WHAT SHOULD WE DO?
The price of freedom is vigilance. For those that may have to be exposed to the environment or circumstances that may encourage the disease, it may be prudent to check again with your doctor if you are in any doubt.
Mr Dagam fetched his 3 children from the Boarding School 6 weeks earlier for the long holidays. That was before he travelled for a work trip to another city. Everything was fine, or so he thought before he left home.
Upon return from his trip, he noticed some rashes on the hands of one of his children. He made nothing of it. Two days later, his wife complained of being unable to have a smooth sleep at night because she tended to have a lot of itchy skin at night. It all started when her husband travelled and she was somewhat embarrassed that a good amount of the itching was in her perineal region.
A further inquiry showed that apart from his wife, his children were having the same experience. His wife had already tried home remedies but the effect was doubtful. The next logical thing to do was go to the hospital.
The doctor asked questions, examined the family members and concluded that the children most probably got Scabies infestation from the boarding house. Unfortunately, other members of the family now have scabies also!
THE DISEASE
Scabies is a skin infestation caused by a mite known as the Sarcoptes scabiei. Untreated, these microscopic mites can live on one’s skin for months. They reproduce on the surface of the skin and then burrow into it to lay eggs. This causes an itchy, red rash to form on the skin.
Although scabies isn’t a sexually transmitted disease, it can be transmitted through intimate contact, sharing clothing, or sharing bedding. Scabies is a very contagious disease and affects about 200 million people globally at a time. Scabies is a worldwide problem but happens most often in tropical areas and in very crowded places.
The mites live in the folds and narrow cracks of the skin, especially in places like:-
- Skin folds in between the fingers and toes.
- Skin folds in the genital area and thigh as well as the region around the waist -the belt area.
- Buttocks.
- Soles of the feet and palms of the hand, scalp, face, and neck (mainly in children)
- Bends at the wrists and knees.
- Under fingernails, rings, wristwatch bands and bracelets
- The region around the armpits, breasts, and nipples.
- Inner elbows
- Shoulder blades
Considering that it is a contagious disease, anyone can get scabies. It’s not a disease caused by poor hygiene even though it is more endemic in poorer countries. However, some people are more likely to get the disease. For example:
- People who live in close, crowded conditions.
- Infants and children. (Children have a lot of close physical contact with their parents, friends, family members and classmates.)
- People who are elderly, especially those living in nursing homes.
- Healthcare workers who care for people who aren’t aware they have scabies.
Types
Apart from classical Scabies, there are other types of scabies, namely:
- Crusted (Norwegian): This type often happens in people with faulty immune systems. May not be itchy. Death may result from a secondary bacterial infection in untreated cases.
- Nodular: (This type is more common among children).
- Bullous
- Scalp
SYMPTOMS
The hallmark symptoms of scabies include a rash and intense itching that gets worse at night and could make it hard to sleep. Continuous scratching of the infested area can create sores that become infected. The rash spreads slowly over a period of weeks or months. In addition to the rash and itching, signs and symptoms of scabies include:
- Bumps that sometimes become infected as a result of scratching.
- A later rash that looks greyish or skin-coloured lines on the skin.
Children with scabies may have a particularly difficult situation. The rash may become generalized and the children may become irritable and tired because of lack of sleep at night.
TRANSMISSION
Scabies is usually transmitted person-to-person through close skin contact (e.g. living in the same house) with an infected person. Transmission risk increases with the level of infestations, with the highest risk due to contact with individuals with crusted scabies. Transmission due to contact with infested personal items (e.g. clothes and bed linens) is unlikely with common scabies but may be important for individuals with crusted scabies. Transmission may occur before the initially infested person even develops symptoms. As in my earlier blogs on cholera, typhoid fever, climate change, genital herpes, and even Head lice, the environment plays a strong role in the determination of disease. We also need a good mindset to overcome negative or unintended consequences. Today’s technological advances in telemedicine will, no doubt, help in no small way in deploying help.
