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Scabies in the Elderly – Causes, Symptoms and Treatment

Scabies in the Elderly The elderly may be in situations that place them at risk of infestation with certain surface parasites as is the case in scabies. It was previously thought to be a skin disease associated with poor hygiene or transferred from close contact with household pets. However, this is not entirely true. Scabies can occur in a person who bathes daily and the scabies mites on dogs and cats cannot cause full-blown scabies in a human. The greatest risk is sharing clothing and bedding and living in close contact with a person with scabies. Therefore this type of infestation is more commonly seen among the elderly living in retirement homes and nursing facilities.

What is scabies?

Scabies is an itchy skin disease that is very contagious. It is a reaction to the tiny scabies mite, Sarcoptes scabiei, which burrows into the skin. The scratching can lead to localized skin infections with bacteria but both scabies and these bacterial infections can be easily treated. In the elderly, however, there is a risk of a more severe form of scabies known as crusted scabies. Here large areas of the body are affected and the skin is crusted and scaly. Crusted scabies is more likely in the elderly who are living in old age homes and nursing facilities, as well as those with weakened immune systems due to a number of other diseases.

Causes of Scabies

The female scabies mite burrows through the skin and lays eggs in the the tunnel that it forms. These eggs hatch within 21 days and new scabies mites can now spread to the surrounding skin, other parts of the body or even other people. There is a greater risk of contracting scabies if a there is close contact with an infected person. This is more likely if a family member or fellow resident in an old age home or nursing facility has scabies. Even without direct contact, scabies can be spread through bedding and sharing clothing. It is also more common in living in crowded conditions, with poverty and malnutrition. The elderly who may be debilitated or immobile may therefore be at a higher risk and proper cleaning is therefore necessary on the part of the caregiver.

Symptoms of Scabies

The itchy skin rash seen with scabies is an allergic reaction to the scabies mite. It is the burrowing in of the mite, the eggs deposited within the skin and fecal matter of the mite that causes the rash. The itch is worse at night and when warm. The most commonly affected areas includes the arms and hands, armpits, legs and feet, breast, buttock and groin. Constant scratching of the affected area can further inflame the skin and lead to complications such as a superimposed bacterial infections where the skin becomes swollen, hot, red and painful. The scabies rash itself, when visible, appears as thin track marks with little blisters on the skin surface.

Treatment of Scabies

Scabies can be easily treated with creams and lotions. The three main types of applications are permethrin 5%, crotamiton and lindane. Crotamiton is more commonly used for babies and lindane is not advisable for use in a person with a weakened immune system. These medications kill the scabies mite and allow the skin to heal. The itching and the rash will not cease immediately even though the mite is eradicated. It can take several weeks and other medication like antihistamines may also be prescribed to ease these symptoms. Antibacterial creams may be used for a secondary bacterial infection. Oral medication like ivermectin may be used for people with weakened immune systems where crusted scabies is more likely to occur.

The key, however, is lifestyle measures to prevent a recurrence or possibly avoid scabies altogether when living with a person who has this problem. Thorough cleaning of clothing and bed linen on a regular basis with hot soapy water is one of the most effective measures. Dry cleaning is also very effective in this regard. Items that cannot be washed or dry cleaned should be placed in a seal plastic bag for a week or more which then starves the mites. Avoid scratching as this can lead to complications. Soaking in a cool water bath and applying over-the-counter applications like calamine lotion can be extremely useful for the itching. Keep the fingernails short to prevent breaks in the skin that can become infected with bacteria.


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