What is Scabies?
Scabies is a type of insect called a mite.
How bad was your itching experience from scabies? Where was it?
Quickcare or ER?
In my experience, a Scabies rash should be seen in a Quickcare clinic setting, not the Emergency Department.
What will your doctor ask?
Your doctor will want to know your symptoms. A symptom is your story. It is a description of your condition to your doctor.
Your doctor will will want to know how you obtained scabies.
Typical questions would be:
How long have you had the rash?
What makes it better?
What makes it worse?
Did you do any recent travels?
Have you tried any new creams or medications?
Do you have anything associated with the rash such as fever, itchiness, pain or shortness of breath?
Classic scabies symptoms include a red itchy rash in between the webs of the fingers. Rash looks like little burrows.
What will your doctor look for?Your doctor will look for physical signs. A SIGN is an objective finding that a doctor discovers upon examination.
Skin rash identification include the size, shape, color , and location.
Your doctor will want to see if there is pus and swelling (which suggests a cellulitis) or is it flat and purple (which suggests a vasculitis).
A classic scabies rash
Notice the rash shows burrows. It is red and raised.
What is your doctor thinking?Your doctor will create a mental list of possible reasons for your signs and symptoms. This list is called a Differential Diagnosis
A skin rash could be caused by so many things.
An itchy rash could be from:
- Viral exanthem
- Contact Dermatitis
- Allergic reaction to medications
What is the treatment of Scabies?
The first thing I tell my patients is to wash all their beddings. Start with a clean sleeping environment.
Scabies treatment include Permethrin which is an insect repellant. I have my patients apply this from the neck down. Sleep in the clean bed. Then bath 12 hours after the medication had been applied.
Ivermectin is an alternative treatment that I have never prescribed.
How long will you have Scabies?
Usually within a few days after the treatment, my patients are much better.
Every once in a while, they will need a second treatment two weeks later.
Still, if there is no improvement after the second treatment, then we need to go back to our differential diagnosis and try a different course.
Did your scabies take more than one treatment?
Let me tell you a story…..
I honestly believe that many times my patients are presented to me for reasons other than medical.
Harry was one such patient. I reviewed the chart before entering the room. “Itchy rash” was the chief complaint.
When I entered, I saw a young pre-adolescent boy with his head down playing a video game on his iPhone.
I stuck my hand as I greeted him with, “Hello. Nice to see you.” His mother was sitting near by, She rolled her eyes and shook her head. “Harry! Put that away.”
He finally came into reality and realized his doctor was there in front to see his rash.
It turns out, he developed an itchy red rash on his hand after going to a friend’s house. His rash was classic. The red rash was in between his fingers. Burrows were noted at the rash site.
When I asked what he did there, he was reluctant to say. He glanced at his mother before fessing up.
“Well, uh, my friend and I were up all night in his room…playing video games.” It turns out that he went on a binge of playing for over 24 hours.
“How did you stay awake?,” I asked. Again he looked at his mother before answering. “Red Bull and Monster,” he answered.
Even with his heavy caffeine load, his little body couldn’t take it any longer. He and his friend finally crashed. They slept for eight hours straight only to get up and do it all over again. Somewhere along this sleep-play cycle, he picked up the scabies bugs from his friend’s bed.
He seemed like such a smart kid. I saw in him something more than just a gamer.
It was June . School was out. I could not control myself. I went on a soap box and said, “What will you do during the summer? And don’t tell that you will spend it playing on your X box. …Read books! Read this summer! Do you know that Theodore Roosevelt was able to read a book a day? You will see so much improvement in your school come Fall if you read now. There is a famous brain surgeon named Ben Carson who was slow in school. As soon he took up reading, his neurons changed. He changed. He then became an excellent student.”
His mother sat there. Stunned that a rash visit became a sermon on the value of reading. Happy that another adult took the time to guide her baby.
Using a paper towel, I then wrote a contract.
I _____________ do solemnly swear to read one (1) book a week this Summer until Labor Day.
The last two lines were for his signature and date.
He filled in the blanks. It was official.
Kids need guidance. They are hungry for structure in this big confusing world.
“Just go to the library. Bring the contract. Show the librarian what you want to do. They will be thrilled,” I added.
I continued with the office visit by doing the doctorly thing. That is, I electronically sent the prescription for scabies (permethrin). I even gave him a refill just in case.
Much more than that, I feel I committed him toward the world of books.
I hope this helps.