The COVID-19 pandemic that began two years ago has brought many things, including an increase in scabies . There are already articles that point to an increase in scabies cases a few weeks after the start of the pandemic, both in Spain and in other countries .
There is talk of an epidemic within a pandemic . It seems that, on the one hand, confinement has increased intra-family infections (we have all been at home for a long time); on the other, the fear of going to hospitals and medical centers has led to consultation later for other problems that, at first, seem less serious, but are tremendously annoying and reduce quality of life.
What is scabies?
Scabies or scabies is an infection caused by a mite, Sarcoptes scabiei hominis variety. These parasites are difficult to see with the naked eye since they measure less than half a millimeter and have a whitish-transparent color.
It is transmitted mainly through direct contact with the skin and more rarely through sheets, towels or other objects.
Contagion usually occurs in the family or in closed living groups , since prolonged and intimate contact is required. It enters the most superficial layer of the skin, where it lives, feeding on the stratum corneum of the epidermis, and reproduces. Outside the human being it survives only 2 or 3 days .
Who is affected? How is it spread?
Although many associate scabies with a lack of hygiene or low socioeconomic status, scabies can affect people of any age, race, sex, and hygiene conditions, and in any country .
It is true that there is a higher risk of contracting the infection if you spend prolonged periods with infected people, if you live in crowded conditions or in poorly ventilated places .
Most outbreaks take place within the same family and are also more frequent in places where there is close coexistence (barracks, social health centers, prisons…).
When it is most contagious it is at night and a fairly close contact is needed, to be very close. At school it is more difficult, in nurseries it can be infected more easily. Check out more interesting articles on our PM Blog.
What are the symptoms of scabies?
The time between infection and the appearance of symptoms varies between 2 to 6 weeks. The main symptom is itching , which appears and/or intensifies at night . In fact, the term scabies comes from the Latin scabere , which means to scratch.
The predominantly nocturnal itch is due to the fact that it is at night when the females dig their furrows under the skin. It is common for there to be several family members with the same symptoms .
The initial skin lesions are usually small pimples or red spots. Scabs and scratch lesions appear later. The most typical lesion of scabies is the sulcus acarina , raised lines a few millimeters long that correspond to the furrows excavated by the mite.
At the end, we can often see a small vesicle, called a pearl vesicle or scabiotic pearl , which corresponds to the place where the female is found.
On some occasions these skin lesions can become superinfected.
The most common places for lesions to appear are the folds , where the skin is thinner and the mite penetrates more easily: between the fingers, wrists, elbows, buttocks, genitals…
Over time and even after treatment, nodular lesions may appear, called postscabiotic nodules due to a hypersensitivity reaction.
How is scabies diagnosed in children?
The diagnosis can be made clinically in many cases. The anamnesis (the symptoms reported by the child and/or the family, the history of cohabitants with the same symptoms) and the physical examination with compatible skin lesions are often sufficient to diagnose scabies. Acarine furrows can be stained with a drop of India ink to make them look better.
If in doubt, the mite or its eggs or droppings can be visualized in a skin scraping under a microscope . They can also be visualized by manual dermatoscope or video dermatoscope. On rare occasions it is necessary to analyze a biopsy of any of the lesions.
Both the symptoms of scabies (itching), and some of its lesions (pimples, scratching lesions, scabs, vesicles…) are common to many skin diseases, which can sometimes delay the diagnosis.
How is scabies treated?
The treatment has two fundamental pillars: on the one hand, to eliminate the mite both from the child’s skin and from sheets, towels and other objects; on the other hand, improve the patient’s symptoms.
To eliminate the mite from the skin, the most common treatment is a scabicide cream (which kills the parasite); in our environment we usually use permethrin . A thin layer is applied all over the skin from the neck down. In infants and children under 2 years of age, we must also apply it to the scalp. It is important to pay special attention to the folds and under the nails (it is advisable to cut them before starting treatment). We must let the cream act for at least 8 or 12 hours (overnight) and we will bathe or shower the child later, the next morning.
As the cream does not kill the eggs, we must repeat the treatment in 7-10 days , which is the time it takes for the larvae to hatch.
Another treatment option is oral Ivermectin , which is not marketed in our country (we can find it as a foreign medicine). It is especially useful when cream treatment fails, in institutions, very extensive scabies or other types of scabies (such as Norwegian scabies) and when cream treatment cannot be carried out.
It is extremely important, as is the case with other parasites such as worms , that all cohabitants receive treatment at the same time , even if they are asymptomatic; since they may be in the incubation phase and if not treated, the infection would perpetuate in the family or group.
To eliminate the parasite from towels, sheets and objects, we must wash them with hot water (at least 60º) and dry them and/or iron them later at high temperatures. What cannot be washed should be kept in a closed bag for three days (some authors extend this period up to a week).
As for the symptoms, a medication to reduce itching (an antihistamine ) and a corticosteroid may be necessary in some lesions. If there is a superinfection, an antibiotic (in cream or by mouth depending on the severity and extent) will also be necessary.
After treatment, itching can persist for up to 3-4 weeks without it being a symptom of persistence of the parasite. Similarly, skin lesions can take up to 4 weeks to completely disappear.
As for the risk of contagion , 24 hours after the application of the treatment it is estimated that it is minimal and the boy or girl can go to school .
Why has the COVID pandemic brought an increase in scabies?
Shortly after the start of the pandemic, an increase in scabies cases was observed. Turkey was probably the first to publish it, and it has also been reported in other countries such as Italy or Spain .
In our country, an increase in incidence has been seen since 2014 , which has been notably exacerbated by the pandemic.
This increase seems to be due to the greater and more prolonged contact in families as they all have to stay at home for long periods of time. In fact, up to 80% of patients diagnosed with scabies during confinement, according to a study , lived with one or more people who also suffered from scabies.
In addition, the fear of going to hospital centers and the collapse of these has made it take longer to consult and the diagnosis has been made later, which has in turn led to a greater number of infections and a more advanced state of the diseases. injuries.