Infestation Facts & FAQs

Bed Bugs (Cimex lectularius)

Frequently Asked Questions

Bed bugs are increasingly becoming a problem within residences of all kinds, including homes, apartments, hotels, cruise ships, dormitories and shelters.

What are bed bugs?

Bed bugs are small wingless insects that feed solely upon the blood of warm‐blooded animals. Bedbugs and their relatives have evolved as nest parasites. Certain kinds inhabit bird nests and bat roosts and await the return of their hosts; others have adapted well to living in the ‘nests’ (homes) of people.

Newly hatched bed bugs are about the size of a poppy seed, and adults are about 1/4 of an inch in length. From above they are oval in shape but are flattened from top to bottom.

Their color ranges from nearly white (just after molting) or a light tan to a deep brown or burnt orange. The host’s blood may appear as a dark red or black mass within the bug’s body.

Because they never develop wings, bed bugs cannot fly. When disturbed, bed bugs actively seek shelter in dark cracks and crevices.

Under ideal conditions, adult bed bugs can survive for more than one year between meals.

Do bed bugs cause harm or spread pathogens (disease‐causing germs)?

Bed bugs seek out people and animals, generally at night while these hosts are asleep, and painlessly sip a few drops of blood. While feeding, they inject a tiny amount of their saliva into the skin. Repeated exposures to bed bug bites during a period of several weeks or more causes people to become sensitized to the saliva of these bugs; additional bites may then result in mild to intense allergic responses. The skin lesion produced by the bite of a bed bug resembles those caused by many other kinds of blood feeding insects, such as mosquitoes and fleas. Bed bugs are not known to transmit any infectious agents.

Where do bed bugs occur?

Bed bugs and their relatives occur nearly worldwide. Bed bugs became relatively scarce during the latter part of the 20th century, but their populations have resurged in recent years, particularly throughout parts of North America, Europe, and Australia. They are most abundant in rooms where people sleep, and they generally hide nearest the bed or other furniture used for sleeping. Bed bugs are most active in the middle of the night, but when hungry, they will venture out during the day to seek a host. Their flattened bodies allow them to conceal themselves in cracks and crevices around the room and within furniture. Favored hiding sites include the bed frame, mattress and box spring.  Clutter around the room offers additional sites for these bugs to hide and increases the difficulty in eliminating bed bugs once they have become established.

How do bed bugs invade a home?

Because bed bugs readily hide in small crevices, they may accompany (as stowaways) luggage, furniture, clothing, pillows, boxes, and other such objects when these are moved between apartments, homes and hotels. Of greatest risk of harboring bed bugs and their eggs are used furniture, particularly bed frames and mattresses. Because they readily survive for many months without feeding, bed bugs may already be present in apparently ‘vacant’ and ‘clean’ apartments. Bed bugs can wander between adjoining apartments through voids in walls and holes though which wires and pipes pass. In a few cases, bats and/or birds may introduce and maintain bed bugs and their close relatives (bat bugs and bird bugs). Pest control personnel should be mindful of the presence of blood feeding insects and mites that may be left behind after removing nests or roosts of birds and bats in and on the home.

How can you tell if the residence is infested?

Bed bugs usually only infest a small proportion of residences, but they should be suspected if residents complain of bites that occurred while sleeping. The bedroom and other sleeping areas should be carefully examined for bed bugs and signs of bed bug activity. Folds and creases in the bed linens, and seams and tufts of mattresses and box springs, in particular, may harbor bed bugs or their eggs. They may also be found within pleats of curtains, beneath loose areas of wallpaper near the bed, in corners of desks and dressers, within spaces of wicker furniture, behind cove molding, and in laundry or other items on the floor or around the room.

Sometimes, characteristic dark brown or reddish fecal spots of bed bugs are apparent on the bed linens, mattress or walls near the bed. A peculiar coriander‐like odor may be detected in some heavily infested residences.

What should you do if you find bed bugs?

