Scabies: how to recognize, how to treat the whole family and why the itching remains after treatment - in Tashkent

Who causes the disease and how it is transmitted

The causative agent is a scabies mite, about a third of a millimeter in size, invisible to the naked eye. The fertilized female penetrates the stratum corneum of the skin and makes a horizontal passage in it, laying several eggs per night. After about two weeks, new adult mites grow from them. It is the female’s nocturnal activity that explains the main sign of the disease: the itching intensifies sharply in the evening and at night, when the tick gnaws through the passage and lays eggs.

A person who gets sick for the first time usually has only ten to fifteen adult females living on his skin—surprisingly few for such severe itching. The fact is that itching is not caused by the mites themselves, but by an allergic reaction to their waste products. This is why, during the first infection, symptoms do not appear immediately, but after two to six weeks: the body needs time to “learn” to react. With repeated infection, itching begins within one to four days, because the immune memory has already been formed. This explains the frequent situation when in one family one person itches, and the other, who became infected at the same time, still does not feel anything.

• The main route of transmission is prolonged close skin-to-skin contact: sharing a bed, sleeping in the same bed, hugging, children playing, intimacy
• A short handshake or accidental touch in transport practically does not lead to infection
• Transmission through linen, towels and clothing is possible, but plays a minor role; the exception is bed linen that has just been used
• The tick does not fly, does not jump and does not live in soil, dust or furniture on its own
• Pets do not get human scabies and do not transmit it: animal mites do not reproduce on human skin and cause only a short-term rash
• In collectives - dormitories, barracks, kindergartens, boarding schools, hospitals - outbreaks occur due to close household contact, and not due to sanitary conditions

Why scabies is not associated with cleanliness

This is the most persistent and most harmful misconception about the disease. Because of it, people do not go to the doctor for months, treat themselves, hide the diagnosis from loved ones - and continue to infect those with whom they live. Let’s look at why the concept of “dirty hands disease” is essentially wrong.

• The mite lives inside the stratum corneum of the skin, and not on its surface: soap, shower gel and washcloth do not physically reach it
• Frequent washing does not kill the tick and does not prevent it from making passages; Showering every day does not protect against infection
• There is a so-called scabies of clean people: in people who wash themselves several times a day, there are few rashes, the passages are almost invisible, and the diagnosis is made very late
• The disease occurs equally in all social groups, including medical workers who wash their hands dozens of times a shift
• Outbreaks in hospitals and nursing homes occur where sanitation requirements are strictly enforced - because contact, not cleanliness, decides
• You can get infected in a hotel, on a train, with relatives, in a children's camp - wherever there is a shared bed

The practical implication of this is simple, but it's worth saying out loud: telling the people you live with and have been in close contact with in recent weeks about your diagnosis is not an admission of something shameful, but a necessary step in treatment. Without this, the disease will go around in circles: a person who has been treated becomes infected again from someone who has not yet been treated and is not yet itching. Doctors call this situation a ping-pong infection, and it happens all the time precisely because of silence.

How does it manifest itself?

The classic picture consists of three components: night itching, characteristic sites of rashes and the scabies themselves. The tract appears as a thin, slightly raised grayish or whitish line a few millimeters to a centimeter long, with a bubble or nodule at the end. It is difficult to see it on combed skin, so the doctor uses a dermatoscope.

• The interdigital spaces of the hands and the lateral surfaces of the fingers are the most typical localization
• Flexion surfaces of wrists, elbows, anterior axillary folds
• Abdomen around the navel, lower back, buttocks, inner thighs
• The area of the mammary glands in women, the genitals in men are very characteristic places
• In adults, the face, neck and scalp are usually free
• In children under three years of age, everything is different: the palms, soles, face and even scalp are affected, and the rashes often look like blisters and pustules
• Scratching, bloody crusts and attached pustules are almost constant companions

There are several common treatment error scenarios worth being aware of. The first is when the rash is mistaken for an allergy and hormonal ointment is prescribed: the itching temporarily decreases, the picture blurs, the passages become indistinguishable, and mites continue to multiply. Doctors call this option hidden, disguised scabies, and it is much more difficult to recognize it later. The second is when the disease is mistaken for eczema or dermatitis and treated for months with external remedies without effect. The key to the correct answer usually comes from one question: is anyone else itching at home? If so, the likelihood of scabies increases dramatically.

