North West London Health Protection Unit
SCABIES
What is scabies?
Classical scabies is a very itchy skin rash. The rash is an allergy to a tiny mite smaller than a pin head.
The mites burrow anywhere in the skin, mostly on the hands, and cannot be seen. The rash is most
frequently seen on finger webs, wrists, under armpits, inner elbows. Other affected areas are
around the breasts, waist, thighs and buttocks. The rash is often symmetrical.
Is it ‘Classical’ or ‘Crusted’ scabies?
The usual kind of infection is called 'classical' scabies. 'Crusted’ scabies, formally called Norwegian
scabies, is the same infection but with many more mites causing scaling of the skin. Not all people
with 'crusted’ scabies itch. Scabies is more likely to spread from
'crusted’ scabies. An urgent appointment with a skin specialist (Dermatologist) is usually necessary.
Why is scabies important?
Itching is very severe and night time sleep is disturbed. Scabies may not be recognised. Long term
scabies may lead to other infections
How do you know you have got it?
You may have an itchy rash. In the bed bound, the back, shoulders neck and scalp may be
particularly affected.
Itching is worse when you are warm in bed or during/after a bath.
Check with your doctor to ensure it is diagnosed properly.
You may know someone else who has an itchy rash.
How can you catch it?
The mites pass easily from person to person when people are in skin to skin contact such as
holding hands, groups of people living in family homes, residential and nursing homes. Outbreak
transmission risk in schools is thought to be lower. Nurses and carers may catch scabies when
looking after people. The itching begins up to two months after catching the mites, so mites can
pass to someone else before the rash appears. Equally, not everyone develops a rash as not
everybody will have sensitivity to the mite.
How much skin contact do you need to catch scabies?
Transmission is by direct, prolonged skin to skin contact.
Scabies is unlikely to be caught by short contact such as shaking hands. Longer contact is needed
but could be as little as 5-10 minutes.
How do you get rid of them?
By treating with a lotion or cream. You can buy it from a chemist without a prescription, but it is
better to see your doctor first.
Who needs treatment?
Everyone who has scabies
Household family contacts
Anyone who has had skin contact with someone with scabies for more than 5-10 minutes
Doctors sometimes advise treatment for suspected scabies, for example when someone has
similar symptoms but may not have any visible burrows
Everyone should be treated at the same time so the mites do not pass back to a treated
person.
Putting on the Lotion or Cream: (eg Lyclear Dermal Cream or Derbac M Lotion)
NB: Cream/lotion must be applied meticulously to every part of the body (see diagram below)
You should not take a bath or shower immediately prior to applying the lotion or cream.
Skin must be dry and cool before lotion/cream is applied.
Take off all your clothes. Remember to remove watches and rings.
The lotion or cream needs to be spread all over the body from the neck downwards.
Children, elderly people, those with immunosuppression or previous failure of scabies treatment
and those with crusted scabies should also include their face, neck, scalp and ears.
Get help for parts of your back that you cannot reach.
Pour lotion (or cream) into the palm of your hand.
Take special care to put it over all parts of the body (see above).
Let the lotion dry before you get dressed or it may rub off (this takes 10–15 minutes).
Do the soles of your feet after getting dressed.
Put more lotion on any parts you wash within the recommended treatment time (i.e. 8
hours for Lyclear dermal cream or 24 hours for lotion), including hands.
How often do you need to apply the treatment?
Note: Cases in a care home or other communal areas need to follow a separate eradication
programme in liaison with the Health Protection Nurse (HPNs) –see contact details at end of
factsheet.
Classical scabies:
Cases: One treatment covering all your skin should kill the mites and their eggs.
Partners & Household Contacts of the case: One treatment should be carried out at the same time
as the case(s) or before further contact with the case(s).
Crusted scabies:
Cases: At least two or three treatments may be necessary in a week.
Partners & Household Contacts of the case: One treatment should be carried out at the same time
as the last treatment of the case.
Note: Two or three tubes of cream may be required if a person is overweight or very tall.
What about mites in clothing and bedding?
Classical scabies:
Mites die if they fall off the body and do not spread on clothes, towels or bedding. Normal washing
of clothes and bedding is recommended.
Crusted scabies:
There are so many mites which may fall off as 'crusts' (like flakes of skin) that all clothing and
bedding should be washed in a hot wash, and floors and chairs vacuumed well.
After Treatment
After treatment (8 hours for Lyclear Dermal Cream, 24 hours for lotions) you can bath or shower as
normal. You can return to work or school.
The skin will need time for the rash to settle down. Itching may last for 2-3 weeks after treatment
due to a ‘Hypersensitivity State’. Use an anti-itch cream or tablets from your pharmacist or doctor.
In treatment of the elderly, in particular, an emollient should be prescribed by the GP as per local
PCT guidelines on emollients and used as prescribed to prevent dryness of the skin that is commonly
associated with Lyclear Dermal cream.
It is important to note that continuing symptoms (i.e. itch/rash) several weeks after treatment does
not necessarily imply a failure of treatment or re-infestation. However, if fresh spots appear or
spots still remain after four weeks after treatment, you should go back to your doctor. You may
need more treatment or have a different skin problem that needs different treatment.
What if you have a skin problem, such as eczema?
The lotions and cream are very gentle on the skin and are generally well tolerated.
What about babies, pregnant women and women who are breast-feeding?
Pregnant women and women breast-feeding must use malathion (Derbac-M). For children 0-2 years
of age, permethrin (Lyclear Dermal Cream) should be used under medical supervision.
For advice and help
Ask the Pharmacist at your local chemist or your family doctor.
For further information or advice please contact the North West London Health Protection Unit on
0208 327 7181
Imperial Early Years Education Centre
Action to be taken In the event of an outbreak of scabies.
The HPA document on scabies is very comprehensive and will be our guidance in the event
of scabies being diagnosed here at the EYEC.
As per the HPA document if there is a case of scabies diagnosed then any persons who
have come into close contact for more than a five to ten minutes need to be treated.
As the children here share toilets, equipment and are in close proximity during the day, we
shall be following the guidelines by requesting that all children and their families as well as
staff, receive treatment.
It is advisable for children to visit their GP however medication can be purchased from the
pharmacy.
In order to contain the outbreak, the EYEC will close for one day in order for treatment to
take affect and allowing the cleaning of the entire premises.
The decision to close is not taken lightly but a sensible course of action in order to contain
the infection
Parents are reminded to refer to the terms and conditions, (section 8 e), which all parents
sign, the manager reserves the right to close the centre.