Scabies (Pediatric Nursing)

00:00 Now let's talk about scabies. Scabies is an itchy skin condition caused by a burrowing mite called Sarcoptes scabiei. It causes intense itching where the mite burrows. The itching is worse at night and this is very contagious. Treatment is available and you have to treat all household contacts at the same time. Itching can persist for a few weeks after treatment.

00:26 So, what is this? This is also known as the human itch mite and it's an 8-legged bug. It's going to be transmitted via skin-to-skin contact or contact with infested items such as bedding, clothing, or furniture. It can survive for 3-4 days without a human host. There are millions of cases per year worldwide and anyone can get scabies. What happens? Well, the mite burrows just beneath the skin and makes a tunnel where it's going to deposit its eggs.

00:57 The eggs hatch and the larva work their way to the surface of the skin where they continue to spread. The intense itching is from the body's reaction to the mites, the mite eggs, and their waste. Signs and symptoms of scabies include intense itching that is worse at night and I always ask my patients who come in with an itchy rash is it different at night, during the day and when they say that itching is out of control at night I'm thinking scabies. You'll see thin irregular burrow tracks marked on their arms or legs and these are made of tiny blisters and bumps. Common sites that we find scabies are between the fingers in the interdigit webspaces and the axilla which is under the arms, inside the wrist, the inner elbows at the antecubital region, around the breast and genitals, around the waist, the buttocks, the soles of the feet, and the knees. The incubation can be variable. So it can be 6 weeks if this patient has never had a previous scabies infection, but it can be as soon as a few days if they have another scabies infection because the body has a memory. On exam, you're going to obtain a full health history and look at your patient's vital signs. These should be normal. Next, you do a thorough skin exam and you're going to be looking for primary scabies lesions and this is the first manifestation of their infestation. It includes papules, vesicles, and burrows. Next, you look for secondary lesions and these are from the result of the patient rubbing and scratching the itchy sites. You're going to practice contact precautions because remember this condition is contagious, and if you're not quite sure of the diagnosis you can do a skin scraping.

02:42 So, how do we treat scabies? We treat this with permethrin and you want your patients to apply this as soon as possible. You have them apply it from their chin all the way down to the soles of their feet including under their nails and in their skinfolds. Remind them to get between their fingers and toes and even between their buttocks. They're going to leave this on for 8-14 hours so it's best if they do this at night and then repeat in 2 weeks if needed.

03:07 So, the itching may get more intense after they use the permethrin treatment and this is the body's reaction to the dead mites. This is really important to tell your patients because without this knowledge they might think their infection is actually worsening when the treatment has worked. You also want to give your patient meds to manage their itching and this includes antihistamines. Also, encourage them to avoid overheating or taking really hot showers because both of these will cause the release of more histamine and more itching. And remember, you have to treat all household contacts at the same time and manage their household fomites so that they don't constantly re-infect each other. There are some complications to scabies because remember this is an intensely itchy situation. It makes it difficult for patients to resist scratching. Because they're scratching, they can cause open sores in their skin and this is prone to infection. Bacterial skin infections can result such as impetigo and this is the most common complication of scabies. Symptoms of impetigo include honey-colored crust and oozing blisters, and we treat this part with antibiotics.