- Beth G Goldstein, MD
Beth G Goldstein, MD
- Adjunct Clinical Assistant Professor
- Department of Dermatology
- University of North Carolina at Chapel Hill
- Adam O Goldstein, MD, MPH
Adam O Goldstein, MD, MPH
- Department of Family Medicine
- University of North Carolina at Chapel Hill
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — General Dermatology
- Professor of Dermatology and Public Health
- University of Colorado School of Medicine
- Colorado School of Public Health
- Chief, Dermatology Service
- US Department of Veterans Affairs
- Eastern Colorado Health Care System
- Moise L Levy, MD
Moise L Levy, MD
- Section Editor — Pediatric Dermatology
- Professor of Pediatrics and Medicine (Dermatology)
- Dell Medical School, University of Texas, Austin
- Clinical Professor of Dermatology and Pediatrics
- Baylor College of Medicine
- Ted Rosen, MD
Ted Rosen, MD
- Section Editor — Infections and Infestations
- Professor, Department of Dermatology
- Baylor College of Medicine
Scabies ("the itch") is an infestation of the skin by the mite Sarcoptes scabiei that results in an intensely pruritic eruption with a characteristic distribution pattern.
The prevalence of scabies undergoes cyclical fluctuations on a worldwide basis, although all parts of the globe are not necessarily in the same phase of the cycle at the same time. In the 1960s the prevalence in Europe and North America began to increase, and by 1980 had reached near-pandemic levels. The estimated prevalence ranges from 0.2 to 71 percent, with as many as 100 million people affected worldwide .
Crowded conditions increase the prevalence of scabies in the population, and scabies can occur in epidemics in institutional settings . In temperate climates, scabies is more common in the winter than the summer probably due to both greater physical crowding in the winter and because mites can survive longer on fomites in colder temperatures .
Transmission of scabies is usually from person to person by direct contact . Transmission from parents to children, and especially from mother to infant, is routine. Schools do not ordinarily provide the level of contact necessary for transmission. In young adults, the mode of transmission is usually sexual contact.
In typical conditions, mites can survive off a host for 24 to 36 hours . They can survive much longer in colder conditions with high relative humidity [4,5]. Under comparable conditions, female mites (which burrow into the skin and cause disease) survive longer than their male counterparts .
- Romani L, Steer AC, Whitfeld MJ, Kaldor JM. Prevalence of scabies and impetigo worldwide: a systematic review. Lancet Infect Dis 2015; 15:960.
- Chosidow O. Clinical practices. Scabies. N Engl J Med 2006; 354:1718.
- Fuller LC. Epidemiology of scabies. Curr Opin Infect Dis 2013; 26:123.
- Arlian LG, Runyan RA, Achar S, Estes SA. Survival and infectivity of Sarcoptes scabiei var. canis and var. hominis. J Am Acad Dermatol 1984; 11:210.
- Arlian LG, Vyszenski-Moher DL, Pole MJ. Survival of adults and development stages of Sarcoptes scabiei var. canis when off the host. Exp Appl Acarol 1989; 6:181.
- Heukelbach J, Feldmeier H. Scabies. Lancet 2006; 367:1767.
- Aydıngöz IE, Mansur AT. Canine scabies in humans: a case report and review of the literature. Dermatology 2011; 223:104.
- Fimiani M, Mazzatenta C, Alessandrini C, et al. The behaviour of Sarcoptes scabiei var. hominis in human skin: an ultrastructural study. J Submicrosc Cytol Pathol 1997; 29:105.
- Currie BJ, McCarthy JS. Permethrin and ivermectin for scabies. N Engl J Med 2010; 362:717.
- Johnston G, Sladden M. Scabies: diagnosis and treatment. BMJ 2005; 331:619.
- Chosidow O. Scabies and pediculosis. Lancet 2000; 355:819.
- Vorou R, Remoudaki HD, Maltezou HC. Nosocomial scabies. J Hosp Infect 2007; 65:9.
- Walton SF, Oprescu FI. Immunology of scabies and translational outcomes: identifying the missing links. Curr Opin Infect Dis 2013; 26:116.
- McCarthy JS, Kemp DJ, Walton SF, Currie BJ. Scabies: more than just an irritation. Postgrad Med J 2004; 80:382.
- Pomares C, Marty P, Delaunay P. Isolated itching of the genitals. Am J Trop Med Hyg 2014; 90:589.
- Eshagh K, DeKlotz CM, Friedlander SF. Infant with a papular eruption localized to the back. JAMA Pediatr 2014; 168:379.
- Witkowski JA, Parish LC. Scabies: a cause of generalized urticaria. Cutis 1984; 33:277.
