Scratching for relief: Why scabies remains a public health concern

An itch so intense it disrupts sleep, accompanied by small, red rashes that spread across the body, is the daily reality for those suffering from scabies. This skin condition is caused by tiny mites burrowing into the skin, triggering allergic reactions that result in discomfort and distress, particularly in crowded or resource-poor settings.

Dr Beatrice Etemesi, a consultant dermatologist explains that scabies is not just a medical condition but a social issue that affects marginalized communities the most. Scabies is caused by the microscopic mite Sarcoptes scabiei var. hominis, which is specific to humans. The female mite burrows into the skin, laying eggs that hatch into larvae. This lifecycle leads to intense itching and visible rashes.

The World Health Organisation (WHO) states that globally, over 200 million people are affected by scabies at any given time. In resource-poor tropical settings, prevalence among children can range from 5-50 per cent. In Kenya, specific national statistics are limited. However, scabies is recognized as a significant health concern, particularly in crowded communities and institutions.

“The lack of accurate data in Kenya hampers effective response. However, global studies show that mass treatment and education can significantly reduce the burden,” Dr Etemesi says.

The primary cause of scabies is direct skin-to-skin contact with an infected person. The mites can also spread through sharing clothing, bedding or towels. It’s important to note that scabies is not a result of poor hygiene; anyone can contract it under the right conditions.

There are several forms of scabies, each presenting with distinct characteristics. Classic scabies is the most common type, marked by intense itching and a pimple-like rash. Nodular scabies, on the other hand, is characterized by firm, raised bumps, often affecting children or individuals with weakened immune systems.

The most severe form is crusted (formerly Norwegian) scabies, which is highly contagious and typically affects those with compromised immune systems. Crusted scabies is marked by thick crusts on the skin, often containing millions of mites, making it the most severe variation. Dr Etemesi explains that while these are the primary clinical variations, crusted scabies, in particular, poses significant health risks due to its high mite count and contagious nature.

Scabies spreads through prolonged skin-to-skin contact or shared items like bedding and clothing. Overcrowding, poverty and poor hygiene increase the risk of outbreaks. Infections are common in settings like schools, refugee camps and prisons.

“Scabies thrives in areas where people are in close contact, especially during colder seasons when mites survive longer,” says Dr Etemesi.

The hallmark symptom is intense itching, especially at night, accompanied by a rash or irregular burrow tracks made up of tiny blisters in areas like the finger webs, wrists, armpits and genital region. In infants, the face, palms and soles may also be affected. “The itching is unbearable, and if untreated, scabies can lead to secondary bacterial infections,” Dr Etemesi warns.

Treatment aims to address both the mites causing the infection and the intense itching. Common treatment options include topical treatments such as benzyl benzoate emulsion, permethrin cream, and sulphur ointment, which are applied directly to the affected skin to kill the mites. In more severe cases or for patients with mental health conditions, oral medications like ivermectin are often preferred. These treatments help eliminate the infestation and alleviate the discomfort associated with scabies.

Dr Etemesi advises, “All household members should be treated simultaneously to prevent reinfection.” Preventive measures include avoiding direct skin contact with infected individuals, refraining from sharing personal items like clothing or bedding and washing clothing and bedding in hot water before drying them on a high heat setting. These steps are crucial in reducing the spread and reoccurrence of scabies.

Effective management involves more than just medication. Bedding and clothing must be washed and ironed. Personal hygiene and awareness are key. Infected individuals should avoid close contact with others until treatment is complete.

If left untreated, scabies can lead to severe complications. Secondary bacterial infections, such as impetigo, may develop due to open sores caused by scratching. In some cases, prolonged skin damage and bacterial invasion can result in systemic issues like renal failure or rheumatic heart disease.

Scabies is a treatable condition, but early detection and comprehensive treatment are crucial to preventing complications and controlling its spread. Though it may seem like just an itchy nuisance, scabies highlights broader socio-economic challenges. If you experience persistent itching or notice a suspicious rash, consult a healthcare professional promptly. With proper treatment and community engagement, its spread can be controlled. Dr Etemesi advises, “Awareness is crucial. The more people know about scabies, the better we can manage and prevent it.”