Scabies is a skin infestation caused by microscopic parasites called mites. The mites burrow under the skin creating small, raised areas. These burrows, which contain fluid, resemble wavy lines and appear frequently on finger webs or on the wrists, elbows, breasts, belt line, thighs and abdomen. A rash may occur anywhere on the body, regardless of the area of infestation. Itching is intense, especially at night.

What is the incubation period?

Persons with no previous exposure begin itching after 2-6 weeks. Persons with prior exposure develop symptoms within 1-4 days.

How is scabies transmitted?

Direct skin-to-skin contact with an infested person. Less commonly, transmission occurs through contact with contaminated clothing, bedding or other articles.

What is the communicable period?

Scabies is easily transmitted from the time of infestation until after mites and eggs are destroyed (ordinarily within 24 hours after the first treatment and occasionally after 2 courses of treatment 1 week apart).

How is scabies diagnosed?

The diagnosis of scabies should be confirmed by a medical professional using skin scrapings and microscopic identification of live mites, eggs and/or fecal pellets.

How should scabies be treated?

Infested persons should be treated with a prescription product as soon as possible after diagnosis. Follow the instructions on the medication exactly. The infested person should avoid social situations, including work or school, until 24 hours after the first treatment. Itching may persist for 1-2 weeks after treatment; this should not be taken as a sign of treatment failure. Household contacts of an infested person should be treated since they may have been exposed. Overtreating should be avoided because the medication can be toxic. Five percent (5%) permethrin is the drug of choice for infants and toddlers.

How should scabies be controlled?

After applying the treatment and waiting the specified time (according to the manufacturer's directions), the infested person should take a bath or shower. If the infested person is in a long-term care facility or hospital, personnel caring for the patient should wear gowns and gloves for the first 24 hours after treatment. Laundry personnel should wear gowns and gloves when handling contaminated linens. Bedding, clothing, underclothes and linens should be laundered and heat dried. Recommendations vary, but personal items that are not easily washed and dried should be kept in a closed plastic bag for a minimum of 5 days. Mop floors and vacuum carpets and furniture.

A high index of suspicion should be maintained for scabies in long-term care facilities. In some instances where facilities are experiencing an epidemic of scabies, mass treatment of patients, contacts and personnel may be indicated (with treatment taking place on the same day). For isolated cases of scabies, selective treatment should be used. Asymptomatic staff (those without any signs or symptoms of infestation) who have provided direct-contact care for the infested patient should be treated, as well as close personal contacts of symptomatic patients (those who have skin contact). Close personal contacts (family members) of symptomatic employees should also be treated.

Where can I get more information?

For more information or to report an outbreak, please contact the Bureau of Epidemiology at (801) 538-6191 or your local health department.

UTAH DEPARTMENT OF HEALTH
BUREAU OF EPIDEMIOLOGY
August 2001