- Chapel TA, Krugel L, Chapel J, Segal A. Scabies presenting as urticaria. JAMA 1981; 246:1440.
- Kartono F, Lee EW, Lanum D, et al. Crusted Norwegian scabies in an adult with Langerhans cell histiocytosis: mishaps leading to systemic chemotherapy. Arch Dermatol 2007; 143:626.
- Wong SS, Woo PC, Yuen KY. Unusual laboratory findings in a case of Norwegian scabies provided a clue to diagnosis. J Clin Microbiol 2005; 43:2542.
- Lin S, Farber J, Lado L. A case report of crusted scabies with methicillin-resistant Staphylococcus aureus bacteremia. J Am Geriatr Soc 2009; 57:1713.
- Mahé A, Faye O, N'Diaye HT, et al. Definition of an algorithm for the management of common skin diseases at primary health care level in sub-Saharan Africa. Trans R Soc Trop Med Hyg 2005; 99:39.
- Heukelbach J, Wilcke T, Winter B, Feldmeier H. Epidemiology and morbidity of scabies and pediculosis capitis in resource-poor communities in Brazil. Br J Dermatol 2005; 153:150.
- Walter B, Heukelbach J, Fengler G, et al. Comparison of dermoscopy, skin scraping, and the adhesive tape test for the diagnosis of scabies in a resource-poor setting. Arch Dermatol 2011; 147:468.
- Dupuy A, Dehen L, Bourrat E, et al. Accuracy of standard dermoscopy for diagnosing scabies. J Am Acad Dermatol 2007; 56:53.
- Goldstein BG, Goldstein AO. Diagnostic procedures. In: Practical Dermatology, 2nd, Mosby-Year Book, Inc., 1997. p.26.
- Prins C, Stucki L, French L, et al. Dermoscopy for the in vivo detection of sarcoptes scabiei. Dermatology 2004; 208:241.
- Katsumata K, Katsumata K. Simple method of detecting sarcoptes scabiei var hominis mites among bedridden elderly patients suffering from severe scabies infestation using an adhesive-tape. Intern Med 2006; 45:857.
- Strong M, Johnstone P. Interventions for treating scabies. Cochrane Database Syst Rev 2007; :CD000320.
- Ly F, Caumes E, Ndaw CA, et al. Ivermectin versus benzyl benzoate applied once or twice to treat human scabies in Dakar, Senegal: a randomized controlled trial. Bull World Health Organ 2009; 87:424.
- Schultz MW, Gomez M, Hansen RC, et al. Comparative study of 5% permethrin cream and 1% lindane lotion for the treatment of scabies. Arch Dermatol 1990; 126:167.
- Centers for Disease Control and Prevention. Scabies. Resources for Health Professionals. http://www.cdc.gov/parasites/scabies/health_professionals/meds.html (Accessed on February 04, 2011).
- Usha V, Gopalakrishnan Nair TV. A comparative study of oral ivermectin and topical permethrin cream in the treatment of scabies. J Am Acad Dermatol 2000; 42:236.
- Burkhart CN, Burkhart CG. Another look at ivermectin in the treatment of scabies and head lice. Int J Dermatol 1999; 38:235.
- Droogan J. Treatment and prevention of head lice and scabies. Nurs Times 1999; 95:44.
- Elmogy M, Fayed H, Marzok H, Rashad A. Oral ivermectin in the treatment of scabies. Int J Dermatol 1999; 38:926.
- Dannaoui E, Kiazand A, Piens M, Picot S. Use of ivermectin for the management of scabies in a nursing home. Eur J Dermatol 1999; 9:443.
- Ahmad HM, Abdel-Azim ES, Abdel-Aziz RT. Clinical efficacy and safety of topical versus oral ivermectin in treatment of uncomplicated scabies. Dermatol Ther 2016; 29:58.
- Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64:1.
- Romani L, Whitfeld MJ, Koroivueta J, et al. Mass Drug Administration for Scabies Control in a Population with Endemic Disease. N Engl J Med 2015; 373:2305.
- http://www.cdc.gov/parasites/scabies/health_professionals/meds.html (Accessed on May 04, 2016).
- Macotela-Ruíz E, Peña-González G. [The treatment of scabies with oral ivermectin]. Gac Med Mex 1993; 129:201.
- Chouela EN, Abeldaño AM, Pellerano G, et al. Equivalent therapeutic efficacy and safety of ivermectin and lindane in the treatment of human scabies. Arch Dermatol 1999; 135:651.