Because several different kinds of insects resemble bed bugs, specimens should be carefully compared with good reference images to confirm their identity. If any questions remain regarding the identity of your samples submit them to a competent entomologist for evaluation.

Once their identity is confirmed, a careful plan should be devised to eliminate the bed bugs in a manner that promotes success while limiting unnecessary costs and exposure to insecticides.

Do not discard furniture and do not treat until and unless you have a plan.

What can you do to manage bed bugs?

• Search for signs of bed bugs. Carefully inspect the bed frame, mattress, and other furniture for signs of bed bugs and their eggs. Although dead bed bugs, cast bug skins, and blood spots may indicate an infestation occurred previously, they do not confirm that an infestation is still active.  Search for live (crawling) bugs and ensure they are bed bugs before considering treating.
• Reduce clutter to limit hiding places for bed bugs.
• Thoroughly clean the infested rooms as well as others in the residence. Scrub infested surfaces with a stiff brush to dislodge eggs and use a powerful vacuum to remove bed bugs from cracks and crevices. Dismantling bed frames will expose additional bug hiding sites. Remove drawers from desks and dressers and turn furniture over, if possible, to inspect and clean all hiding spots.
• Mattresses and box springs can be permanently encased within special mattress bags. Once they are installed, inspect the bags to ensure they are undamaged; if any holes or tears are found, seal these completely with permanent tape. Any bugs trapped within these sealed bags will eventually die.
• To prevent bed bugs from crawling onto a bed, pull the bed frame away from the wall, tuck sheets and blankets so they won’t contact the floor, and place the frame legs into dishes or cups of mineral oil. Caulk and seal all holes where pipes and wires penetrate walls and floor, and fill cracks around baseboards and cove moldings to further reduce harborages.
• Hire a licensed pest control operator who is knowledgeable and experienced in managing bed bug infestations to confirm the infestation and to develop an integrated pest management plan. If you are a tenant, contact your property manager or landlord to discuss your respective obligations, and to agree on a plan to manage the infestation. If you find bed bugs in a hotel room, inform the hotel manager and public health.
• Because bed bugs and other pests may spread through cracks and holes in the walls, ceilings and floors, it is wise to inspect adjoining apartments or rooms on the same floor as well as those directly above and below.

What not to do.

• Don’t panic. Although bed bugs can be annoying, they can be battled safely and successfully if you adopt a well‐considered strategy.
• Do not apply pesticides yourself. Do not use:
  • Aerosol sprays – these will cause bed bugs to scatter
  • Bug bombs ‐ these do not kill bed bugs.
• Do not dispose of furniture that is useful. Infested furniture can be cleaned and treated. Placing infested furniture (particularly mattresses) into common areas or on the street may simply help spread bed bugs to the homes of other people. Infested furniture intended for disposal should be defaced to make it less attractive to other people.

How can you have specimens examined?

Specimens suspected of being bed bugs should be collected into small break‐resistant containers (such as a plastic pill bottle or a zipper‐lock plastic bag. They may also be secured to a sheet of white paper using clear packaging tape. These containers should be packaged carefully to prevent damage/crushing of the sample and be sent to the Georgia Department of Public Health for identification.

What products are used to control bed bugs?

Insecticide formulations used to treat bed bug infestations consist mainly of the following:

• Insecticidal dusts abrade the insect’s outer waxy coat and cause the bugs to dry out quickly. Some consist of a finely ground glass or silica powder. These dry dusts may be applied in cracks and crevices, as well as within the hollow interior of a tubular bed frame. Some dust formulations include another kind of insecticide.
• Contact insecticides are those that kill the bugs shortly after they come into direct contact with the product or its residue. These mainly consist of one or more kinds of pyrethroids (synthetic analogs of the extract of chrysanthemum flowers). These products tend to rapidly ‘knock down’ bugs that wander over or otherwise contact the insecticide. Because pyrethroids can be irritating and repellent to many insects, bed bugs may avoid treated surfaces. A different kind of contact insecticide, chlorfenapyr, is now available in a product available to pest control operators. This product is non‐ repellent and effective for a longer period.
• Insect Growth Regulators (IGRs) affect the development and reproduction of insects. Although these products can be quite effective in reducing the population of the pests, they do not kill bugs quickly. Thus, pest control operators often use these products as a supplement to other kinds of insecticides.

