Severe itching and minor skin changes should be taken seriously

The disease is caused by the itch mite (Sarcoptes scabiei). It is so small that it is barely visible to the naked eye. After close skin-to-skin contact, the fertilized female mite transfers to a new host and burrows tunnels a few millimeters long into the outermost layer of the skin. There, she lays eggs daily. After a few days, these eggs hatch into larvae, which develop into adult mites.

It is not the mites themselves that cause the intense itching, but rather the immune system’s reaction to their excretions, eggs, and body parts. In cases of initial infection, symptoms often do not appear until two to six weeks later.

People who have had scabies before often develop the typical symptoms within a few days. 

In most cases, infection occurs through prolonged direct skin-to-skin contact. This includes, for example, sharing a bed, close physical contact within the family, or caregiving activities in which skin comes into contact with skin for an extended period.

Outside the human body, scabies mites can survive only for a short time. Therefore, transmission via clothing, bedding, or towels plays a significantly smaller role. The situation is different with what is known as crusted scabies. This rare, highly contagious form occurs primarily in people with severely weakened immune systems. In this case, there are a very large number of mites on the skin, which significantly increases the risk of infection. 

The first and most noticeable symptom is severe itching, which is particularly pronounced in the evening and at night. Scratching often causes small breaks in the skin, through which bacteria can enter and cause additional skin infections.

Typical skin changes include:

• small red nodules
• blisters or crusts
• fine, winding mite burrows
• scratch marks
• inflamed areas of skin

The spaces between the fingers, wrists, armpits, elbows, the area around the navel, buttocks, genital area, and feet are particularly commonly affected. In infants and toddlers, changes may also appear on the scalp, face, palms, and soles of the feet. 

In principle, anyone can develop scabies. The risk increases wherever many people live together in close quarters or have regular close physical contact. People with weakened immune systems are also at higher risk, as the mites can multiply more rapidly.

This includes, among others:

• Families living in close quarters
• Daycare centers and schools
• Nursing homes
• Hospitals
• Facilities for people with disabilities
• Shared housing 

Often, the combination of nighttime itching, typical skin changes, and close contact with affected individuals already provides important clues. The skin is examined carefully. Mite burrows can be made visible using a special magnifying glass or a dermatoscope. In addition, a small skin sample is sometimes taken, or material from a mite burrow is examined to detect mites, eggs, or fecal pellets.

Since other skin conditions can cause similar symptoms, conditions such as atopic dermatitis, eczema, allergic reactions, or insect bites must be ruled out. 

Scabies can be completely cured in most cases. Often, a cream containing the active ingredient permethrin is applied to the entire body. It must remain on the skin for the prescribed amount of time and then be washed off. Depending on the situation, a second treatment may be necessary after a few days. If creams are not suitable or the condition is more severe, an oral medication may also be prescribed.

After successful treatment, the itching may persist for several weeks. However, this does not mean that live mites are still present. The skin simply needs some time for the inflammatory reaction to subside completely. 

People who have had close physical contact with an affected individual should also definitely be treated, even if they have not yet developed any symptoms. This is because if only one person is treated, family members, for example, can keep infecting one another. 

Simple measures can help reduce the risk of reinfection.

These include:

• Washing bedding, clothing, and towels at a minimum temperature of 60 degrees.
• Seal textiles that cannot be washed in an airtight container for several days.
• Vacuum upholstered furniture and mattresses thoroughly.
• Wear freshly washed clothing after treatment.
• Inform close contacts about the condition.

Excessive disinfection of the home or special sprays are generally not necessary for common scabies. 

With an early diagnosis and the right treatment, the prognosis is very good. The mites can be reliably eliminated if the treatment is carried out correctly and close contacts are included. It’s also important to be patient. The skin often takes several weeks to fully recover. If new mite burrows or skin lesions appear after treatment is completed, a follow-up medical examination should be conducted to rule out a relapse or reinfection.