H&S: HOW TO TREAT SCABIES

Scabies used to be a regular problem throughout the prison estate; it’s not so common nowadays, but we are still seeing the odd case. Jackie Marshall NEC reports on how to deal with an outbreak

WHAT IS SCABIES?

Scabies is a contagious infection condition caused by microscopic scabies mites burrowing in your skin.

SIGNS AND SYMPTOMS

The typical symptom of scabies is a terrible itching and a rash in the areas where mites burrow; it can be worse at night.

THE MOST COMMON SKIN REGIONS FOR SCABIES ARE:

• Between your fingers
• Armpits
• The inner elbow
• Around the waist
• Soles of the feet
• Around the breast
• Around male genitals
• Hips
• Knees.

HOW LONG IT TAKES TO SHOW

If you have had scabies before, then you may develop symptoms within 1 to 4 days. For those infected for the first time, it may take up to 6 weeks for signs and symptoms to show.

Even if you have no signs or symptoms, you can still pass it on to other people.

TRANSMISSION

Scabies is transmitted by: skin-to-skin contact with someone with scabies, usually among family members; people who are living near each other; and sexual contact.

It is unlikely that will get scabies following a brief, casual contact. However, contact for longer than 5-10 minutes can increase the risk of transmission. This can include oral, vaginal, or anal sex.

BEFORE TREATMENT

Scabies is diagnosed by a physical examination from the site of the rash and the presence of mites and burrows. Always confirm the diagnosis before starting treatment.

TREATMENT

Scabies treatments are effective, and outbreaks of infection can be stopped if treatment is planned and coordinated thoroughly, and appropriate lotions are applied correctly from the neck down, to the right people at the same time. Depending on the extent of the symptoms, multiple applications of creams/lotions may be required. Usual lotions include Malathion aqueous liquid; Derbac M; Permethrin; and Lyclear dermal cream.

YOU MAY ALSO BE ADVISED TO:

• Wash your clothes and bedding with hot water (60°C or higher)
• Dry your clothes with a hot iron
• If your clothes cannot be washed, then seal them in a bag for at least three days
• If you have babies or young children who suck their hands and feet put socks and gloves on them
• Abstain from sexual intercourse or close physical contact until after your treatment
• Avoid sharing bedding, clothes or towels with anyone infected with scabies.

PLANNING TREATMENT

If only one person requires treatment, this can be carried out as soon as the prescription has arrived.

ON TREATMENT DAY (FIRST AND SECOND TREATMENT)

Treatment should be applied to cool, dry skin, not after a shower. The lotion may evaporate or be absorbed too quickly into warm skin and not work properly. If a shower is necessary, allow the skin time to cool before applying the lotion.

The lotion should be applied thoroughly all over the body including the hands, armpits, genital area, soles of feet and the head avoiding face and eyes, and so on.

Fingernails should be cut short and underneath the nails thoroughly cleaned. The lotion should then be applied under the nails (it may be easier to do this with a cotton bud or similar).

Lotion must be left on for the recommended time period, and must be reapplied after washing any part of the body, including the hands.

AFTER TREATMENT

The treatment will kill the scabies mites, but they remain in the skin. Therefore, the rash and itching may persist for several weeks after the treatment.

The presence of the rash or continued itching after treatment does not necessarily mean the treatment has failed.

Monitoring of prisoners and staff should continue after treatment to ensure that no new cases of scabies occur. Apparent treatment failure may be due to inadequate contact tracing or inadequate or incorrect application of the treatment.

TWO OR MORE PRISONERS, OR AN OUTBREAK SITUATION:

• Set a date for everyone identified as a close contact to treat themselves or to be assisted with treatment
• A second treatment may need to take place one week after the first treatment
• Ensure that the approach is coordinated
• Order adequate amounts of the lotion
• Issue lotion to the affected prisoners and those who have been identified as contacts, for example cell mates
• Staff requiring treatment should visit their GP
• Close contacts of infected prisoners, such as relatives and visitors who have had prolonged skin-to-skin contact must also be encouraged to treat themselves
• All hard surfaces in the cell and mattress should be wiped down with an approved detergent
• After the recommended time period, the lotion can be washed off. Clothing and bedlinen should be changed and sent to the prison laundry as infected linen
• All clothing and bedding should be laundered at 60°C.