What might you do when returning from a visit to an infested residence?

Travelers increasingly encounter bed bugs during their stays away from home. If signs of bed bugs were observed or suspected, consider the possibility that you may have unwittingly transported bedbugs or their eggs in your luggage and other personal effects. Clothing should be laundered in very hot water to kill bugs and their eggs before or as soon as these items are brought back into the home. Suitcases should be carefully inspected, scrubbed with a stiff brush, and thoroughly vacuumed. Leaving such luggage for several hours in a closed vehicle in full summer sun may render the items bug free as long as the suitcase is empty.

For insect identification, contact: Rosmarie Kelly PhD, Public Health Entomologist, Georgia Department of Public Health, 404‐408-1207, [email protected].

BED BUGS (Cimex lectularius)

Hemiptera: Cimicidae

SIZE: 1/4 to 3/8 inch (4-5 mm) 

COLOR: Reddish brown or brown

SHAPE: A mature bed bug is oval-bodied, wingless and flattened top to bottom.

DESCRIPTION: Bed bugs are small wingless insects that feed solely upon the blood of warm-blooded animals. They are sometimes mistaken for ticks or cockroaches. Bed bugs are sometimes called "red coats," "chinches," or "mahogany flats."

HABITAT: At the beginning of an infestation, bed bugs are likely to be found only in the crevices in the bedsteads. In areas of heavy infestation bed bugs can be found in tufts, seams, and folds of mattresses and bed covers. Because certain cimicid species can live in bird nests, houses and buildings with several bird nests in the eaves and on the roof will often have these bugs coming into the living areas. Bat colonies also have bed bugs associated with them. Some species that are bird or bat ectoparasites will bite humans who come into contact with them.

LIFE CYCLE: The life cycle stages of a bed bug are egg, nymph, and adult. The females lay about 200 eggs, usually at the rate of three or four a day, in cracks and crevices in the floor or bed. Newly hatched bugs begin feeding immediately. They shed their skin five times before becoming adults.

TYPE OF DAMAGE: Bed bugs feed principally on human blood by piercing the skin with a long beak, or proboscis, and sucking blood into their stomachs. They feed mostly at night but will feed during the day if hungry and the light is dim.

CONTROL: Find all the areas that bed bugs hide in during the daytime. These must be treated with chemicals applied by a licensed pest control applicator. In hotels, apartments, and other multiple-type dwelling places, bed bugs may spread from one unit to another. All units should be inspected. Remove bird nests to eliminate bird biting species. Eliminate bat infestations to get rid of bat biting species.

INTERESTING FACTS: Bed bugs are able to go without feeding for 80 to 140 days; older stages can survive longer without feeding than younger ones. Adults have survived without food for as long as 550 days. A bed bug can take six times its weight in blood, and feeding can take 3 to 10 minutes. Adults live about 10 months and there can be up to 3 to 4 generations of bed bugs per year.

ADDITIONAL INFORMATION:

The Ohio State University Extension Office https://www.thespruce.com/test-your-knowledge-of-bed-bugs-4061490

University of California IPM Online http://www.ipm.ucdavis.edu/PMG/PESTNOTES/pn7454.html

CDC - Emerging Infectious Diseases https://wwwnc.cdc.gov/eid/article/11/4/04-1126_article

PEDICULOSIS CAPITIS (Head Lice)

DEFINITION

Pediculosis is an infestation of the head by Pediculus humanus capitis.   It is most common in school-age children.

