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Scabies Nursing Guide

Content created by: Annette Brownlee RN, BSN

Overview: Scabies

This content is intended as a Quick Reference for scabies and will provide an overview as well as nursing considerations utilizing the nursing process.

 

Etiology and Epidemiology

Scabies is a skin condition caused by an eight-legged mite called Sarcoptes scabiei that burrows under the skin and produces an itchy red rash, papules, or crusty layers. The mites burrow under the top layer of the skin and lay eggs. According to the World Health Organization (2020), the eggs hatch in 3 to 4 days and develop into adults, usually around 10 to 15 mites, in about 2 weeks. After 4 to 6 weeks, the affected individual will start to see a red itchy rash. This is an allergic reaction to mite proteins and feces in the burrow.

Scabies is extremely contagious and is contracted by contact with another person who has scabies. It is usually spready by direct prolonged skin-to-skin contact and is easily spread to sexual partners and household members. Mites can live up to 2 months on a human host. Without a human host, they do not survive more than 72 hours.

Crusted scabies, also called Norwegian scabies, can develop in individuals who are immunocompromised. While rare, crusted scabies is caused by an infestation of mites, up to 2 million, and produces a crust. Individuals may not experience pruritis with crusted scabies. Infection and sepsis are possible, and individuals may transmit through indirect contact including sharing of clothing or bedding.

According to the World Health Organization (2020), at any time there are an estimated 200 million people with scabies globally. Young children and the elderly are more susceptible to scabies as are those living in facilities such as long-term care facilities and prisons. Those in resource poor areas are also vulnerable. Infestation rates are highest in warm and tropical climates especially where there is limited medical access, poverty, and overcrowding.

Scabies Diagnosis

The diagnosis of scabies is made by a thorough history intake and physical examination by the healthcare provider. 

Signs and symptoms of scabies include:

  • Pruritus
  • Papular rash
  • Presence of burrows
  • Crust

According to the Centers for Disease Control and Prevention (2018), mite burrows commonly occur in the following areas:

  • Finger webbing
  • Armpit
  • Waist
  • Wrist
  • Elbow
  • Sole of the foot
  • Breast
  • Penis
  • Buttock
  • Knee
  • Palm of the hand

Individuals with crusted scabies may not show the usual signs and symptoms of pruritis and rash. If possible, a diagnosis should be confirmed by identifying and removing a mite, mite eggs, or mite fecal matter.

Diagnostic tests that may be ordered include viewing skin under the microscope for presence of mites (dermatoscopy) or a burrow ink test in which the provider utilizes a special ink to identify mite burrows under the skin (Leung & Miller, 2011).

Management

Management and treatment of scabies will depend on the cause as well as the classification and severity. 

Scabies treatments may include the following:

  • Assess and stabilize airway, breathing, and circulation
  • Provide calm environment
  • Obtain ordered lab work
  • Monitor vital signs
  • Medications as ordered
  • Monitor for signs and symptoms of infection
  • Maintain contact precautions until scabies has resolved and mites are eradicated from environment
  • Decontamination to eradicate mites from environment

According to the American Academy of Dermatology Association (2021), antihistamines and steroids may be prescribed to help control the itching and antibiotics may be prescribed if the skin or lesions are infected. To treat scabies, the most common medication providers prescribe is 5% permethrin cream (Acticin®). Applied topically, it can be used to treat people age 2 months and older as well as women who are pregnant. Ivermectin (Stromectol®), an anthelmintic, is often prescribed. Other topical scabicides include the following:

  • 10% crotamiton cream (Eurax®)
  • 5% to 10% sulfur ointment (Sulfpho-Lac®)
  • 1% lindane lotion (Kwell®)

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for scabies are listed below.

Assessment

Assess signs and symptoms, such as:

  • Pruritis
  • Excoriation
  • Signs and symptoms of infection
  • Skin including rash, papules, lesions, or crusts
  • Psychosocial wellbeing
  • Sleep quality and hours of sleep

Nursing Diagnosis/Risk For

  • Risk for infection related to severe pruritis and skin rash, evidenced by:
    • Scratching
    • Excoriation
    • Inflammation
    • Fever
    • Redness to affected area
  • Impaired comfort related to subdermal organisms, evidenced by:
    • Verbalization of discomfort
    • Pruritis
    • Skin inflammation
  • Risk for transmission to others related to contagious organisms, evidenced by:
    • Skin-to-skin contact with infected individual
    • Decreased immune system
    • Positive scabies diagnosis
  • Disturbed sleep pattern related to nighttime waking caused by pruritis, evidenced by,
    • Verbalization of impaired sleep
    • Fatigue
    • Decrease in hours of sleep

Interventions

  • Monitor skin for signs and symptoms of infection.
  • Maintain contact precautions per state and department of health requirements.
  • Provide psychosocial support to individual and family.
  • Provide non-pharmacological comfort measures to relieve pruritis.
  • Facilitate decontamination procedures.

Expected Outcomes

  • Verbalizes that they will avoid contact with anyone until scabies mites are no longer present
  • Demonstrates understanding of how scabies is spread
  • Reports improved sleep pattern and increase in hours of sleep
  • Remains free of infection
  • Verbalizes improved comfort level and reduced itching
  • Maintains skin integrity

Individual/Caregiver Education

  • Condition, treatment, and expected outcomes 
  • Side effects of prescribed medications
  • Signs and symptoms of scabies
  • Decontamination process and requirements
  • Signs and symptoms of infection 
  • Notify healthcare provider or seek immediate medical care for: 
    • Redness, infection, or bleeding
    • Fever
    • Worsening signs and symptoms
  • Recommended follow-up with healthcare provider 

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Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2028

Content Contributor

The content for this course was created by Annette Brownlee RN, BSN

Annette Brownlee is an SME Writer for the Post-Acute Care team. She has a Bachelor of Arts in advertising from Michigan State University and a Bachelor of Science in nursing from the University of Northern Colorado. Annette has worked in skilled nursing and home health. Her most recent experience includes being a Staff Development Coordinator and Infection Prevention.

Resources

References

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