Scabies in African children

Introduction Skin diseases and infections are not uncommon in African children as in children from other parts of the world. A recent study conducted in a public primary school in Ibadan, Nigeria concluded that fungal infections and scabies were the most common skin diseases in children (1). Several other studies from Mali, Malawi, Tanzania and Sierra Leone (2-5) also point to scabies as one of the common skin problems in Africa.

This report explores Scabies, one of the highly contagious skin infections commonly seen in Africa, to understand the disease and ways of prevention and treatment.

Overview In general terms, scabies is an itchy, highly contagious skin infection caused by tiny mites or bugs that are barely visible. In scientific terms, these mites are called Sarcoptes scabei.(Fig.1) These mites are so small that they can only be seen under a microscope.

Fig. 1: The Sarcoptes scabei mite.
Courtesy: CDC

Although scabies mites may infest people of any age in any climate, it is most common in children and is widespread in the hot humid climates of tropics like Africa.

Scabies is a skin disease known to humans for at least 2,500 years. Dermatologists estimate that more than 300 million cases of scabies occur worldwide every year (6).

The condition can strike anyone of any race or age, regardless of personal hygiene. Scabies is not a condition only of low-income families and neglected children, although, it is more often seen in crowded living conditions with poor hygiene.

How scabies develops Scabies is almost always caught from another person by close contact. It could be a child, a friend, or another family member. Everyone is susceptible. However, contact must be prolonged (a quick handshake or hug will usually not spread the disease). The scabies mites may also get transmitted via bedding or clothing. Scabies spreads rapidly where there is frequent skin-to-skin contact between people, such as in hospitals, institutions, child-care facilities, and nursing homes.

Scabies mite is a very tiny, eight-legged bug with a round body. The mites hold onto the skin using suckers attached to the two pairs of front legs. They burrow under the skin and live there quietly for 2 to 6 weeks. During this time, the female mites lay eggs (Fig 2) which hatch after about 4 or 5 days. After this silent period, the person develops an allergic reaction causing severe itching. A rash starts to develop (7).

Fig. 2: Scabies - Microscopic view of Sarcoptes scabiei eggs and fecal pellets (scybala)
Courtesy: Dept. of Dermatology / University of Iowa

Symptoms Scabies causes little bumps with raised lines on the skin. These little red bumps or pimple like irritations are most frequently found on the hands (particularly the webbing between the fingers, (see fig. 3); under the arms; the folds of the wrist, elbow or knee; or the back and shoulder blades, (see fig 4). There may also be a red, slightly raised rash, often seen on the abdomen or thigh. In addition to the rash, the most characteristic symptom of scabies is that the rash is intensely itchy, especially at night. Further complications may result due to bacterial infections from scratching.

Fig. 3: Scabies lesions are caused by Sarcoptes scabei burrowing under the skin. A typical location is on the hands, particularly the webbing between the fingers, as shown in this image.
Courtesy: CDC

Fig. 4: Scabies lesions at the back, arm and shoulder in an eight year old girl caused by Sarcoptes scabei burrowing under the skin.
Courtesy: DermAtlas

How to detect scabies The burrows made in the skin by the scabies mites may be seen as fine gray thread-like lines. They may be more easily felt like a thickened cord below the skin surface. Because scabies is so itchy, scratching leads to sores that may become inflamed or scab over.

Health professionals can recognize scabies due to the clinical symptoms. If there is any question as to whether scabies is present, they may conduct a simple test by applying a drop of sterile mineral oil to the suspected area. The site is then scraped lightly and the scrapings are examined under a microscope. A diagnosis is made if scabies mites or their eggs are found (7).

Treatment If one family member has scabies, often all members are treated, even if they are not yet affected. Under medical guidance scabies is treated using one of several anti-parasitic drugs, e.g., 5% permethrin applied as a lotion or cream to the whole body below the neck (and to the head in children under two). The cream or lotion must be kept on for 24 hours (8). Infants and pregnant women may use milder creams that have less risk of side effects.

Although scabies mites are usually swiftly killed by treatment, the itching can last for a month after the mites are gone. So anti-itch medications like calamine lotion and cool baths may be necessary. All sores should be healed within four weeks of starting the treatment.

In addition to treating all the family members, all bed linens and clothing should be washed in hot water to stop the scabies from coming back. Anything that cannot be washed should be put away from human contact for four days, since the mites cannot live longer than that on their own.

Anyone outside the family who has been in close contact with a child with scabies should also be informed so they can take appropriate action.

Treatment through community action A long-term skin disease control project in Kenya trained community health workers to carry out regular visits to schools and nurseries (9). The aim was to treat children with skin infections including scabies. This project was established in 1994 by the German non-government organization (NGO)Doctors in Aid of Children with Skin Diseases in Africa. The project demonstrated that the skin disorders in rural Africa could be controlled through treatment schemes within the primary health care system.

Similar successful community intervention model was demonstrated among the aboriginal peoples in Australia. Continuing community health education and regular screening were found to be crucial in controlling scabies (10). Community action is also recommended in high incidence situations like displacement camps where certain environmental conditions support the spread of scabies.

Control programs should be implemented in an integrated nature, by reducing overcrowding, and by improving health education, personal hygiene, treatment and surveillance among high-risk population (5).

Conclusion Scabies is a highly infectious skin disorder commonly seen among children living in hot humid climates. Although distressing, scabies is actually fairly common and affects children of all races and social classes. The good news is that with better detection methods and treatments, scabies is readily treatable and controllable.

Author contact: Dr. Annie S. Wesley. Email: awesley2002ca@yahoo.ca

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