ETIOLOGY

The head louse attaches to hair.   Females lay eggs embedded in water-insoluble glue that adhere the eggs to the hair shaft. Eggs hatch after 4 to 14 days. The lice ingest blood every few hours and can only survive 1 to 2 days away from a blood supply. Transmission occurs by direct contact, such as sharing hairbrushes, caps or clothing, or through close living quarters.

DIAGNOSIS

Lice or nits may be attached to head hair, eyebrows or eyelashes. Adult lice are hard to find as there are usually <10/patient. With recent infestation, eggs are a creamy-yellow color.

Empty eggshells are white. Common infestation sites are the back of the head and behind the ears. Nits are firmly attached to the hairs and cannot be moved up and down the hair shaft like hair casts, scales and dandruff.

Itching, and possibly rash, will likely be evident. Nits or adult lice may be seen. There may be a history of exposure to lice. Small red papules or secondary excoriations may be present.

Occipital or cervical lymphadenopathy may be present.

TREATMENT

Treatment should be considered only if active head lice or viable eggs are observed. Once a confirmed diagnosis of head lice infestation is made there are several treatment options to choose from. Methods include mechanical removal, treatment with pediculicides, and topical treatment with alternative products. Adjunctive activities include the elimination of lice and nits from the environment as well as from any other contacts who also have head lice, regular reinspection for lice and nits after treatment, and, if indicated, the reapplication of a pediculicide 7 to 10 days after the initial treatment.

There are many medicated products (pediculicides) available for treatment of head lice.  Most are available over the counter, but some are by prescription only. All products must be used strictly in accordance with label directions to ensure effectiveness and prevent adverse reactions from overuse or misuse. When used properly, their effectiveness in eliminating head lice infestations has been reported to be 80% to 95%. However, there are reports of localized resistance to all of these products. Remember, these products are not preventive and should only be used if lice are present.

Cleaning the environment will help reduce the chances of becoming reinfested with head lice. Check everyone in the household at the same time, prior to cleaning the environment. Vacuum all floors, rugs, pillows, carpet squares, and upholstered furniture. Combs and brushes used on an infested individual should be immersed in water hotter than 130°F, Lysol®, rubbing alcohol, or a pediculicide for one hour.

Play clothes, linens, smocks and cloth toys worn or handled by an infested individual within two days before diagnosis should be washed in water hotter than 130°F, or machine dried at the highest heat setting for at least 30 minutes

INFORMATION FOR SCHOOLS

• Contacts should be treated only if infestation is found.
• Avoid unnecessary re-treatment because of the toxic hazard.
• Children can return to school following initial treatment.
• Itching may persist for 1-2 weeks even after adequate treatment and should not be considered a reason for reapplication of medication.
• Educate about the person-to-person mode of transmission, and procedures to prevent transmission.

FOLLOW-UP

Reevaluate in one week if symptoms persist. Re-treatment may occasionally be necessary.  Use an alternate regimen if the infestation is not responding to treatment.

ADDITIONAL INFORMATION

CDC - https://www.cdc.gov/lice/about/head-lice.html

The National Pediculosis Association - http://www.headlice.org/

Nemours Foundation - https://kidshealth.org/en/parents/head-lice.html

Talking Points – Head Lice (answers to common questions)

Where do head lice come from?

People get head lice by being in close contact with someone else who has head lice.  Head lice can infest people of all ages, but children are prone to getting head lice because of their habit of playing in close contact, sharing hats, headphones, combs and brushes, sleeping bags, stuffed animals, and clothing.

Only dirty people get head lice, right?

No, dirty people are not the only people who get head lice. Personal hygiene & cleanliness is important in the home or school to reduce chances of infection or reinfection for those who have come in contact with someone with head lice.

Where do head lice hide when they aren’t on my head?

Head lice spend their entire life on a person’s head. Active stages cannot survive for more than a few days away from a person and will usually die within hours if knocked off the hair.

Why does my child still have head lice after I treated him/her?

