Oct 15, 2012
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
In mid-September, I came home for lunch and I thought I saw a kite stuck on the garage roof. I was wrong. It was a patio umbrella. You see the kids had a day off of school. I guess the teachers were already tired of them. I know I would be. The weather was still nice so Eric and his friend Jett were mucking around in the back yard. In the process of whatever they were doing, they decided to play with the patio umbrella. The interesting thing was it was a windy day. Eric didnt give a lot of details, but somehow the patio umbrella went straight up and lodged on the garage roof. It is handy that my kids give me an endless stream of intros to these articles.
Sometimes the article itself takes a long time to research and write. Not this time. Recently, Kari Hanneson, one of our pharmacists, came up to me and said, Wow we went through a lot of scabies cream this weekend. The next day a doctor called and asked us to compound an alternative to commercial scabies cream for a child. We recommended a sulfur based ointment. So I guess Im going to talk about scabies this time.
Scabies is a highly contagious infestation of the skin by the human mite called Sarcoptes scabie var homini. The scabies mite is almost too small to be seen with the naked eye. The mites also burrow under the skin so they are almost never seen. Over 300 million people world wide have scabies, and it is most common in people living or working in very crowded conditions. Schools are not usually crowded enough to promote transmission. Scabies is most commonly transmitted by close personal contact (i.e. usually by skin to skin contact). The pregnant female mite burrows 0.5 to 5 mm per day through the top layer of skin and lays two to three eggs per day. Three or four days later, the eggs hatch and the larvae travel to the skin surface and mature into adult mites in 14 to 17 days. The smaller male mite lives on the skin surface and dies shortly after mating. The female mite lives about 30 days.
What are the main symptoms of scabies? The most common symptom of scabies is itching. It can be quite severe and worse at night. If this is the first infestation a person has with scabies, the itchiness may not occur until weeks after the infestation. The itchiness is due to sensitization to the mites, eggs and feces. If a person has had scabies before, the itchiness can happen as early as 24 hours after infestation. As the female digs through the skin, she leaves behind burrow. The burrows look like tiny lines or waves in the skin 2-5 mm long. The burrow lines dont appear on every patient, but if you can see the wavy lines it is easier for the doctor to confirm the itch is from scabies. In adults, the itch and rash dont appear on the face or scalp, but in young children they can. Excessive scratching can lead to secondary infections like impetigo.
So what do you do if someone in your house is very itchy, especially at night? See the doctor to find out what the itch is for certain. After the diagnosis of scabies is confirmed, we should treat the infested person and their close physical contacts at the same time, whether or not symptoms are present. Remember some people can have scabies for weeks before they start itching, and they are still contagious during that time. Permethrin 5% cream is the preferred agent for anyone over 2 months old. We usually tell people to use the permethrin cream before bed. We then tell the person take a warm (not hot) bath or shower, and dry off. They should massage the cream into the skin from their neck down to the soles of their feet. They should pay special attention to areas between fingers and toes, under fingernails, wrists, armpits, buttocks, and external genitalia. After applying the cream they should put on clean clothing, put clean sheets on the bed and climb in. The cream should be washed off in the shower or bath after 12 to 14 hours. Usually one treatment will kill off the scabies, but a second treatment in 7-10 days may be used if there is no improvement or if new rashes occur. The itchiness will take 1-2 weeks to go away, and is not a sign that the scabies treatment isnt working. A child is safe to go to school the day after using the permethrin cream.
The sulfur treatment I mentioned before also works, but it is messier and smellier than permethrin. It is also less convenient as it has to be applied for 3 days in a row. But the sulfur ointment is an effective alternative to permethrin. Under the direction of a physician, we compounded the sulfur ointment for a young patient who didnt tolerate the permethrin cream.
What about cleaning the house, bed linens and yourself? Start by trimming finger and toe nails to make sure there arent mites hiding there. Then wash clothes and linens in soap and hot (60 C) water. Items that cant be washed should be drycleaned, or put in a plastic bag for a week. The mite doesnt survive for more than two days off of people. All surfaces, rugs, and furniture should be vacuumed. There is some controversy about how likely it is to get scabies from inanimate objects like bed sheets. The easiest way to get scabies is from skin to skin contact with a person who has scabies. Although there are documented cases of people getting scabies only through touching bed sheets, it is apparently much more difficult than through contact with a person.
Unlike his sister, Eric is not big on details about his adventures. He never really explained how he and Jett got the patio umbrella on the roof. Our neighbor, Steve Hogue joked that if there was a surveillance tape it would show Eric hanging onto the umbrella, Mary Poppins style, riding it to the roof and then scrambling down. When I asked Eric what happened, he just shrugged his shoulders and said he didnt know. Maybe if I attached a camera directly to Eric, Id get some even better things to write about.
The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
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As always if you have any questions or concerns about these or other products, ask your pharmacist.