Scabies has been a human problem for many centuries. It goes so far back that it has even been written about by the likes of Aristotle and biblical authors. Somewhere along the way it earned a reputation as a disease that happens to people with poor hygiene. Exactly when (and why) these thoughts became mainstream is unclear, but even I can remember hearing the neighbors gossip about “dirty kids” or negligent mothers when scabies was noticed at school or play.
Regardless of when and why scabies became associated with filth, it’s simply untrue. And we dedicate this article to debunking the myth that Scabies is caused by being dirty.
First, let’s have a quick refresher of what a person with scabies is experiencing…because there are a lot of issues that present as scabies that are NOT scabies and vice-versa.
How Do You Get Scabies in the First Place?
Scabies is a parasitic infestation caused by close contact with the skin, clothing, or bedding of someone else who already has it. It isn’t picked up from playing in the dirt or neglecting to wash your hands after an afternoon of gardening or making mud pies.
While touching someone with scabies, a tiny 8-legged mite can transfer from one individual to the other and burrow under the skin to lay its eggs. Tiny tunnels can be seen at the surface that shows where the mites have traveled. When the eggs are ready, the resulting larvae move around and cause even more itching as they rise to the surface, ready to infest another area or another victim.
The itching is not really caused by the mite, but rather it is caused by the body’s delayed allergic response to the mite and its larvae. This is why it can take weeks after an infestation for symptoms to appear.
How Scabies Presents
As with most other mites and parasites of the world, the mites that cause scabies prefer moisture and dampness. A person with scabies experiences pimple-like rashes, mostly in the body’s warm, moist nooks and crannies, but they can appear anywhere except on an adult’s head.
Infants often have scabies on their heads, diaper area and the soles of their feet. The rash itches relentlessly and can be so bad that sleep is impossible and the skin can be etched with wounds by fingernails’ incessant scratching
What Kind of Contact is Needed to Catch Scabies?
A simple handshake or hug ‘could’ provide a route for the mites to travel to a new host, but more prolonged contact is more likely to result in an infestation. The mites are microscopic, so you won’t see this happening. Sexual activity and wearing an infested person’s recently removed clothing or sleeping in their bed can be other ways to get it. You’ll be relieved to know that the mite doesn’t jump through the air or swim.
Can You Get Scabies Twice?
Because it’s an infestation and not an infection, scabies doesn’t provide its host with antibodies to protect against it and it can recur again and again unless measures are taken to remove and kill all the mites and larvae on the body and in the environment. Subsequent infestations take much less time to start itching because the body’s allergic response to it is already in place. However, the symptoms are just as bad as the first time one has it.
How Is Scabies Treated and Re-Infestation Prevented?
There are prescription medicated creams and salves that kill mites, their eggs and larvae. No over-the-counter lotions or creams are not always reported as being effective, but the severity of the infestation could be a determining factor.
Medications are typically applied from an adult patient’s neck to their toes. In infants, the head is included in the treatment. The lotion is left on the body for 8 to 12 hours, so many people put it on just before bed and wash it off just after rising.
In a family setting, all members should be treated. Persons living in close quarters like prisons, nursing homes, orphanages and schools all need to be treated as well to avoid re-infestation. In addition, all suspicious clothes and bedding must be washed in hot, soapy water or dry-cleaned.
More good news: the mites only survive a few days to a week without residing on a human body, so laundry and suspicious items can also be sealed in a plastic bag for a week or so to starve them to death.
Can Our Pets Get Scabies?
Dog scabies mites are different from human mites, but the infestation looks the same and if left untreated can cause severe mange. Many stray dogs carry it and it can easily travel within a shelter. While pet mites can be transferred to a human, the mites can’t survive on human skin, so there’s no danger of getting it from your Fido or Fluffy. The same precautions and treatment with veterinary scabicides will end the infestation. Pet beds and blankets must all be washed in order to stop infestation.
Is Scabies Dangerous?
While scabies doesn’t directly pose a risk to the host’s life, there are problems that can occur that might threaten long-term health and morbidity:
- Secondary infections caused by scratching the skin until it’s open and/or bleeding. These can include fungal infection or infections caused by staph or strep bacteria, such as impetigo, another fiercely maligned disease. If left untreated these infections can lead to sepsis (infected blood) and cellulitis (serious tissue infection) and result in amputations and even death. They must be treated with antibiotics.
- Crusted, or Norwegian scabies, is a very severe form that occurs in high risk individuals like HIV patients and other people with compromised immune systems. Older people and diabetics are also at risk. Crusted scabies causes thick, gray or red plaques covering hands and other infested parts of the body. It’s caused by the same mite that causes regular scabies, but instead of 10-15 mites on the body, there are thousands or even millions. Norwegian scabies needs to be treated aggressively, likely with drugs like ivervectin, which can carry a potential of toxicity to the patient but are the most effective in eradicating the mites.
Is Scabies Caused by Being Dirty: By now it should be clear that scabies is a disease of opportunistic, microscopic mites, not one caused by a failure to stay clean or use good hygiene. The infestation impacts all levels of society, all nationalities and ages.
At any given time around the world, there are an estimated 300 million people infected with the parasite. Some medical groups suspect there are many more because the infestation is not always reported. It is found everywhere in all climates, and travels internationally on planes and boats.
There is no vaccine and successful treatment is dependent on careful and complete eradication of the mite in places where it appears.
References and further reading