How to make a diagnosis

1. Расспрос: когда начался зуд, усиливается ли ночью, чешется ли кто-то of живущих рядом, был ли контакт, поездка, стационар, гостиница.
2. Осмотр всей кожи, включая межпальцевые промежутки, запястья, живот, ягодицы и половые органы, — ограничиваться участком, который беспокоит, нельзя.
3. Дерматоскопия — увеличивающий прибор позволяет увидеть ход и характерную тёмную точку на его конце, соответствующую клещу.
4. Соскоб или извлечение клеща of хода с последующим микроскопическим исследованием: обнаружение самки, яиц или продуктов жизнедеятельности подтверждает диагноз окончательно.
5. Пробное окрашивание подозрительного участка красящим раствором, который затекает в ход и делает его видимым.
6. При сомнениях диагноз может быть поставлен по совокупности признаков, включая зуд у контактных лиц: отрицательный соскоб не исключает болезнь, потому что клещей на коже мало.

Treatment: why the whole family is treated

The principle of treatment looks simple, but it is the violation of its details that most often leads to failure. The external preparation is applied to the entire skin, and not just to itchy areas, everyone living together is treated on the same day, and the exposure time on the skin is strictly observed.

1. All члены семьи и половые партнёры обрабатываются одновременно, в один вечер, независимо от наличия жалоб. Это ключевое условие: лечение по очереди почти гарантированно приводит к повторному заражению.
2. Перед нанесением препарата принимают душ с мылом и хорошо вытираются: это удаляет часть клещей с поверхности и улучшает проникновение средства.
3. Средство наносят на всю кожу от шеи до кончиков пальцев ног, не пропуская подмышки, пупок, промежность, межпальцевые промежутки и кожу под ногтями. Детям до трёх лет обрабатывают также лицо и волосистую часть головы, избегая области вокруг глаз и рта.
4. Ногти коротко стригут: под ними скапливаются яйца, занесённые при расчёсывании, и необработанный участок сводит на нет весь курс.
5. Препарат оставляют на коже на то время, которое указал врач, — обычно от восьми до двенадцати часов, то есть удобнее наносить на ночь. Если в этот период мыли руки, средство наносят на кисти заново.
6. Схему повторяют через интервал, назначенный врачом, чтобы уничтожить клещей, вылупившихся of яиц уже после первой обработки.
7. Контрольный осмотр через две-четыре недели: врач оценивает, появляются ли новые ходы и высыпания.

Lingerie, things and itching after treatment

Processing of things is necessary, but its volume is often exaggerated, and families spend weekends pointlessly disinfecting the apartment. It is enough to take care of what has been in direct contact with the skin in the last few days.

• Bed linen, towels, underwear and clothing that have been used in the last three days are washed at a temperature of at least 60 degrees and ironed with a hot iron
• Things that cannot be washed with hot water are placed in a tightly closed bag for at least three days, preferably a week: the tick dies without a person
• Outerwear, jackets, shoes, pillows and blankets usually require only airing or insulation in a bag, not dry cleaning
• It is enough to vacuum upholstered furniture, carpets and toys; There is no need to treat walls, floors and surfaces with disinfectants
• On the day of treatment, change the linen completely, and after the final treatment - again
• Children are not taken to kindergarten or school until the end of treatment; the case must be reported so that contacts can be examined

And the most important thing is that it relieves anxiety and prevents unnecessary courses of treatment: the itching after successful treatment does not go away instantly. It may persist and even intensify slightly in the first days, and then gradually subside over two to four weeks, occasionally longer. The reason is that killed mites and their metabolic products remain in the stratum corneum, and the body continues to react to them until the skin is renewed. This condition is called post-scabiosis itching. It does not mean that the treatment did not work, and does not require repeated application of the anti-scabies drug - on the contrary, unnecessary courses dry out and irritate the skin, giving rise to real dermatitis.