There are 4 reasons why a child will continue to have head lice after being treated: 

• The lice are gone but there are still dead nits on the head
• The child has again come into contact with someone who has head lice
• Improper or incomplete treatment
• The lice are resistant to the treatment

In many cases treatment has not been done correctly. Directions need to be followed EXACTLY for the treatment to work.

My child is getting lice from the school rugs/chairs/mats/etc. Why doesn’t the school do something about this problem?

Although lice can be transferred through shared bedding, it is very unlikely that the child is getting lice from school equipment, desks, or rugs. Normal cleaning would remove any lice that were on rugs and other surfaces and lice do not survive off the person’s head for more than a few days at most.

Can my child get lice from the dog (or cat)?

No, head lice are only found on people and cannot live on pets.

What is the best treatment for head lice?

Ideas on this vary. The best thing to do is to contact your child’s pediatrician, the school nurse, or the local health department for the best method for your child. Be sure to follow all instructions exactly.

How about alternative treatment? Do they work?

Mechanically removing lice and nits, using lice or nit combs, can be effective but time consuming. A specialized nit comb is an important tool for nit-picking, as a regular hair comb may not remove head lice and nits.

Suffocants (i.e., petroleum jelly, mayonnaise, or oil-based products) can obstruct the respiratory spiracles of active lice and potentially block the holes in the operculum of the eggs thereby suffocating the louse.  NOTE: This method does not always work well and can be very messy.

Do I need to spray my house? Why won’t the school spray for lice?

Spraying or fogging a home is NOT RECOMMENDED and may be harmful if used in a poorly ventilated area.

What else can I do to stop my child from getting lice?

Cleaning the home (vacuum, wash bedding, clean brushes, etc.) will help reduce the chances of becoming reinfested with head lice. Check everyone in the household at the same time, prior to cleaning the home. This includes grandparents, younger and older siblings and parents. Statistics have suggested that 60% of people with head lice don’t know they have them and have no symptoms. They may be unintentionally infecting others and continuing the cycle.

Why did I have to keep my child home from school until the nits were gone? Why were infected children allowed back in school with nits?

While there is no scientific evidence demonstrating that keeping children with head lice home will reduce head lice transmission, the head lice policy is ultimately up to the school administration. However, a student should not miss more than one or two days from school because of head lice.

Why doesn’t my child’s school screen for head lice?

Mass screenings are no longer recommended, but if a substantial number of cases are found, screening the entire school population should be considered.

Puntos de Conversación - Piojos (Respuestas a preguntas comunes)

¿De dónde vienen los piojos?

Las personas se contagian de piojos al estar en contacto cercano con alguien más que tenga piojos. Los piojos pueden infectar a personas de todas las edades, pero los niños están propensos a contagiarse con piojos debido a su hábito de jugar en contacto cercano, compartir gorras, audífonos, peines y cepillos de cabello, bolsas de dormir, animales de peluche, y ropa.

Solamente las personas sucias se contagian con piojos, ¿cierto?

No, las personas sucias no son las únicas personas que se contagian con piojos. La higiene y limpieza personal son importantes en el hogar y en la escuela para disminuir las posibilidades de infestación o volverse a infestar para aquellos que hayan estado en contacto con alguien que tenga piojos.

¿Dónde se esconden los piojos cuando no están en mi cabeza?

Los piojos pasan su vida entera en la cabeza de una persona. En las fases activas no pueden sobrevivir por más de unos cuantos días lejos de una persona, y usualmente mueren dentro de horas si se les retira del cabello.

¿Por qué mi hijo(a) todavía tiene piojos después de que le he dado tratamiento?                 

Existen 4 razones por las que un(a) niño(a) continúa teniendo piojos después de ser tratado(a): los piojos se han ido pero todavía quedan liendres en la cabeza, el(la) niño(a) ha vuelto a estar en contacto con alguien que tenga piojos, tratamiento inadecuado o incompleto, o los piojos son resistentes al tratamiento. En muchos casos el tratamiento no se ha hecho correctamente. Las instrucciones necesitan seguirse EXACTAMENTE para que el tratamiento funcione.

