The Big Itch - Getting Rid of Scabies
The mention of scabies is likely to have most people recoiling in horror. An infestation of small mites that dig under your skin and leave eggs to hatch along the way is hardly attractive.
Unfortunately, it is precisely this stigma that stops many people getting help immediately. As well as prolonging a sufferer's discomfort, this delay puts friends and family at a significantly higher risk of becoming infected too.
We are just past the peak of a 30-year cycle of scabies in the UK, but despite it being a common complaint, most of us remain hopelessly ignorant of what scabies is, how it is spread and how to treat it.
An unwelcome visitor
Scabies is a mite infestation. A female mite, about 4mm long, tunnels into the skin where she lays eggs and then moves on. Behind her she leaves burrows of up to a centimetre in length, noticeable on the skin, sometimes red, sometimes a grey/white colour. After the mite has been in the skin for around four weeks, sufferers experience intense itching especially at night or after a hot shower - which first alerts them that they have the condition.
In most cases, the mites, and therefore the itching, can be found on the fingers or wrists, and in children, on the face or the soles of the feet. It also tends to occur on the penis or scrotum in men and on the nipples in women.
Scabies is extremely infectious, and people who come into close contact with an infected person have a 40 per chance of contracting the condition. It is spread by one way only - skin-to-skin contact.
In most cases, this simply relates to holding hands, which explains why families and old folks' homes are particularly susceptible to scabies. But close genital contact can also spread the condition, which explains why many wrongly see it as purely a sexually transmitted disease.
However, apart from the stigma of scabies and delay in symptoms, one of the major problems is that the disease is chronically misdiagnosed, says Philip Cox, an entomologist from the Medical Entomology Centre in Cambridge. "It can be put down to anything from heat rashes to insect bites."
That problem is confirmed by GP Jim Lawrie, who works in east London. "It's known as 'the great mimic' because it can look like 100 other things from eczema to all different types of rashes. Unless your suspicion is high, you may not notice it," he says.
And the longer scabies goes unnoticed, the greater the infestation will become and the higher the risk of it spreading to others.
Fortunately, it is easy to test for the disease, says Philip. "You take a scraping and it takes five minutes to do the test. Simple."
Once diagnosed, treating scabies is easy: sufferers use an over-the-counter body cream similar to the shampoo used to get rid of head lice - something every parent will be aware of.
A waiting game
But this can cause further problems. "You have to get the treatment right," Dr Lawrie explains. "You have to cover your whole body with the cream and then leave it on for at least 12 hours. The problem is that people go to the toilet, wash their hands, and don't reapply it."
With just one of the mites' favourite places free from the cream designed to kill them, the infestation will continue.
Coupled with this, even after a successful treatment, patients may continue itching for up to two weeks, making it even harder to know if the scabies has been wiped out. If one family member fails to rid themselves from the lice, the whole infestation could start all over again.
Scabies won't disappear by itself, but with some attention it is no more difficult to get rid of than head lice. Plus, fortunately, the disease is in decline at the moment. After five years of increasing incidence in scabies, there was a reduction in 2001, Douglas Fleming, director of the Royal College of General Practitioners recently noted.
That reduction looks set to continue over the next few years until it eventually reaches the previous low of 1988. However, without a more widespread understanding of scabies among the general public, it is almost certain to rise again.
Even with wider understanding, it seems unlikely we will ever get rid of the pest, Dr Lawrie says.
"You see, the itching comes from an allergic reaction to the mite's faeces. Some people get terrible itching while others feel nothing, so they happily wander around co-existing with their parasites," he says.
A lovely image if ever there was one.
Public Health Laboratory Service