Parasites on the skin

If the typical symptoms – itching and inflammation – don’t make you especially think of scabies, you might first suspect an eczema. But the parts of the body where the »eczema« occurs should make you think of scabies. Itch mites especially like to settle in the spaces between fingers, on wrist joints, elbows, in the groin region, around the nipples and on the penis. The itch mite can only be seen as a small dot by the human eye.

The female mite bores 0.5 to 2 centimetres long angularly kinked passages into the upper skin and deposits three to four eggs there daily. Three to six days later, larvae hatch which grow up quickly. About ten to thirty days after the infection, badly itching nodules, pustules or also small blisters will appear. If the person affected was infected by itch mites once before in the past, the skin will react already after a few days. By scratching, the skin may be infected again.

The transmission of itch mites takes place especially via close body contact. Scabies can be found worldwide and affects people of all ages. Even so, certain groups are more at risk than others: children, the elderly and people with a weakened immune system. No wonder itch mites are feared in retirement or nursing homes. If it isn’t discovered and contained early, it may quickly develop to an endemic disease. Nursery schools too are predestined for itch mite outbreaks.

Scabies is treated by using an anti-scabies agent which kills larvae as well as eggs. The agent of first choice is permethrin (for example in Gepescab®, Infectoscab®). Patients should apply the remedy completely over the entire body from the lower jaw right down to the toes. It is left to act for eight to twelve hours and is then washed off. After the treatment the patient should care for the skin using a basic cream to prevent it from dehydrating and getting irritated. Alternatively, Benzyl benzoate (Antiscabiosum®) or Crotamiton (Crotamitex®) can be used. These preparations are repeatedly applied. Usually the therapy works very well. If no effect is experienced, it is mostly due to an application error or a renewed infection. Then the treatment needs to be repeated, but only after checking with the patient that possible application errors have been excluded.

If a topical full-body treatment cannot be carried out appropriately or if there are any contraindications, a one-time dose of an ivermectin tablet (Driponin®) could be a therapeutic option.

The persons in direct contact to the patient should also be examined for scabies or, as a precaution, also receive the treatment.