Parasites on the skin
If the typical symptoms – itching and inflammation – don’t make you especially think of scabies, you might first suspect an eczema. But the parts of the body where the »eczema« occurs should make you think of scabies. Itch mites especially like to settle in the spaces between fingers, on wrist joints, elbows, in the groin region, around the nipples and on the penis. The itch mite can only be seen as a small dot by the human eye.
The female mite bores 0.5 to 2 centimetres long angularly kinked passages into the upper skin and deposits three to four eggs there daily. Three to six days later, larvae hatch which grow up quickly. About ten to thirty days after the infection, badly itching nodules, pustules or also small blisters will appear. If the person affected was infected by itch mites once before in the past, the skin will react already after a few days. By scratching, the skin may be infected again.
The transmission of itch mites takes place especially via close body contact. Scabies can be found worldwide and affects people of all ages. Even so, certain groups are more at risk than others: children, the elderly and people with a weakened immune system. No wonder itch mites are feared in retirement or nursing homes. If it isn’t discovered and contained early, it may quickly develop to an endemic disease. Nursery schools too are predestined for itch mite outbreaks.
Scabies is treated by using an anti-scabies agent which kills larvae as well as eggs. The agent of first choice is permethrin (for example in Gepescab®, Infectoscab®). Patients should apply the remedy completely over the entire body from the lower jaw right down to the toes. It is left to act for eight to twelve hours and is then washed off. After the treatment the patient should care for the skin using a basic cream to prevent it from dehydrating and getting irritated. Alternatively, Benzyl benzoate (Antiscabiosum®) or Crotamiton (Crotamitex®) can be used. These preparations are repeatedly applied. Usually the therapy works very well. If no effect is experienced, it is mostly due to an application error or a renewed infection. Then the treatment needs to be repeated, but only after checking with the patient that possible application errors have been excluded.
If a topical full-body treatment cannot be carried out appropriately or if there are any contraindications, a one-time dose of an ivermectin tablet (Driponin®) could be a therapeutic option.
The persons in direct contact to the patient should also be examined for scabies or, as a precaution, also receive the treatment.
Clothing, bed linen, towels and items with prolonged body contact such as a blood pressure cuff or stuffed animals and soft toys should be washed at a minimum temperature of 50 °C for at least 10 minutes or be decontaminated by means of a hot steam device thus getting rid of the mites. A suitable alternative would be to store the items hermetically packed in foil or plastic sacks at 21 °C minimum for at least 72 hours. Upholstered furniture, sofa cushions or textile floor coverings can be vacuumed using a strong vacuum cleaner or left unused for at least 48 hours. According to the Robert Koch Institute, this action is, however, not necessarily required due to the low risk of infection.
Bedbugs are mostly brought into your own home when returning from a business trip or from holiday. The insects could have also nested in furniture and items bought second-hand. They can be found regardless of hygienic conditions. If you suspect to have caught bedbugs, it is recommended to unpack your luggage for example inside a bathtub to be able to see the escaping bugs. The fact that bedbugs are gaining ground in Germany and worldwide has to do with the increasing resistance of the insects to insecticides. The parasites get really active only at night. Looking for food, they visit the sleeping host who attracts them with his body heat. The bugs mostly bite several times and between bites, always move on a small piece thereby forming the typical “bedbug streets”. As the insect’s saliva contains anaesthetic ingredients, the bites are not noticed to begin with. After a few hours the skin may redden, become swollen and begin to itch. The skin’s reaction is individually very different. With some people nothing can be seen, others are very sensitive to bedbug saliva. Medics call the clinical picture of the skin cimicose. The therapy is purely symptomatic and consists of antipruritic creams or oral antihistamines.
Bedbugs are not impressed by biocides from the pharmacy. To remove them permanently, a professional pest controller is required. The procedure can last several weeks.
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