Scabies is a contagious human skin infection caused by the itch mite. The mites are only 0.3 to 0.5 mm in size and therefore barely visible to the naked eye. The mites burrow into the top layer of human skin, where the female then lays several eggs per day over her lifetime of four to eight weeks. After a while, the person’s skin will break out in a rash, as a reaction to the mites’ excretions. Itch mites are more likely to spread where people live close together, which is why clustering of the disease occasionally occurs, especially in community or care facilities.
Itch mites can spread between humans, especially during prolonged skin contact (longer than five to ten minutes), for example while playing together, cuddling, helping with personal hygiene, when sharing a bed or during sexual intercourse. Shaking hands or a brief hug usually does not lead to transmission. In the case of crusted scabies (scabies crustosa), a highly contagious form of scabies, the number of mites on the skin is very high, which is why even short-term skin contact may lead to an infection.
Outside the host, itch mites can survive for around two days in clothing or bedclothes. Transmission via shared bed linen, blankets, cushions or clothing is rare, however, although it is possible in the case of crusted scabies because of the large number of itch mites.
The first symptoms of scabies often include skin burning and itching, which are made worse by warmth. Itching may even affect skin areas that are not directly infested by itch mites. The spaces between fingers and toes, the wrists, ankles, armpits, elbows, nipples and genitals are affected primarily. In infants and young children, however, the scalp, face as well as the palms and soles may also be affected.
Typical symptoms include fine, dark and irregular lines in the skin that are difficult to see with the naked eye. They correspond to the burrow tracks of the mites. After a while, the skin reacts by developing blisters the size of a pinhead, reddened raised nodules or pustules. In addition, skin areas injured by scratching may also develop purulent inflammation. In the case of prolonged infestation, a large-scale allergic skin rash may develop in response to the mites’ excretions.
People with a weakened immune system are at particular risk of developing crusted scabies. In these patients, a great number of mites are present in the skin, accompanied by pronounced encrustation.
Upon first infection, the symptoms become apparent after only two to five weeks, while they occur as soon as after one to four days on reinfection. Scabies is therefore contagious long before patients exhibit any symptoms and remains so while itch mites are present on the skin. Skin changes may be minor and a mite infection can go unnoticed for a long time in patients who maintain strict personal hygiene and use cosmetics. Scabies often becomes chronic if left untreated.
Scabies occurs worldwide and may affect people of any age. In Central Europe, children, seniors in nursing care and people with a weakened immune system are affected more frequently. Clustering of the disease typically occurs in community facilities such as nurseries and nursing homes, where the supervisory and care staff are also at increased risk.
Your local health authority can provide you with further advice and information. They will also have the latest information and be very experienced in dealing with the disease.
More (specialist) information is also available online from the Robert Koch Institute (www.rki.de/skabies). For more information about infection prevention, please visit the website of the Federal Centre for Health Education (www.infektionsschutz.de).