How do I treat scratches

scabies

scabies (Scabies): By female Itch mites (Sarcoptes scabiei) caused infectious skin disease. The strong, especially nocturnal itching is diagnostically groundbreaking; the skin symptoms vary, depending on the extent, from comma-shaped papules to crusted lesions. The suspected diagnosis is underpinned by microscopic evidence of mites, their eggs and mite excrement in scraped skin particles.

Creams and lotions are used to kill the itch mites; in severe cases, the anti-itch agents must also be taken orally. In order to avoid re-infection, it is necessary to take hygienic measures to rid bedding, clothing, stuffed animals and other textiles and objects that are close to the body.

Leading complaints

  • Especially nocturnal itching
  • Winding, millimeter-long palpable mite ducts with dark dots at the end of the duct (mite hill)
  • Later papules, nodules, vesicles and crusts
  • Scratch effects.

When to the doctor

The same day if

  • the symptoms or skin signs mentioned above occur.

The illness

Epidemiology

Scabies is common worldwide, according to WHO data, 300 million people worldwide have it. It is unclear how many people are infected in Germany, since the scabies must only be reported if they are found in facilities such as B. daycare centers, prisons or nursing homes occurs. According to the Robert Koch Institute, the data situation is therefore very sketchy. For some years now, however, more anti-itch drugs have been prescribed, which is why experts assume that the disease will increase.

Scabies can affect people of all ages, but increased closeness when breastfeeding, cuddling and sexual intercourse mainly affects infants, toddlers and people between 15 and 45 years of age.

transmission

The transmission of itch mites occurs primarily directly through close physical contact (including during sexual intercourse), and less often indirectly through shared objects such as clothing, pillows, bed linen, cuddly toys or blood pressure cuffs. Scabies is not a result of poor hygiene - it also occurs in the best families. It usually takes up to 8 weeks before the infection is noticed. The first symptoms only appear 3–4 weeks after infection. People with scabies should not visit community facilities such as schools or kindergartens.

Clinic and localization

The female mite drills passages in the horny layer of the skin. There it lays its eggs, from which new mites develop within 3 weeks. On closer inspection, the mite ducts, which are up to 1 cm long, are visible on the affected areas of the skin as tiny red lines with a slightly raised end, later often small reddish nodules and vesicles appear. In children in particular, brown-red lumps 1–2 cm in size are sometimes formed, preferably on the trunk and genitals.

Skin areas with very thin skin, e.g. B.

  • between your fingers or toes
  • on the wrists, elbows
  • on the inner edge of the foot
  • on nipples and on the penis
  • on the head, face, soles of the hands and feet (in babies).

The accompanying excruciating itching occurs as a reaction to the mite droppings. It increases when it is warm (e.g. at night in bed) and leads to scratching the skin.

Special forms

Scabies crustosa (Scabies). This variant of scabies is highly contagious and mainly affects people whose immune defenses are weakened. The skin is infested with mites en masse, crusts and barks form on a red background. Because the immune reaction is weakened, those affected often do not feel itchy. Patients with scabies crustosa are isolated and treated both externally and internally with anti-itch drugs.

Scabies nodosa. Very rare form of scabies with an increased immune reaction to the mite excrement. Itchy nodules that only recede long after treatment are typical. Infants, toddlers and the elderly are mostly affected, especially on the genitals, in the anal region and in the armpits.

Complications

The skin injured by scratching is prone to bacterial infections, which manifest themselves in purulent pustular rashes (impetigo).

Diagnostic assurance

Itching at night and close contact with those affected in the immediate vicinity are groundbreaking for the diagnosis. To prevent scabies from skin diseases with a similar appearance, e.g. To differentiate between a contact allergy and neurodermatitis, the doctor has the following options:

  • Examination of skin material with the Light microscope: To do this, he uses a needle or a scalpel to open a mite duct at the blind end (i.e. at the mite hill) and scrapes the duct contents onto a slide. Usually mites, eggs and mite droppings can then be seen under the microscope.
  • Examination of the skin with the Reflected light microscope (Dermatoscopy). The doctor uses a particularly strongly illuminated magnifying glass that he places directly on the affected area of ​​skin. He often recognizes the mites by their triangular shape.
  • Tape test. After sticking a transparent adhesive tape on a suspicious area of ​​skin, the doctor pulls the adhesive film off with a jerk and examines it under the microscope for mite droppings, eggs and mites. The tape test is not suitable for sensitive skin.

Differential diagnosis. Scabies can be mistaken for many itchy skin conditions, such as: B. with neurodermatitis, fungal diseases of the skin, or allergic eczema. An important differential diagnosis for scabies in which scabs have formed is psoriasis.

treatment

The goals of treatment for scabies are to kill the mites (and thereby end the risk of infection) and to relieve the excruciating itchiness (and thereby heal the skin lesions). In order to avoid renewed infections, the area around the infected person must also be cleaned up. For measures to remove mites from clothing, bed linen, cuddly toys and home textiles, see "Your pharmacist recommends".

