Scabies

File:Sites of scabies.png|thumb|upright=1.3|Commonly involved sites of rashes of scabies Symptoms typically appear two to six weeks after infestation for individuals never before exposed to scabies. For those having been previously exposed, the symptoms can appear within several days after infestation. However, symptoms may appear after several months or years. On those with weaker immune systems, the host becomes a more fertile breeding ground for the mites, which spread over the host's body, except the face. The mites in crusted scabies are not more virulent than in noncrusted scabies but are much more numerous, sometimes up to two million. People with crusted scabies exhibit scaly rashes, slight itching, and thick crusts of skin that contain large numbers of scabies mites. For this reason, persons with crusted scabies are more contagious to others than those with typical scabies. Such areas make eradication of mites particularly difficult, as the crusts protect the mites from topical miticides/scabicides, necessitating prolonged treatment of these areas. == Cause ==

Scabies mite '' mite In the 18th century, Italian biologists Giovanni Cosimo Bonomo and Diacinto Cestoni (1637–1718) described the mite now called Sarcoptes scabiei, variety hominis, as the cause of scabies. Sarcoptes is a genus of skin parasites and part of the larger family of mites collectively known as scab mites. These organisms have eight legs as adults and are placed in the same phylogenetic class (Arachnida) as spiders and ticks. S. scabiei mites are under 0.5 mm in size; they are sometimes visible as pinpoints of white. Gravid females tunnel into the dead, outermost layer (stratum corneum) of a host's skin and deposit eggs in the shallow burrows. The eggs hatch into larvae in three to ten days. These young mites move about on the skin and molt into a "nymphal" stage, before maturing as adults, which live three to four weeks in the host's skin. Males roam on top of the skin, occasionally burrowing into the skin. In general, the total number of adult mites infesting a healthy hygienic person with non-crusted scabies is small, about 11 females in burrows, on average. This includes sexual intercourse, although a majority of cases are acquired through other forms of skin-to-skin contact. Less commonly, scabies infestation can happen through the sharing of clothes, towels, and bedding, but this is not a major mode of transmission; individual mites can survive for only two to three days, at most, away from human skin at room temperature. As with lice, a latex condom is ineffective against scabies transmission during intercourse, because mites typically migrate from one individual to the next at sites other than the sex organs. Multiple transmission factors allow scabies to achieve very high prevalence rates in institutional outbreaks, including crowded living conditions with high host density, social interactions involving prolonged skin-to-skin contact, sharing of bedding and clothing, frequent manual handling, limited access to laundry services, and immunocompromised populations. Healthcare workers are at risk of contracting scabies from patients, because they may be in extended contact with them. ==Pathophysiology==

The symptoms are caused by an allergic reaction of the host's body to mite proteins, though exactly which proteins remains a topic of study. The mite proteins are also present in the gut, and in mite feces, which are deposited under the skin. The allergic reaction is both of the delayed (cell-mediated) and immediate (antibody-mediated) type, and involves IgE (antibodies are presumed to mediate the very rapid symptoms on reinfection). The allergy-type symptoms (itching) continue for some days, and even several weeks, after all mites are killed. New lesions may appear for a few days after mites are eradicated. Nodular lesions from scabies may continue to be symptomatic for weeks after the mites have been killed. == Diagnosis ==

of an itch mite (S. scabiei) Scabies may be diagnosed clinically in geographical areas where it is common when diffuse itching presents along with either a lesion in two typical spots or itchiness is present in another household member. == Prevention of passing on scabies to other people ==

Mass-treatment programs that use topical permethrin or oral ivermectin have been effective in reducing the prevalence of scabies in several populations. == Management ==