- Madan V, Jaskiran K, Gupta U, Gupta DK. Oral ivermectin in scabies patients: a comparison with 1% topical lindane lotion. J Dermatol 2001; 28:481.
- Twum-Danso NA. Serious adverse events following treatment with ivermectin for onchocerciasis control: a review of reported cases. Filaria J 2003; 2 Suppl 1:S3.
- Gardon J, Gardon-Wendel N, Demanga-Ngangue, et al. Serious reactions after mass treatment of onchocerciasis with ivermectin in an area endemic for Loa loa infection. Lancet 1997; 350:18.
- Barkwell R, Shields S. Deaths associated with ivermectin treatment of scabies. Lancet 1997; 349:1144.
- Coyne PE, Addiss DG. Deaths associated with ivermectin for scabies. Lancet 1997; 350:215.
- Diazgranados JA, Costa JL. Deaths after ivermectin treatment. Lancet 1997; 349:1698.
- Bécourt C, Marguet C, Balguerie X, Joly P. Treatment of scabies with oral ivermectin in 15 infants: a retrospective study on tolerance and efficacy. Br J Dermatol 2013; 169:931.
- Roberts LJ, Huffam SE, Walton SF, Currie BJ. Crusted scabies: clinical and immunological findings in seventy-eight patients and a review of the literature. J Infect 2005; 50:375.
- Humphreys EH, Janssen S, Heil A, et al. Outcomes of the California ban on pharmaceutical lindane: clinical and ecologic impacts. Environ Health Perspect 2008; 116:297.
- Chhaiya SB, Patel VJ, Dave JN, et al. Comparative efficacy and safety of topical permethrin, topical ivermectin, and oral ivermectin in patients of uncomplicated scabies. Indian J Dermatol Venereol Leprol 2012; 78:605.
- Goldust M, Rezaee E. The efficacy of topical ivermectin versus malation 0.5% lotion for the treatment of scabies. J Dermatolog Treat 2013.
- Marlière V, Roul S, Labrèze C, Taïeb A. Crusted (Norwegian) scabies induced by use of topical corticosteroids and treated successfully with ivermectin. J Pediatr 1999; 135:122.
- Corbett EL, Crossley I, Holton J, et al. Crusted ("Norwegian") scabies in a specialist HIV unit: successful use of ivermectin and failure to prevent nosocomial transmission. Genitourin Med 1996; 72:115.
- Taplin D, Meinking TL. Treatment of HIV-related scabies with emphasis on the efficacy of ivermectin. Semin Cutan Med Surg 1997; 16:235.
- Huffam SE, Currie BJ. Ivermectin for Sarcoptes scabiei hyperinfestation. Int J Infect Dis 1998; 2:152.
- Karthikeyan K. Treatment of scabies: newer perspectives. Postgrad Med J 2005; 81:7.
- Mittal A, Garg A, Agarwal N, et al. Treatment of nodular scabies with topical tacrolimus. Indian Dermatol Online J 2013; 4:52.
- Almeida HL Jr. Treatment of steroid-resistant nodular scabies with topical pimecrolimus. J Am Acad Dermatol 2005; 53:357.
- Marks M, Taotao-Wini B, Satorara L, et al. Long Term Control of Scabies Fifteen Years after an Intensive Treatment Programme. PLoS Negl Trop Dis 2015; 9:e0004246.
- Kearns TM, Speare R, Cheng AC, et al. Impact of an Ivermectin Mass Drug Administration on Scabies Prevalence in a Remote Australian Aboriginal Community. PLoS Negl Trop Dis 2015; 9:e0004151.
- Chambliss ML. Treating asymptomatic bodily contacts of patients with scabies. Arch Fam Med 2000; 9:473.
- FitzGerald D, Grainger RJ, Reid A. Interventions for preventing the spread of infestation in close contacts of people with scabies. Cochrane Database Syst Rev 2014; :CD009943.
- Centers for Disease Control and Prevention. Scabies. http://www.cdc.gov/parasites//scabies/ (Accessed on February 11, 2011).
- Centers for Disease Control and Prevention. Scabies. Resources for Health Professionals. http://www.cdc.gov/parasites/scabies/health_professionals/institutions.html (Accessed on February 11, 2011).
- MORPHOLOGY AND HABITS
- CLINICAL MANIFESTATIONS
- Incubation period
- Typical infestation
- Crusted scabies
- Skin scraping
- Adhesive tape test
- Test selection
- DIFFERENTIAL DIAGNOSIS
- Eradication of mites
- - Permethrin
- - Oral ivermectin
- - Other agents
- - Treatment of crusted scabies
- Mass treatment
- CONTROL OF TRANSMISSION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS