Do Scabies Come Back After Treatment? Understanding Recurrence and Prevention
Do scabies come back after treatment? The unfortunate answer is yes, scabies can come back after treatment, but typically not because the treatment itself failed. Recurrence usually stems from re-infestation due to ongoing exposure to infested individuals or environments.
Understanding Scabies and Its Treatment
Scabies is a highly contagious skin infestation caused by the Sarcoptes scabiei mite. These microscopic parasites burrow into the upper layer of the skin, where they live and lay eggs. This causes intense itching, especially at night, and a pimple-like rash. Effective treatment involves using prescribed scabicides, such as permethrin cream or ivermectin. Understanding the intricacies of treatment and potential pitfalls is crucial to preventing recurrence.
Why Scabies Might Seem to Come Back
The perception that scabies “comes back” after treatment can be misleading. In most cases, it’s not that the initial treatment failed to kill the mites, but rather that one of the following scenarios occurred:
- Re-infestation: This is the most common reason. If a treated individual comes into contact with someone else who has scabies, or uses bedding or clothing that is contaminated with mites, they can become re-infested. Scabies mites can survive for 24-36 hours off the human body under normal room temperature.
- Incomplete Treatment: Sometimes, the treatment is not applied correctly or for the recommended duration. For example, forgetting to apply the cream under fingernails (a common hiding spot for mites) can lead to re-infestation.
- Treatment Resistance: While rare, there have been reported cases of scabies mite resistance to certain medications. This is more likely to occur with repeated use of the same scabicide.
- Post-Scabetic Itch: Even after the mites are eradicated, itching can persist for several weeks. This is due to an allergic reaction to the dead mites and their waste products. It’s important to differentiate this from active infestation.
Ensuring Effective Treatment
To maximize the chances of successful treatment and prevent recurrence, it’s essential to follow these steps:
- Proper Diagnosis: Ensure the diagnosis is confirmed by a healthcare professional. Conditions like eczema or contact dermatitis can mimic scabies symptoms.
- Prescription Adherence: Strictly follow the instructions provided by your doctor or pharmacist regarding the application and duration of the treatment.
- Treat All Contacts: All household members and close contacts should be treated simultaneously, even if they don’t have symptoms. This prevents the “ping-pong effect” of re-infestation.
- Environmental Cleaning: Wash all bedding, clothing, and towels in hot water and dry them on high heat. Items that cannot be washed should be sealed in a plastic bag for at least 72 hours to kill the mites.
- Nail Hygiene: Trim fingernails short and clean them thoroughly, as mites can hide under the nails.
- Second Treatment: A second treatment is often recommended, usually one week after the first, to kill any newly hatched mites.
- Treat Itching: Antihistamines or topical corticosteroids can help alleviate itching during the post-scabetic phase.
Differentiating Between Re-Infestation and Post-Scabetic Itch
It’s important to distinguish between a true re-infestation and post-scabetic itch. Key differences include:
| Feature | Re-Infestation | Post-Scabetic Itch |
|---|---|---|
| Onset | Usually occurs several weeks or months after treatment | Starts shortly after treatment and gradually decreases |
| Itch Intensity | Intense and often worsening at night | Can be intense, but usually gradually decreases |
| New Burrows/Rash | Yes, new burrows and rash are present | No new burrows or rash |
| Response to Scabicide | Symptoms improve with repeat treatment | No improvement with scabicide treatment |
Prevention is Key: Stopping the Scabies Cycle
Preventing scabies recurrence hinges on breaking the cycle of infestation. Here are key prevention strategies:
- Avoid Close Contact: Avoid close skin-to-skin contact with individuals who have scabies.
- Avoid Sharing Personal Items: Do not share clothing, bedding, towels, or other personal items with others.
- Prompt Treatment: If you suspect you have scabies, seek medical attention and begin treatment promptly.
- Educate Others: Inform close contacts about scabies and the importance of treatment.
- Monitor Symptoms: Be vigilant for any signs or symptoms of scabies, especially after potential exposure.
Frequently Asked Questions (FAQs)
What are the first signs that scabies has returned after treatment?
The first signs of a scabies recurrence are typically intense itching, especially at night, and the appearance of a new rash consisting of small, raised bumps or blisters. These may appear in the same areas as the original infestation or in new areas.
How long does it take for scabies symptoms to reappear if I get re-infested?
If you get re-infested with scabies, it can take 2-6 weeks for symptoms to appear. This is because it takes time for the mites to burrow into the skin, lay eggs, and trigger an allergic reaction.
Can I spread scabies even if I don’t have any symptoms yet?
Yes, you can spread scabies even before you have any symptoms. The incubation period for scabies is 2-6 weeks, during which time you are contagious.
What should I do if I think my scabies treatment didn’t work?
If you suspect your scabies treatment didn’t work, contact your doctor immediately. They may recommend a different scabicide, a second treatment, or investigate other possible causes for your symptoms.
Are there alternative treatments for scabies if I’m resistant to permethrin?
Yes, there are alternative treatments for scabies, including ivermectin (an oral medication), lindane lotion (though this is less commonly used due to potential side effects), and crotamiton cream. Your doctor can determine the best option for you.
How often should I wash my bedding to prevent scabies recurrence?
To prevent scabies recurrence, you should wash all bedding, clothing, and towels in hot water (at least 130°F or 54°C) and dry them on high heat whenever treatment is initiated and then regularly, ideally every 2-3 days, until symptoms resolve.
Can scabies live on surfaces like furniture or carpets?
Scabies mites can survive 24-36 hours off the human body under normal room temperature and humidity. Therefore, it’s important to vacuum furniture and carpets thoroughly to remove any mites that may be present.
Is it possible to have scabies only on one part of my body?
While scabies can be more prominent in certain areas like the hands, wrists, elbows, and genitals, it is uncommon to have scabies only on one specific area of the body. Typically, the infestation is more widespread.
What can I do to relieve the itching associated with post-scabetic itch?
To relieve itching associated with post-scabetic itch, try using antihistamines (such as diphenhydramine or cetirizine) and topical corticosteroids (such as hydrocortisone cream). Cool compresses and oatmeal baths can also provide relief.
Does post-scabetic itch mean I’m still contagious?
No, post-scabetic itch does not mean you’re still contagious. It’s simply an allergic reaction to the dead mites and their waste products. You are no longer contagious once the mites have been successfully eradicated by treatment.
Are there any natural remedies that can cure scabies?
While some natural remedies, like tea tree oil and neem oil, have shown some potential activity against scabies mites in laboratory studies, there is not enough scientific evidence to support their use as a sole treatment for scabies. It’s crucial to use prescribed scabicides for effective treatment.
How long does post-scabetic itch typically last?
Post-scabetic itch can last for up to several weeks after successful treatment. The duration varies from person to person and depends on the severity of the initial infestation and individual sensitivity.