A scabies sob story: The bus-stop is where people in transit gather to board public commercial vehicles on their way to various destinations. At the bus-stop, during the rush hours, all kinds of personalities and professionals including students can be seen. The interesting thing is that most of them are estranged to each other. So certain comportment and behaviour are expected of one when at the bus-stop. So when in the Yoruba lingo ‘ko mu bus stop,’ literally meaning “no respect for bus stop,” is used to describe a clinical condition, it means that when the lesion takes hold, you’d react and not care about where you are.
It so happened with this fair skin lady in her late 40s, who came in with severe PRURITUS or generalized itching. According to her, it has been on for two weeks and won’t allow her to sleep at night. She wouldn’t even care about my presence and was just scratching away and moaning. What a beauty in distress, I thought. Her mind has been focused on her cream, bathing soap and all sorts of consumables as the cause of her predicament. She had changed her toiletries thrice in two weeks. She had been on antihistamines and now wants steroids for the supposed allergy. Steroids, as a rule, are not what you rush to prescribe because in prolonged usage it can suppress the body’s immune system and lead to flaring up of infections. But we still went ahead to place her on a short course of steroid. It was of no significant benefit. She kept coming back and scratching.
By her third visit, her kids were also scratching and it was almost a nightmare for everyone. It was time to do some skin scrapings and microscopy in other to clinch a diagnosis. The result of the blood count had been normal; not even the EOSINOPHIL percentage was raised. She had complained about the potency of the antihistamine she bought from a particular drug store and would try her luck elsewhere. On getting there, she got lucky as she ran into another lady who shared her experience with her and told her the local name of the lesion as ‘ko mu bus stop.’ The pharmacist had no difficulty knowing that what the lady had was SCABIES.
This lesion is caused by the female mite SARCOPTES SCABIEI. The mites burrow into the skin, lay eggs and live. This leads to an immune response by the host, which results in severe itching and pimple like rashes in light skin individuals. The itching can be so intense that one won’t even bother about his location while scratching the skin. Decorum is completely lost. Occasionally, the burrows caused by these mites may be seen as tiny lines on the skin. When scratching is serious, skin breeches may occur leading to secondary bacterial infection.
Scabies is very contagious, and is transmitted through prolonged skin-to-skin contact from an infected individual. This includes sexual intercourse. Though not very common, transmission can result from shared clothing, towels and beddings. It must be stated that latex condoms are useless in preventing the infection of scabies during sexual intercourse because of the migratory nature of these mites. Health care givers are always at risk of contracting scabies due to extended period of exposure and contact with the patient.
The diagnosis of scabies clinically can be made using the geographical area where the disease is prevalent and identifying another household member that has similar symptoms. In its classical presentation, the lesion has a characteristic of appearing in two typical spots. The gold standard is to scrape the skin of the suspected area and mount it in POTASSUM HYDROXIDE and examine it under a microscope or using a DEMOSCOPE to view the skin directly. This equipment is not commonplace in our environment. On the other hand, the burrows in the skin can be demonstrated by simply rubbing fountain pen ink on the skin surface and wiping it with alcohol.
Having said this much, there are other skin lesions that may mimic scabies. These include skin parasites, like lice and fleas. Other skin diseases include inflammation of the skin covering known as dermatitis, syphilis ringworm, allergy and so on. Erythema multiformis (multiple under skin bleeding) and urticaria are all in this category.
In children, scabies is one of the three common disorders of the skin following ringworm and pus forming bacterial infection or pyoderma. Scabies is more often seen in crowded environment; a common feature among prison inmates. Scabies affects all ages, races and socioeconomic classes in different climates equally. The mite is less than 0.5mm in size. To the sharp eyes, it is sometimes visible as white pin-point on the skin. The male is almost half the size of the female, which, when gravid tunnels into the dead outermost layer of the skin known as Stratum Cornum where they lay their eggs. It is the movement of the mites within and on the skin that causes the itching. The laid eggs hatch in three to 10 days into Nymphs before maturing into adult forms. They live for three to four weeks on the human skin before demise. The scabies mite has not been known to survive for 72 hours out human body.
Infection by this mite does not require a large population; just about 11 female mites in a burrow are enough to exhibit symptoms. The itching is as a result of delayed cell mediated inflammatory response to the proteins found on the body of the mite. Also, immediate antibody mediated inflammatory response is a feature of scabies, especially in cases of re-infection.
In this environment, the treatment of scabies has been largely done with Benzyl Benzoate and Sulfur preparations. The products are not expensive and so very affordable. They are locally produced. Having so stated, the treatment of choice is PERMETHRIN, which is a pesticide. This topical application is best used at night. It is applied from neck down and left for at least 12 hours before washing it off. IVERMECT orally administered as a single dose has been shown to eradicate the mite.
Prevention of scabies and reduction of its prevalence as a giving is through mass treatment programmes in the communities of high incidence. Topical Permethrin and oral Ivermectin have been found useful in such programmes. As a rule both symptomatic and asymptomatic potentially exposed individuals are availed to this treatment option. With regards to fumigation of the environment and objects of contact, this is usually not necessary, as the mite cannot survive for more than three days outside human skin. When the scratching is intractable, think scabies.