Mi hijo(a) se está contagiando con piojos de las alfombras, sillas, tapetes, etc. de la escuela. ¿Por qué la escuela no hace algo acerca de este problema?

Aunque los piojos pueden transferirse a través de la ropa de cama compartida, no hay mucha posibilidad de que el(la) niño(a) se esté contagiando del equipo, escritorios, o tapetes de la escuela. La limpieza normal eliminaría cualquier piojo que se encuentre en los tapetes, etc. y los piojos no sobreviven fuera de la cabeza de una persona por más de un máximo de unos cuantos días.

¿Puede mi hijo(a) contagiarse con piojos de un perro (o gato)?

No, los piojos se encuentran solamente en las personas, y no pueden vivir en las mascotas.

¿Cuál es el mejor tratamiento para los piojos?

Las ideas varían en esto. La mejor cosa que hacer es ponerse en contacto con el pediatra de su hijo(a), la enfermería de la escuela, o el departamento de salud pública local para el mejor método para su hijo(a). Asegúrese de seguir todas las instrucciones exactamente.

¿Qué tal los tratamientos alternativos? ¿Funcionan?

El retirar mecánicamente los piojos y liendres, utilizando peines para piojos o liendres, puede ser eficaz, pero lleva mucho tiempo. Un peine especial para liendres es una herramienta importante para sacar las liendres, ya que un peine regular quizá no saque los piojos y liendres.

Los sofocantes (ej. Gel de petróleo, mayonesa, o productos de aceite) pueden obstruir los poros a través de los cuales respiran los piojos, y potencialmente obstruyen los orificios de salida del huevo de piojo de esa forma sofocando al piojo. NOTA: Este método no siempre funciona bien y puede ser muy ensuciase.

¿Necesito rociar mi casa? / ¿Por qué la escuela no rocía para eliminar los piojos?

NO SE RECOMIENDA rociar un hogar, y puede ser dañino si se realiza en un área con poca ventilación.

¿Qué más puedo hacer para evitar que mi hijo(a) se contagie con piojos?

La limpieza del hogar (aspirar, lavar la ropa de cama, limpiar los cepillos de cabello, etc.) ayuda a reducir las posibilidades de volverse a infectar con los piojos.  Inspeccione a todos en el hogar al mismo tiempo, antes de la limpieza del hogar. Esto incluye a los abuelos, hermanos más pequeños y mayores, y a los padres. Las estadísticas han sugerido que el 60% de las personas con piojos no saben que los tienen y no tienen síntomas. Estas personas pueden estar infestando a otras no intencionalmente y continuar el ciclo.

¿Por qué tengo que mantener a mi hijo(a) en mi hogar sin ir a la escuela hasta que ya no tenga liendres? / ¿Por qué se le permitió a los niños infectados que regresaran a la escuela con liendres?

Aunque no existe prueba científica que demuestre que el mantener a los niños con piojos en el hogar reduce la transmisión de piojos, la política de piojos es cuestión de la administración de la escuela. Sin embargo, un estudiante no debería perder más de uno o dos días de escuela debido a los piojos.

¿Por qué mi hijo(a) no es inspeccionado(a) para ver si tiene piojos?

Las inspecciones en masa ya no son recomendadas, pero si un número substancial de casos son encontrados, la inspección de toda la población escolar debería ser considerada.
 

Scabies Frequently Asked Questions

What is scabies?

Scabies is an infestation of the skin with the microscopic mite Sarcoptes scabei.

Infestation is common, found worldwide, and affects people of all races and social classes. Scabies spreads rapidly under crowded conditions where there is frequent skin-to-skin contact between people, such as in hospitals, institutions, child-care facilities, and nursing homes.

What are the signs and symptoms of scabies infestation?

