Everything You Need to Know About Scabies

Some nasty buggers are basically using your skin as their personal toilet.

by Eric Spitznagel
Sep 14 2017, 4:00pm

Theresa Chromati

If there's one thing that doesn't inspire a lot of terror in sexually active adults, it's scabies. Is that even an STD? Nobody seems entirely sure. In last spring's Pirates of the Caribbean: Dead Men Tell No Tales, Johnny Depp's Jack Sparrow claimed to have scabies, though it was never clarified how he got them or if he actually meant scurvy. When a Reddit user announced to the Internet, "I got Diagnosed with Scabies today. AMA," the response was a universal ... nah, we're good. "It's not a big deal," wrote one unconcerned Reddit user.

He may be right that it's not a big deal, but it is still a deal. Diana Martin, a research microbiologist with CDC's Center for Global Health, Parasitic Disease Branch, says scabies isn't really an infection, "it's more like an infestation." But it gets creepier when she gets into specifics. Scabies is caused by mites called Sarcoptes scabiei, Martin says, that "burrow under the skin." Only females dig burrows, and the males "just wander into pre-made burrows looking for females to mate with." It's basically a small colony of microscopic horny creatures—10 to 15 in most cases, but in people with compromised immune systems, it could be thousands—making love nests in your skin so they can reproduce. But let's not freak out—yet. Here are answers to all of your burning questions.

How do I know I have scabies? What do these little bastard mites look like exactly?
Don't bother looking for the mites themselves. They're about one third of a millimeter long, so your chances of seeing one and flicking it off your body are next to nil. What you'll notice first are the rashes. The rashes are red with pimple-like bumps or scales, which are sometimes misdiagnosed as either mosquito or bed bug bites, probably because of the itching. Adam Friedman, residency program director at the George Washington School of Medicine and Health Sciences in Washington, DC, says the itch is "your immune system's response to the presence of the mite, and possibly both the eggs and feces it lays within the top layer of your skin."

Feces? As in poop?
Yes. These nasty buggers are using your skin as their personal toilet. And so are their babies.

Is it true the itching is worse at night?
It is, although nobody knows for sure why. There's speculation that the itching gets worse at night because the mites do their best work when it's quiet, dark, and warm, but Sejal Shah, a board-certified dermatologist in New York City, doesn't buy it. "It's likely because generally most people are distracted during the day with work, school, or other activities," she says, "so they may not notice the itch as much."

Where do scabie rashes usually occur? Just in the genital region?
You may get them around your genitals, but you're just as likely to get them on your butt, waist, belly button, wrist, nipples , knees, armpits, elbows, and even between your fingers. Mites are transferred by prolonged skin-to-skin contact, so anywhere on your body with skin is a potential host for scabies.

Wait, I'm confused. Why is scabies classified as a sexually transmitted disease? It doesn't sound like sex has much to do with it. Couldn't I get scabies just as easily by shaking hands with somebody who's infected?
Whitney A. High, a professor of dermatology at the University of Colorado School of Medicine, says that scabies needs prolonged skin-to-skin contact to make the leap to a new host. Sex leads to scabies not because of the intercourse, but because you've got two naked bodies pressed against each other. "In general, the contact must be prolonged and substantial," High says. "A quick handshake or hug is usually not enough."

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So condoms aren't going to do much to stop it?
We definitely recommend condoms, but not specifically to prevent scabies. Unless "the mites are confined to the penis," Martin says. And that's rare. "There is no way to prevent spread of scabies aside from avoiding prolonged skin-to-skin contact with an infested person," Martin adds. This can admittedly be tricky, because many people with scabies don't even know they have it. Symptoms can take four to six weeks to become noticeable, but somebody can be contagious even without noticeable rashes. If they've had scabies in the past, the symptoms show up a little faster, between one and four days after being exposed.

If it's all skin contact, does that mean I don't need to worry about things like towels and bedsheets?
If those things have touched somebody with scabies, then yes, you do need to worry. "Scabies sometimes is spread indirectly by sharing articles such as clothing, towels, or bedding used by an infested person," High says. If you or somebody you're intimate with has scabies, wash everything—clothes, towels, bedding—with hot water and soap, and then dry 'em with high heat. Heat is the most important thing here. You want to boil those suckers. If you can't wash or dry-clean something, just seal it in a plastic bag for a few weeks and the mites will eventually die. They can't survive for long without us.

Okay, but how do I get the mites off me? If I ignore the itching, will they just leave on their own eventually?
They might disappear in a few months, but they more likely won't go anywhere until you do something about it. A better plan is to visit your doctor, and have him or her confirm whether it is indeed scabies. They do this with a scalpel blade soaked in mineral oil, Friedman says, which they "scrape across the active areas and then view it on a slide with a microscope." If you have scabies, they'll prescribe an oral or topical medication like permethrin cream, which needs to be applied over your entire body.

Not just the rashes?
No, everywhere. That includes the soles of your feet. If it's a part of your body covered in skin, it needs cream. You'll need to keep the cream on there for up to ten hours, and then sometimes repeat the process in a few weeks, depending on your infestation. Let your doctor decide on the best course of treatment.

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