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Scabies Infection Treatments - Safe Herbal Solutions
scabies / Head Lice Information
With the new school year finally here, I was reminded by this clinical review in this week's British Medical Journal (free text link below) about an embarrassing problem some of your children may be facing: Head lice.
Head lice -- also going by the moniker scabies -- is highly contagious and spreads through direct skin-to-skin contact. Scabies is an intensely itchy dermatosis caused by the mite Sarcoptes scabiei. A patient with an "ordinary case" of head lice has an average of 12 mites on their bodies, but those suffering from crusted scabies may have millions of them. Outbreaks of head lice rise and fall cyclically, according to the report, peaking for unknown reasons every 15-25 years.
A lower prevalence of infestation has been observed in African-Americans than in other ethnic groups in the United States. Scabies is endemic in developing parts of the world, where treatment is expensive. Scabies is currently widespread in North America and Europe, with no evidence that this epidemic is abating.
The conventional treatments aren't safe solutions, as those creams, lotions and shampoos contain toxic insecticides like permethrin and malathion, and combing them out isn't an option at all.
A better and safer strategy: Apply essential oils like anise and ylang ylang on the infected areas. some mix rosmarin oil into the lot, others use tee tree oil. Try natural scabies remedies
Crusted Scabies
Crusted scabies is also known as Norwegian scabies because of its initial description in Norwegian patients with leprosy. In patients with neurological disorders or immunosuppression the number of mites can escalate rapidly. This may be due to the impaired immune response, the lack of pruritus, or the patient's physical inability to scratch. Clinically, the eruption is suspected when there is marked thickening and crusting of the skin (fig 3), particularly on the hands, although the entire body including the face and scalp is often involved.
- In adults, scabies is characterised by intractable pruritus, worse at night, and with lesions in the web spaces, fingers, flexor surfaces of the wrists, axillae, abdomen (around the umbilicus), lower portions of the buttocks, and genital areas.
- In women itching of the nipples associated with generalised pruritic papular eruption is characteristic
- In men itchy papules on the scrotum and penis are virtually pathognomonic.
- In infants and young children scabies often affects the face, head, neck, scalp, palms, and soles, and there is often generalised skin involvement. In infants the commonest presenting lesions are papules and vesicopustules. Vesicopustules are particularly common on the palms and soles.
A high index of suspicion is needed to diagnose scabies correctly because of the wide range of symptoms and presentations. Furthermore, the distribution of lesions in adults (very rarely on the face and neck) and children (commonly on the face and neck) is different.
Is it different in very young children?
Very young children often have widespread eczematous erythema, particularly on the trunk, which is sometimes more symptomatic than the lesions on the typical sites. Very young babies do not scratch and may just seem miserable or feed poorly. Pinkish brown scabetic nodules are particularly characteristic of scabies in babies.
How scabies spread
- skin-to-skin
- Transfer from clothes and bedding occurs rarely and only if contaminated by infested people immediately beforehand.1
Infestation occurs when the pregnant female mite burrows into the skin and lays eggs. After two or three days, the larvae emerge and dig new burrows. They mature, mate, and repeat this cycle every two weeks.
How do I confirm the diagnosis?
Scabies is usually diagnosed on history and examination. Definitive diagnosis relies on microscopic identification of mites or eggs from skin scrapings of a burrow. However, treatment should be started if scabies is suspected clinically, even if it cannot be confirmed by microscopy.
A history of itching in several family members over the same period is almost pathognomonic. However, lack of a history of itching in family members does not exclude scabies. It can be notoriously difficult to get family members to admit to a history of possible scabies, and some people with scabies genuinely seem not to itch.
If left untreated, scabies can continue for many months. It is important to remember that recurrence of symptoms after attempted treatment does not exclude the diagnosis of scabies because patients may not have treated themselves correctly or may have been reinfested by an untreated contact.
What are the symptoms and signs of scabies?
The main symptoms of scabies are probably a result of the host immune reaction to the burrowed mites and their products.2 Scabies presents within two to six weeks of initial infestation, but reinfestation can provoke symptoms within 48 hours. Pruritus is the hallmark of scabies regardless of age.
The most common presenting lesions are papules, vesicles, pustules, and nodules. The pathognomonic sign is the burrow; a short, wavy, scaly, grey line on the skin surface. These burrows are most easily found on the hands and feet, particularly in the finger web spaces, thenar and hypothenar eminences, and on the wrists. They are often missed if the skin has been scratched, has become secondarily infected, or if eczema is present.
Eczema can either be pre-existing or can develop as a result of infestation with the scabies mite. Indeed, scabies can cause widespread eczema, probably as a result of patients' immune reaction to burrowing mites and their faecal products. This eczema can become secondarily infected with Staphylococcus, Streptococcus, or both.
Scabies Prognosis
Infestation with scabies is curable. An individual with scabies, when correctly treated, has a good prognosis, and both the itching and eczema should resolve. However, in endemic areas reinfection by future contacts is highly likely.
Despite being readily treatable, scabies remains common. This is because it can be difficult both to diagnose and to ensure adequate treatment of patients and their contacts. This article seeks to clarify the diagnostic problems and help optimise treatment
What are the risk factors if you have SCABIES?
Scabies is transmitted by close personal contact. Infants and children are therefore particularly liable to infection from close physical contact with other children and adults at home and at school. Outbreaks can occur among elderly people in nursing homes and can be transmitted to nursing staff. Transmission between adults is often by sexual contact.
Patients with HIV infection or AIDS are more prone to develop crusted scabies.
Patients with crusted scabies are a common cause of institutional outbreaks of scabies.
Scabies - tips
- Ask about family members who itch
- Treat all close contacts at the same time
- Itch can persist for up to six weeks after treatment
- Diagnostic difficulty may occur when Scabies occurs in infants and young children Scabies occurs in adults or children with pre-existing eczema
- There is secondary bacterial infection of the skin A patient who has been previously treated becomes reinfested
Successful treatment of scabies requires:
- Correct diagnosis: this is the most important message of this article, as incorrect diagnosis is the main reason for patients being treated inappropriately
- Elimination of the mites by means of scabicides (applied correctly)
- Treatment of symptoms
- Treatment of secondary infection if present.
Conventional Scabies Treatments
Scabies treatment failures have been reported with lindane, crotamiton, and benzyl benzoate, and resistance may be emerging to permethrin. Resistance to permethrin is well recognised, but only two cases of ivermectin resistance to scabies have been reported in humans (both in patients with Norwegian scabies who received multiple treatments). Resistance can be difficult to determine clinically because scabies treatment failure is usually due to inadequate scabies treatment or reinfestation from untreated contacts.
Are there any side effects to Pharmaceutical Scabies Medications?
Permethrin 5% dermal cream is well tolerated and has low toxicity,1 7 but burning and stinging sensations and pruritus can occur.
Malathion should be used as second choice and for adult contacts who pay for NHS prescriptions (as malathion is cheaper than both a prescription and permethrin). Children should be given aqueous preparations because alcoholic lotions sting and can cause wheezing.
Does Scabies Treatment Fail?
Yes, and evidence of previous treatment should not exclude the diagnosis of scabies because patients can be reinfested by untreated contacts. Common reasons for treatment failure include
- Infants removing the treatment from their hands when sucking their fingers
- Adults inadvertently washing the lotion off their hands
- Escaping treatment—This often happens in pregnant women, people with other skin disease, and small babies. Also, children sometimes live in more than one household and may be omitted from treatment.
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