Scabies

My 19-month-old son was diagnosed last week with scabies. Our family plus his day care provider and the other families have all gone through 'the protocol' with the cream and thorough laundering of all bed clothes, apparel and toys. We have received (and found) very little information about this disease -- primarily prevention, and incubation period. We are all at a loss as to how he contracted this and are desperately trying to determine a source so this does not reoccur.

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

There are two common skin ailments of childhood that cause intense itching, eczema and scabies. Fortunately, the rashes from these two problems are not particularly similar, so distinguishing between the two is relatively easy. The other difference is that eczema is caused by a skin disorder while scabies is due to an infestation by the mite, Sarcoptes scabiei. The similarity to the two is the itching which can make a person miserable.

This mite, which is too tiny to see with the naked eye, is transferred from person-to-person primarily through close contact. Thus, daycare settings where toddlers and preschoolers are playing closely, is a common place to acquire this infestation. However, the family unit is also a good place. So, it is quite common to find multiple members of the family who have acquired the mite but haven't realized it yet. The mite is able to burrow under the skin and deposit its eggs. It's burrowing, the feces, and the eggs eventually cause a significant allergic reaction of the skin which accounts for the rash and the itching.

The time between the mite's initial burrowing and the skin's allergic reaction is about 1 month. So, by the time the rash appears, the infestation has been occurring for quite some time. This is why the mite is easily transferred between people. By the time the infestation is obvious from the skin rash, the infestation has been going on for weeks.

The typical rash is one of many red bumps, often fluid filled, which may be obscured by scratch marks because of the itching. These bumps are often in the crevices if the body such as the webbing of the fingers, the armpits, and underneath the breasts of women. In babies, these bumps may be scattered all over the body. If one looks carefully at an individual skin lesion, one can see a burrow track leading to the red bump which represents the mite's burrowing tunnel. The diagnosis is easily made in the doctor's office by having a few of these bumps or burrow tracks scraped in an attempt to catch the mite. These scrapings are then looked at under the microscope (see picture).

There are several topical creams that will adequately treat scabies. However, because the itching is an allergic reaction, it often takes weeks before this bothersome symptom goes away. Many physicians feel it is necessary to treat all family members (even those that aren't itching) to adequately get rid of the infestation. Prevention of this infestation is difficult because of the large length of time between initial burrowing and symptoms. Therefore, "prevention" really comes in the form of limiting spread. The fact that your son's daycare has been alerted and all families are being treated is the best way to prevent further spread. Scabies is not the sign of poor hygiene or bad health conditions. Unfortunately, this mite simply likes people, and when there are situations in which children are in close contact, spread of the mite is common.

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