Scabies

That is the most important point of all. Treating one after another means reinfecting each other — people without complaints who are in close contact belong too.

From the neck to the toes, between fingers and toes too, under the nails, at the navel, in the cleft of the buttocks and on the genitals. In babies and older people the scalp and face as well. Leave on for eight to twelve hours, then wash off.

The remedies act on the mites, not reliably on the eggs. The second application after seven to fourteen days catches what has hatched in the meantime.

Wash bedding, towels and clothes worn in the last few days at sixty degrees. Whatever cannot be washed hot goes into a closed bag for three days — without skin the mite does not survive that. Disinfecting the whole home is not necessary.

Itching on for two to four weeks does not mean the treatment has failed — the skin’s reaction fades more slowly than the mites disappear. Rich moisturisers and something against the itching help over that time; a third treatment is usually not needed.

If moisturiser and cortisone cream achieve nothing over weeks and it is worse at night than by day, the skin belongs looked at closely once more — with a dermatoscope.

The very widespread form with thick, scaly crusts occurs with strongly weakened defences, sometimes hardly itches and is extraordinarily catching. It is treated with cream and tablets at the same time.

The mite needs skin contact, not dirt. Washing more often and more harshly dries the skin out and strengthens the itching. This information takes away the shame — and shame is the reason many come too late.

Where it sits, how the burrow is recognised, who is treated along with you and why the laundry matters less than the second treatment day.

Permethrin cream kills the mites in one application; ivermectin as tablets needs two doses seven to fourteen days apart, because it does not reach the eggs. The itch stays for two to four weeks afterwards — that is the reaction to the dead mites and no sign of failure; this is exactly where unnecessary re-treatment happens. Everyone in the household is treated at the same time, even without symptoms, otherwise it goes back and forth.

From infection to itching takes two to six weeks the first time — which is why the chain of infection is so hard to see. On re-infection it is one to four days. Transmission needs close skin contact for about five to ten minutes; a handshake is not enough. Off the human body the mites survive two to three days. The itch after successful treatment lasts two to four weeks.

In the warmth of the bed it becomes unbearable, during the day it is bearable. Anyone who cannot sleep because of it is describing one of the most reliable features.

Between the fingers, at the wrists, in the armpit folds, around the navel, at the belt line, at the nipples, on the penis. The back and the face usually stay free in adults — in babies it is the other way round.

That is the hint that helps fastest. With a single person with dry skin nobody thinks of it — but if a partner, child or grandparent itches too, the question has been asked.

Fine, slightly winding lines a few millimetres long with a dark dot at the end are proof. On the penis and in the armpits firm, strongly itching lumps often remain, which need weeks even after treatment.

Two to six weeks between catching it and the itching — which is why searching for a trigger in the last few days is pointless, and why close contacts have to be treated too, even when they have no complaints.

A cortisone cream takes away the redness and the itching briefly, while the mites keep multiplying. The picture becomes untypical, and the diagnosis is delayed by months.

Scabies itching peaks at night and affects several places at once — fingers, wrists, belt line, genital and anal area.

Can be slightly raised, but often are not. The diagnosis is made on the skin — with a dermatoscope or adhesive tape, not in the blood.

Rises with widespread involvement and falls again after treatment. It contributes nothing to the diagnosis and is not needed for it.

Normal as long as only the mite is there. If it rises, the scratched skin has also become infected with bacteria — that is treated separately.

Belongs alongside with the rare, very widespread form with thick crusts: it occurs with strongly weakened defences, is highly catching and is treated differently.

Skin and lining renew themselves quickly and need zinc for it. With places that heal badly, cracked corners of the mouth and frequent skin infections a lack is a serious possibility.

Without vitamin C no stable collagen forms — the wound closes but holds less well. With a very one-sided diet, smoking and alcohol the intake is often tighter than assumed.

Steers the horn-forming of the skin. Too little makes it rough and dry, too much over longer periods harms liver and bone — and in pregnancy a strict upper limit applies.

Every healing needs building material. Anyone eating little during an illness loses exactly that — a sufficient amount spread across the day belongs to the treatment.

The reason for most relapses is not the mite but the application: the second treatment after seven to fourteen days is needed, because the eggs survive the first — and everyone in the household at the same time, including those who feel nothing. The itching often continues for another two to four weeks; that is not a sign of failure.

As a tablet one of the two recognised treatments, in two doses a week apart. It works better taken with food — on an empty stomach less arrives. That is one of the few cases in which the instruction on how to take it decides success or failure.

In the test tube it kills the mite, including strains that respond less well to the usual agents. In humans it has only been examined in single case reports and irritates the already scratched skin. Conceivable as an addition, not as a replacement.

Cortisone ointment takes the itch and lets the mites multiply unchecked — ordinary scabies then becomes the highly contagious crusted form with thousands of mites. That is one of the most consequential treatment mistakes with itchy skin.

With weakened defences — diabetes, old age, cortisone, cancer treatment — scabies runs differently: little itch, but thick crusts. Exactly there it is overlooked longest.

Scabies is caused by mites and treated with skin preparations or tablets. The itch can last another 2–4 weeks after successful treatment — that is not a sign of failure.

Effective against mites in the laboratory, not sufficiently studied in humans. Scabies is treated with permethrin or ivermectin — and the whole household at once, or it comes back.