Scabies: an update for community nurses

Being aware of the clinical features of scabies can help ensure that the affected individual receives a prompt diagnosis and effective treatment. A cycle of infection can be initiated if more than one person has scabies. There is some evidence that scabies is becoming more common and, on occasion, difficult to treat (Sunderkötter et al, 2021). Older adults are more vulnerable to scabies due to age-related changes (Nigam and Knight, 2017). This article will examine the clinical features of scabies, how it is treated and how to manage its complications.

Scabies is one of the most common dermatological conditions and affects more than 200 million people at any given time. While scabies occurs worldwide, it is most common in hot, tropical countries and in areas of high population density (World Health Organization (WHO), 2020).

Scabies is caused by a small mite called Scaroptes scabei. There are two classes of scabies infection, both of which are caused by the same mite. These are: classical scabies (present in people with normal immune systems) and hyperkeratotic scabies. In classical scabies, there are 12-20 mites in the body in a typical infestation. Hyperkeratotic scabies (also known as atypical scabies, crusted scabies and Norwegian scabies) is a super infestation that occurs in people with immunodeficiencies and in some frail older adults. There can be hundreds, or even thousands, of mites. The skin can become thickened, scaled and crusted. The crusts can break off and mites can live in the crusts for some days, increasing infection risks. Hyperkeratotic scabies is highly infectious (Bernigaud et al, 2020). Figure 1 illustrates the differences between a classical scabies infection and a superinfection.