One condition commonly seen in children who are internationally adopted is scabies. Scabies is caused by an insect that burrows under the skin and lays eggs. It cannot be seen with the naked eye. The mite and eggs cause severe itching, a red pinpoint raised rash and sometimes will appear as small brownish nodules, especially in clothing covered areas of the skin. It is most commonly seen in the skin area between the fingers, toes, and on the feet but in infants it is also frequently seen on the palms of the hands, the waist, groin, armpits and even the head.
Scabies is usually treated with a cream that contains a chemical insecticide called permethrin. The cream should be applied to all parts of the body avoiding the face. Special care should be taken when applying the lotion to young children who may place their fingers or hands into their mouth. The cream should be left on the skin for 8-14 hours before washing off with water. Treatment is repeated one week later to be sure that the infestation does not reoccur from persistent eggs hatching. For infestation of the eyelashes, petroleum ointment may be applied 3-4 times/day for 8-10 days.
Because this mite causes severe itching, we often prescribe an antihistamine such as diphenhydramine ("Benadryl").
Scabies can be a highly contagious condition. All family members should be watchful for signs of rash or unexplained itching. Scabies can appear as late as two months after exposure.
Bedding and clothing worn next to the skin prior to four days before treatment should be washed in hot water. Clothing that cannot be laundered in hot water should be removed and stored for several days in order to prevent reinfestation. Thorough vacuuming of the carpet and furniture may be helpful in preventing reinfection.
Children may return to school or childcare once treatment has been completed even if the rash is still present.
After Scabies Treatment
The rash and itching of scabies will continue for several weeks or months. Although the skin has been treated, remnants of the dead mite remain under the skin for a period of time. Your child may continue to need treatment with an antihistamine for comfort.
A 1% hydrocortisone cream can be applied to the rash and/or dry patches of skin, but only after treatment has been completed.