or socks overnight to keep the medicine out of his mouth.
If your child has a stubborn or severe case, his doctor may also prescribe an oral medication to kill the scabies mites.
The rash itself can take two to six weeks to clear up. If the rash continues to spread or you see new burrows, the doctor may advise you to repeat the treatment. (Some doctors automatically recommend a second dose of the medication a week or two after the first dose.)
Because it takes some time for the irritants in the skin to go away, the itching can continue for as long as three weeks after the mites are gone. Applying cool compresses or calamine lotion to the skin may help with itching. If it's still bothersome, your child's doctor may prescribe an oral antihistamine or a steroid cream for relief. In the meantime, keep your child's fingernails short to prevent him from tearing the skin and introducing an infection.
Can my child go to daycare or school if he has scabies?
Your child can return to daycare or school after one treatment with the cream.
How do I protect the rest of my family from scabies?
Some doctors will recommend that all other members of the household, as well as caregivers, be treated, even if they show no symptoms. (It's best if everyone gets treated at the same time, so one contaminated person doesn't reinfect everybody else.) Other doctors take a wait-and-see approach, suggesting that everyone be examined but only those who have signs of scabies be treated.
There's some disagreement about how likely it is for a person to get scabies from clothing or linens. If you're concerned, you may also want to wash all clothing, towels, and bedding in water hotter than 140 degrees Fahrenheit and dry it in a dryer. Remember to turn your water thermostat back down to no higher than 120 degrees F. when you're finished to prevent scalding.
Seal any stuffed animals or toys that can't be washed in a plastic bag for a week. Scabies mites can't live that long without a human host.
You may also want to vacuum your floors and throw the vacuum bag in the trash. If your child has crusted scabies, you'll definitely want to take the time to vacuum the floors and launder everything.
How can I keep my child from getting scabies?
The only way to avoid scabies is to avoid contact with anyone who might have it. That can be tricky, especially if your child is around other children and multiple caregivers. If your child has scabies, you can help prevent a reinfestation by making sure that you treat him before sending him to daycare or school.