Common scabies can be treated at home. Patients with scabies crustosa are usually referred to a hospital, where they are isolated until the end of treatment because of the high risk of infection.

Killing the mites

Active ingredients to be used externally. To treat scabies, ointments, emulsions or gels with active ingredients that kill mites are available. To get rid of the mites from the body, all of the skin from the neck down must be treated. Since scabies is contagious, this procedure applies to the entire family. Infants and toddlers are treated with the head and scalp, only the area around the eyes, nose and mouth are left out. The following active ingredients are available:

  • 5% permethrin ointment (e.g. Infectoscab®) kills the itch mites during the first treatment. Despite its stronger effects, this insecticide is less toxic to humans than the previously used hexachlorocyclohexane (= lindane, e.g. in Jacutin® Gel), which also requires several treatments. Permethrin is the first choice for patients of all ages. It is also the first choice for pregnant and breastfeeding women, but must be used off-label as, like all other anti-itch products, it is not approved for pregnant or breastfeeding women.
  • 25% benzyl benzoate as an emulsion is applied to the skin on 3 consecutive days and then washed off or showered off on the 4th day. As an emulsion, it is also suitable for treating affected scalps. For children, 10% emulsion is used.
  • Crotamiton as a 10% solution, cream or ointment is applied for 3–5 days and then washed off.

Note: Babies and toddlers should bandage their hands after rubbing in and cover the skin completely so that the active ingredient cannot be licked off the skin.

Active ingredients to be used internally. Systemic treatment with ivermectin tablets (Scabioral®) has been possible in Germany since May 2016. A one-time dose of 200 µg per kilogram of body weight is required. Systemic treatment is recommended in immunocompromised patients and patients who do not respond to permethrin ointment. Another indication is extensive eczema. Ivermectin is also suitable for the treatment of those affected, for whom correct treatment with external means cannot be guaranteed, for example in the case of physical and mental disabilities or organizational difficulties.

Repeat therapy. In the following cases, it is recommended to repeat the local or oral therapy after 7 or 14 days:

  • Patients with weakened immune systems
  • Widespread scabies
  • Signs of active infection after 14 days (papules, ducts, microscopic evidence)
  • Scabies in community facilities (to break chains of infection)
  • Scabies crustosa.

Treatment of itching

The doctor prescribes antipruritic agents such as oral antihistamines (e.g. levocetirizine or desloratidione) or low-dose cortisone ointments to combat the excruciating itching that sleeps those affected, especially at night.

Duration of the risk of infection

After completing treatment with an anti-scabies rub-in or 24 hours after taking ivermectin, people with common scabies are no longer considered contagious; H. Children can go back to school or daycare.

Patients with crustacial scabies are highly contagious and must remain isolated throughout their treatment period (approximately 2 weeks).

If people in a community facility suffer from scabies, special provisions apply. Contact persons and (treated) infected people are examined several times over a period of 6 weeks and have to stay away from the community facility until further spread is ruled out.

forecast

It often takes several days or even weeks after the therapy for the skin changes and the itching to subside. This is not an indication of an insufficient effect, but of an allergic reaction that is triggered by the remaining feces and the killed or damaged mites.

Your pharmacy recommends

Redevelopment of the area

  • Re-make up the beds and change clothes after the treatment.
  • Wash clothes, towels, bed linen, slippers and soft toys for at least 10 minutes at 60 ° C. If such washing is not possible, you can also use a hot steam device.
  • Alternatively, you can freeze textiles (including cuddly toys and other "body-hugging" objects) for 2 hours at −25 ° C to kill the mites. However, conventional freezers often only cool to −18 ° C. It is uncertain whether this temperature is sufficient to kill the itch mites; no data are available on this.
  • You can also put cuddly toys, slippers and other textiles in a plastic bag and store it for 72 hours at a constant temperature of 21 ° C.
  • Carefully vacuum furniture such as sofas, armchairs or beds as well as floor coverings with the vacuum cleaner. Outside the human body, the mites survive for a maximum of 2–4 days at normal room temperature and humidity, and for up to 14 days in cooler and more humid air (e.g. in basements).
  • If you have crustacial scabies, you will also need to decontaminate the patient's mattress. This z. B. by storing the mattress for 7 days at a room temperature of at least 21 ° C.

Complementary medicine

Herbal medicine. Topical application of 5% tea tree oil has proven effective. In experiments, itch mites died within a few hours of being rubbed in with tea tree oil.

Hydrotherapy. Baths with hops, valerian, rosemary or lemon balm can be taken as a support for drug treatment. Increasing arm and foot baths (e.g. enriched with essential oils from camphor, cloves or lavender) or oil baths are recommended.

Further information

RKI advice on scabies at https://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_Skabies.html

Law for the prevention and control of infectious diseases in humans (Infection Protection Act - IfSG): § 34 at https://www.gesetze-im-internet.de/ifsg/__34.html

Authors

Dr. med. Arne Schäffler, Dr. Bernadette Andre-Wallis in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 10:53


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.