What is scabies and how it is transmitted?
Scabies, which is caused by scabies mites (sarcoptesscabiei var.hominis), is one of the common infectious diseases in the Division of Dermatology. It is a human-specific parasite, which only infects humans, not animals. A typical patient with scabies has an average of 10 to 20 scabies mites on his/her body, and the scabies mites usually only survive for a short time after leaving the host. Scabies mites are parasitic on the stratum corneum of the human body and cause skin diseases. Scabies mites are more likely to be parasitic on the elderly, the weak, the long-term bedridden, and those with poor living habits. The main way to transmit scabies is infection through close contact, such as sharing towels, sheets, quilts, underwear, etc., thus, it is more common in healthcare institutions, such as nursing centers, long-term care facilities, nursing homes, hospitals, etc.
Clinical symptoms of scabies: 
After scabies mites penetrate the skin, they will come into contact with keratinocytes and release some substances to cause inflammation and the immune response. It takes approximately 10 to 30 days for the skin rash to appear. The period from infection to the appearance of symptoms is also called the window period, during which a host will further cause infection in others. Patients infected with scabies will feel very itchy, and the symptoms of itching will deteriorate from the middle of the night to the early morning. Itching will be more severe during the night under a blanket or during a hot shower. There will be multiple pimples, spots, small scabs, or small pigmented spots, nodules, dander, insect tunnels, etc. on the skin, which are distributed in the skin creases, such as the fingers, palms and wrists, breasts, groin, genitals, elbows, and underarms.
The above symptoms are not necessarily scabies. If you experience the above symptoms, please visit a dermatologist as soon as possible.

Treatment methods for scabies: 
Scabies is a curable disease, and treatment only requires environmental clothing disinfection and appropriate topical medication. In principle, the treatment will be effective after three days. During the treatment, bathe with soap every day and clean the skin with a soft nylon brush. After bathing, apply the medication from the neck down to the soles of the feet, especially in skin creases.

Common anti-scabies drugs, usage, and precautions are, as follows:
  1. B.C Cream/10g (Lindane): Bathe thoroughly before applying the medicine. Use a soft brush or towel to scrub the skin. After washing the affected area, open the burrow of the scabies, and apply the medication to the whole body from the neck down to the soles of the feet, especially between the fingers (toes), wrists, underarms, genitals, and in skin creases. After applying the medication, put on clean clothes. Dosage: Use 1 to 2 times a day, and scabies scraping is required to evaluate the effectiveness of the treatment one week after the medication.
  2. Jaline lotion (Benzylbenzoate) 250 mg/ml 150ml: From the neck down to the soles of the feet, apply the medication to the whole body once a day, including areas where there are no lesions. The frequently overlooked areas include the back of the ears, underarms, genitals, belly button, and nails. The medication should be washed off the next day during a bath, the body should be dried, and the medication reapplied. One treatment course lasts for approximately two to three days, and can be repeated every other week according to the dermatologist's instructions. This medication is irritating and must be diluted 2 to 3 times when used on children.
  3. Lyclear dermal cream/Permethrin cream 5% 30g: The U.S. CDC recommends clinical use of 5% Permethrin as the first choice for the treatment of scabies infection. Treatment for adults: Apply the medication evenly to the skin from the neck to the soles of the feet, including the creases and depressions of the fingernails and toenails. Let the medication to stay on the skin for 8 to 14 hours, and then, wash off the medication with soap. It is recommended to repeat the treatment after one to two weeks.
  4. Ivermection 200ug/kg: One dose can be taken orally to achieve efficacy, and an additional dose can be added within 10 to 14 days if necessary. While this medication is safe, it is not recommended for pregnant women and children. This medication is safe for the human body, but may cause side effects, such as headache, itching, joint and muscle pain, fever, rash, lymphatic enlargement, and increased eosinophilia.
Home prevention:
  1. When the scabies mites leave the skin for approximately two weeks, they will all die. When the clothes, sheets, quilts, beddings, pillows, etc. that are changed by the patient at home are placed into a plastic bag for two weeks, the scabies mites will die naturally, and the above items can be used again. Scabies mites cannot live for more than 5 minutes in an environment with a temperature above 60°C, thus, clothes and beddings can be heated and dried or ironed.
  2. The scabies the infection is usually caused by direct close contact or bedding, people who live together with the patient should pay attention to proper isolation.
  3. Do not share the same sanitary equipment with patients diagnosed as scabies.
  4. Maintaining personal hygiene and environmental hygiene can reduce the chance of scabies mites breeding.
  5. Please isolate yourself during treatment and avoid contact with people.
  1. Taiwanese Dermatological Association (2017, 08/23). Medications for Scabies. Cited from http://www.derma.org.tw/index.php?sort_no=1379727060&sort_s_no=1379760888%20&%20id=1500528490
  2. Tsai, M. C., Chan, M. C., Lin, Y. C. (2020). Using team resource management to manage scabies in respiratory care patients. Infection Control Journal, 30(2), 83-92. http://doi.org/10.6526/ICJ.202004_30(2).0002
  3. Lai, B. R. (2019). Scabies-How to Diagnose? How to Effectively Treat it? Journal of Healthcare Quality, 13(5), 76-79. http://doi.org/10.3966/199457952019091305015
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