Scabies on the tip of the iceberg

Few diseases have as many pejorative connotations as scabies. It provokes reactions of alarm, fear and estrangement, surely inherited from past times, which evoke intense itching, important discomfort, prolonged if not stopped and transmitted through intense contact.
Scabies is caused by an insect, a mite, Sarcoptes scabiei. The itching is severe and usually predominantly nocturnal. It results from a hypersensitivity reaction to the mite, faeces and eggs (1) and manifests itself as an intensely itchy rash on the fingers, interdigital areas, wrists, armpits, mammary areolas and genitals. The back of the body is relatively free of complications and the head is free, except in very young children.
Scabies, a less common form related to reduced immunity, is associated with increased numbers of mites, with thick scales, scabs and fissures (1).
Although it can affect people of any age and socioeconomic status (1), it is more common in crowded situations, along with difficulties in changing personal and bedding clothes and accessing showers. Mites can survive on a host for 24 to 36 hours.
The healthcare approach is simple and well known, so some people affected by scabies with longevity may not have contacted the healthcare system, due to lack of knowledge, lack of healthcare coverage, or difficulty in communicating. In addition to the above-mentioned hygiene rules, local treatment is proposed
For this reason, the demand for scabies care may facilitate contact with people who have not previously used the health system.

The usual treatment is a 5% permethrin cream that must be carefully applied from the neck to the feet, leaving it for 8 to 14 hours and then showering. Although your need has not been proven, it may be wise to repeat the treatment after one week. Permethrin is usually the preferred treatment for pregnant and lactating women.
In some cases where it is considered that the treatment is not going to be possible, oral treatment with ivermectin can usually be used, usually 1 tablet, which will be repeated after 1 week. (2)

It may be considered to treat household members and close contacts even if there are no symptoms, to avoid a repetitive cycle of infection.

Although scabies spread less frequently from the clothes or sheets of an infected person, it is prudent to wash or insulate any personal or bedding that the person has touched within the previous three days of treatment. It is usually not necessary to wash other items. You can choose to place them in plastic bags for at least three days or machine wash.

  1. Goldstein BG, Goldstein, AO. Epidemiology, clinical features, and diagnosis. UpToDate ( 22-12-19)

2. Goldstein BG, Goldstein, AO. Scabies. Management UpToDate (22-12-19)