• Pimple-like irritations, burrows or rash of the skin, especially the webbing between the fingers; the skin folds on the wrist, elbow, or knee; the penis, the breast, or shoulder blades.
• Intense itching, especially at night and over most of the body.
• Sores on the body caused by scratching. These sores can sometimes become infected with bacteria.

How did I get scabies?

By direct, prolonged, skin-to-skin contact with a person already infested with scabies. Contact must be prolonged (a quick handshake or hug will usually not spread infestation). Infestation is easily spread to sexual partners and household members. Infestation may also occur by sharing clothing, towels, and bedding.

Who is at risk for severe infestation?

People with weakened immune systems and the elderly are at risk for a more severe form of scabies, called Norwegian or crusted scabies.

How long will mites live?

Once away from the human body, mites do not survive more than 48-72 hours. When living on a person, an adult female mite can live up to a month.

Did my pet spread scabies to me?

No. Pets become infested with a different kind of scabies mite. If your pet is infested with scabies, (also called mange) and they have close contact with you, the mite can get under your skin and cause itching and skin irritation. However, the mite dies in a couple of days and does not reproduce. The mites may cause you to itch for several days, but you do not need to be treated with special medication to kill the mites. Until your pet is successfully treated, mites can continue to burrow into your skin and cause you to have symptoms.

How soon after infestation will symptoms begin?

For a person who has never been infested with scabies, symptoms may take 4-6 weeks to begin. For a person who has had scabies, symptoms appear within several days. You do not become immune to infestation.

How is scabies infestation diagnosed?

Diagnosis is most commonly made by looking at the burrows or rash. A skin scraping may be taken to look for mites, eggs, or mite fecal matter to confirm the diagnosis. If a skin scraping or biopsy is taken and returns negative, it is possible that you may still be infested. Typically, there are fewer than 10 mites on the entire body of an infested person; this makes it easy for an infestation to be missed.

Can scabies be treated?

Yes. Several lotions are available to treat scabies. Always follow the directions provided by your physician or the directions on the package insert. Apply lotion to a clean body from the neck down to the toes and left overnight (8 hours). After 8 hours, take a bath or shower to wash off the lotion. Put on clean clothes. All clothes, bedding, and towels used by the infested person 2 days before treatment should be washed in hot water and dried in a hot dryer. A second treatment of the body with the same lotion may be necessary 7-10 days later. Pregnant women and children are often treated with milder scabies medications.

Who should be treated for scabies?

Anyone who is diagnosed with scabies, as well as his or her sexual partners and persons who have close, prolonged contact to the infested person should also be treated. If your health care provider has instructed family members to be treated, everyone should receive treatment at the same time to prevent reinfestation.

How soon after treatment will I feel better?

Itching may continue for 2-3 weeks and does not mean that you are still infested. Your health care provider may prescribe additional medication to relieve itching if it is severe. No new burrows or rashes should appear 24-48 hours after effective treatment.

Scabies Fact Sheet

DEFINITION

Scabies is caused by a tiny mite. It is often hard to detect, and causes a fiercely, itchy skin condition. Dermatologists estimate that more than 300 million cases of scabies occur worldwide every year. The condition can strike anyone of any race or age, regardless of personal hygiene.

ETIOLOGY

Scabies is caused by a microscopic mite that burrows in the skin. Within several weeks, an allergic reaction develops causing severe itching; often intense enough to keep sufferers awake all night. It may take up to a month before a person will notice the itching.

Human scabies is almost always caught from another person by close contact. Attracted to warmth and odor, the female mite burrows into the skin, lays eggs, and produces toxins that cause allergic reactions. Newly hatched mites travel to the skin surface, lying in shallow pockets where they will develop into adult mites. If the mite is scratched off the skin, it can live in bedding for up to 24 hours or more.

DIAGNOSIS

The earliest and most common symptom of scabies is itching, especially at night. Little red bumps like hives, tiny bites, or pimples appear. In more advanced cases, the skin may be crusty or scaly.

