Ask the Pharmacist

Q. I just learned that my child has scabies. What do I need to know about it?

A. Scabies, a skin condition caused by an 8-legged mite known to scientists as Sarcoptes scabiei, causes a pimply rash and extreme itching where the tiny mites burrow themselves under the skin. They most particularly love the folds on our wrists, breasts, armpits, waist, shoulder blades, knees, elbows, penis among others. These burrowed areas are a result of the females working their way under the skin to lay their eggs and show up as grayish/white lines or skin coloured lines that appear somewhat raised on the skin. These eggs eventually hatch and become mite larvae which subsequently work their way back to the skins’ surface. The larvae mature into adult mites and can eventually spread to other areas of your body and/or other persons. It can take up to 2 months for your body to show any evidence of having scabies and therefore it is entirely possible that you can spread it to others before you were even aware that you have it yourself. However, if you have had scabies in the past, you may show signs within a few days of being exposed to the mites. Usually mites do not live in large numbers which can make them difficult to spot.

However, there have been cases of people infested with crusted scabies in which thousands of mites may be involved and thus they would be even more contagious and more difficult to treat than the average individual. Even with a normal case, scabies is very contagious and easily spread with close personal contact so it is not surprising that it can spread rapidly in nursing homes, extended-care facilities, child-care facilities and prisons. For this reason, not only is it important to treat the affected individual(s) but it is recommended to treat everyone that is in close contact to him or her. However, bear in mind that usually more than a quick hug is needed to spread scabies so there is no need to avoid a handshake with affected individuals. A common symptom of scabies is intense itching due to your bodies reaction to the mites including their eggs and their waste. To help alleviate the itch, you can try

· Soaking in cool/ tepid water or sitting in an oatmeal bath

· Antihistamines such as cetirizine (Reactine) can be taken

· Calamine lotion

· Oatmeal lotion (Aveeno)

To get rid of the scabies, you need to use products that kill the scabies and their eggs. Ivermectin (Stromectol) is an oral treatment that can be taken by adults and any children that weigh at least 15kg, providing they can swallow pills. It is a 2 dose treatment taken 7 to 14 days apart. Permethrin 5% cream (Nix Dermal, Kwellada-P) is the recommended treatment for pregnant women and for children who cannot take oral medication. These topical creams/lotions should not be confused with the 1% products that are used to treat lice as they are not strong enough to work against the mites. The topical preparations need to be applied to the entire body from the neck down (mites do not tend to migrate to the head or face), not just to the areas of concern. It is best to apply them at bedtime and to wash them off in 12 to 14 hours. It is strongly encouraged that you repeat the application of the cream in 7 to 10 days to ensure you have fully eradicated the mites. There are steps that can be taken to prevent re-infestation which may seem onerous at the time but a worthwhile endeavour to keep you and your loved ones free from further episodes. Among these prevention steps are;

· Use hot soapy water to clean all clothes, towels and bedding that have been used within 3 days prior to treatment

· Any items that are considered to be un-washable should be placed in a tightly sealed plastic bag and placed in a garage or suitable alternative