Treatment Several medications are effective in treating scabies. Treatment should involve the entire household and any others who have had recent, prolonged contact with the infested individual. Bedding, clothing and towels used during the previous three days should be washed in hot water and dried in a hot dryer. Treatment protocols for crusted scabies are significantly more intense than for common scabies. Permethrin Permethrin, a pyrethroid insecticide, is the most effective treatment for scabies, and remains the treatment of choice. Permethrin may cause slight irritation of the skin that is usually tolerable.. 2022 studies performed in Kuşadası, Türkiye showed in cases where patients failed to improve with 5% permethrin, 100% of scabies mites analyzed were sensitive to in-vitro 5% permethrin, suggesting that lack of efficacy could be due to treatment non-compliance rather than true resistance. However, a 2024 study published in Salzburg, Austria revealed permethrin resistant-scabies in nearly 3 out of 4 cases studied. In this population, treatment with benzyl benzoate had a considerably higher cure rate. Additional studies will be needed to confirm the presence of permethrin-resistance determine its epidemiology. Ivermectin Oral ivermectin is effective in eradicating scabies, often in a single dose. It has also been useful for sarcoptic mange, the veterinary analog of human scabies. One review found that the efficacy of permethrin is similar to that of systemic or topical ivermectin. A separate review found that although oral ivermectin is usually effective for the treatment of scabies, it does have a higher treatment failure rate than topical permethrin. Another review found that oral ivermectin provided a reasonable balance between efficacy and safety. A study has demonstrated that scabies is markedly reduced in populations taking ivermectin regularly; the drug is widely used for treating scabies and other parasitic diseases, particularly among the poor and disadvantaged in the tropics, beginning with the developer Merck providing the drug at no cost to treat onchocerciasis from 1987. Others Other treatments include lindane, benzyl benzoate, crotamiton, malathion, and sulfur preparations. but may be used in other states as a second-line treatment. Sulfur ointments or benzyl benzoate are often used in the developing world due to their low cost; and sulfur ointments are typically used for at least a week, though many people find the odor of sulfur products unpleasant. Although such strategies have shown to be able to reduce the burden of scabies in these kinds of communities, debate remains about the best strategy to adopt, including the choice of drug. The resources required to implement such large-scale interventions in a cost-effective and sustainable way are significant. Furthermore, since endemic scabies is largely restricted to poor and remote areas, it is a public health issue that has not attracted much attention from policymakers and international donors. == Epidemiology ==

Scabies is one of the three most common skin disorders in children, along with tinea and pyoderma. Globally as of 2009, an estimated 300 million cases of scabies occur each year, although various parties claim the figure is either over- or underestimated. About 1–10% of the global population is estimated to be infected with scabies, but in certain populations, the infection rate may be as high as 50–80%. == History ==

Scabies has been observed in humans since ancient times. Archeological evidence from Egypt and the Middle East suggests scabies was present as early as 494 BC. In the fourth century BC, Aristotle reported on "lice" that "escape from little pimples if they are pricked" – a description consistent with scabies. Arab physician Ibn Zuhr is believed to have been the first to provide a clinical description of the scabies mites. Roman encyclopedist and medical writer Aulus Cornelius Celsus (circa 25 BC – 50 AD) is credited with naming the disease "scabies" and describing its characteristic features. == Scabies in animals ==

, Indonesia, with sarcoptic mange Scabies may occur in some domestic and wild animals; the mites that cause these infestations are of different subspecies from the one typically causing the human form. These subspecies can infest animals that are not their usual hosts, but such infections do not last long. and is distinguished from human scabies by its distribution on skin surfaces covered by clothing. Scabies-infected domestic fowl develop what is known as "scaly leg". Domestic animals that have gone feral and have no veterinary care are frequently affected by scabies. Nondomestic animals have also been observed to develop scabies. Gorillas, for instance, are known to be susceptible to infection by contact with items used by humans, and it is a fatal disease of wombats. Scabies is also a concern for cattle. ==Society and culture==

worker Stefania Lanzia using a soft toy scabies mite to publicise the condition in a 2016 campaign The International Alliance for the Control of Scabies was started in 2012, and brings together over 150 researchers, clinicians, and public-health experts from more than 15 countries. It has managed to bring the global health implications of scabies to the attention of the World Health Organization (WHO). ==Research==

Moxidectin is being evaluated as a treatment for scabies. It is established in veterinary medicine to treat a range of parasites, including sarcoptic mange. Its advantage over ivermectin is its longer half-life in humans, thus the potential duration of action. == References ==