Scabies prefers warmer sites on the skin such as skin folds, where clothing is tight, between the fingers or under the nails, on the elbows or wrists, the buttocks or belt line, around the nipples, and on the penis. Mites also tend to hide in, or on, bracelets and watchbands, or the skin under rings. In children, the infestation may involve the entire body including the palms, soles, and scalp.

Bacterial infection may occur due to scratching. In many cases, children are treated because of infected skin lesions rather than for the scabies itself. Although treatment of bacterial infections may provide relief, recurrence is almost certain if the scabies infection itself is not treated.

Crusted (Norwegian) Scabies

Crusted scabies is a form of the disease in which the symptoms are far more severe. Large areas of the body, like the hands and feet, may be scaly and crusted. These crusts hide thousands of live mites and their eggs, making treatment difficult because medications applied directly to the skin may not be able to penetrate the thickened skin. This type of scabies is extremely infectious and occurs mostly among the elderly, in some AIDS patients, or in people whose immunity is decreased.

Who is most at risk?

Scabies is most common in those who have close physical contact with others, particularly children, mothers of young children, sexually active young adults, and elderly people in nursing homes.

TREATMENTS

Getting rid of the mites is critical in the treatment of scabies. Everyone in the family or group, whether itching or not, should be treated at the same time to stop the spread of scabies. This includes close friends, day care or school classmates, or nursing home residents. Bedding and clothing must be washed or dry cleaned.

PERMETHRIN: Five percent permethrin cream is applied to the skin from the neck down at bedtime and washed off the next morning. Dermatologists recommend that the cream be applied to cool, dry skin over the entire body (including the palms of the hands, under fingernails, soles of the feet, and the groin) and left on for 8 to 14 hours. A second treatment one week later may be recommended. Side effect of 5% percent permethrin cream includes mild temporary burning and stinging. Lesions heal within four weeks after the treatment. If a patient continues to have trouble, reinfestation may be a problem requiring further evaluation by the dermatologist.

LIDANE: One percent lindane lotion is applied from the neck down at night and washed off in the morning.  It may be reapplied one week later. Lindane should not be used on infants, small children, pregnant or nursing women, or people with seizures or other neurological diseases, and has been banned in the state of California.

OTHER: Ten percent sulfur ointment and crotamiton cream may be used for infants. Ivermectin is an oral medicine which may be prescribed for the difficult to treat crusted form. It is not to be used in infants or pregnant women.

Antihistamines may be prescribed to relieve itching, which can last for weeks, even after the mite is gone.

Successful eradication of this infestation requires the following:

• See a dermatologist as soon as possible to begin treatment. Remember, although you may be disturbed at the thought of bugs, scabies is no reflection on your personal cleanliness.
• Treat all exposed individuals whether obviously infested or not. Incubation time is 6-8 weeks so symptoms may not show up for a while. If you do not treat everyone, it is as if you were never treated.
• Apply treatment to all skin from neck to legs. This includes between toes, the crease between the buttocks, etc. If you wash your hands after application, you need to reapply the medication to your hands.
• Wash clothes. Do all the laundry with the hottest water possible. Items you do not wish to wash may be placed in the dryer on the hot cycle for 30 minutes or pressed with a warm iron. Items may be dry-cleaned.
• Items may also be placed in a sealed plastic bag and placed in the garage for two weeks. If the mites do not get a meal within one week, they die.
• Change the bedding.
• Carpets or upholstery should be vacuumed through the heavy traffic areas. Vacuum the entire house and discard the bag, just to be on the safe side.
• Pets do not need to be treated.

Additional Information:

CDC - https://www.cdc.gov/scabies/about/

Nemours Foundation - http://www.kidshealth.org/parent/infections/skin/scabies.html

American Academy of Dermatology - http://www.aad.org/skin-conditions/dermatology-a-to-z/ (search scabies)