Scabies is caused by a microscopic mite that burrows under the top layers of skin and deposits its eggs. The rash that results from scabies is actually a reaction to the mite’s body, eggs, and excretions. Once the mite gets into the skin, it takes two to four weeks for the rash to appear.
In an older child, this rash appears as numerous itchy, fluid-filled bumps that may be located under the skin next to a reddish burrow track. In an infant, the bumps may be more scattered and isolated and often are found on the palms and soles. Because of scratch marks, crusting, or a secondary infection, this annoying rash often is difficult to identify.
According to legend, when Napoleon’s troops had scabies, one could hear the sound of scratching at night from over a mile away. A bit of exaggeration perhaps, but it illustrates two key points to remember if you think your child has scabies: It’s very itchy and contagious. Scabies is spread only by person-to-person contact, and this happens extremely easily. If one person in your family has the rash, the others may get it, too.
Scabies can be located almost anywhere on the body, including the area between the fingers. Older children and adults usually don’t get the rash on their palms, soles, scalp, or face, but babies may.
If you notice that your child (and possibly others in the family) is scratching constantly, suspect scabies and call the pediatrician, who will examine the rash. The doctor may gently scrape a skin sample from the affected area, and look under the microscope for evidence of the mite or its eggs. If scabies turns out to be the diagnosis, the doctor will prescribe one of several antiscabies medications. Most are lotions that are applied over the entire body—from the scalp to the soles of the feet—and are washed off after several hours. You may need to repeat the application one week later.
Most experts feel the whole family must be treated—even those members who don’t have a rash. Others feel that although the entire family should be examined, only those with a rash should be treated with antiscabies medications. Any live-in help, overnight visitors, or frequent baby sitters also should receive care.
To prevent infection caused by scratching, cut your child’s fingernails. If the itching is very severe, your pediatrician may prescribe an antihistamine or other anti-itch medication. If your child shows signs of bacterial infection in the scratched scabies, notify the pediatrician. She may want to prescribe an antibiotic or another form of treatment.
Following treatment, the itching could continue for two to four weeks, because this is an allergic rash. If it persists past four weeks, call your doctor, because the scabies may have returned and need retreatment.
Incidentally, there is some controversy over the possible spread of scabies from clothing or linen. Evidence indicates that this occurs very rarely. Thus, there’s no need for extensive washing or decontamination of the child’s room or the rest of the house, since the mite usually lives only in people’s skin.