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By Dr. Jane Aronson

Scabies are ectoparasites. They are mites which cannot be seen by the naked eye and they burrow under the skin causing intense itching 6-8 weeks after they have initially affected the skin. The itching is art of a hypersensitivity reaction of the human body to the waste products deposited by the scabies under the skin. Tiny red raised spots called papules are often found on the palms of the hands and Soles of the feet in infants and children. Other common locations for the skin manifestations of scabies are the armpits, face, and waist. The red papules can become blister-like and they can be secondarily infected with bacteria, particularly Group A streptococci. When these bacteria infect the scabies lesions, the diagnosis is Impetigo.

Scabies is very common in the United States especially in daycare settings. It is also very common in orphanages abroad. It is easy to treat scabies, but sometimes it is not so easy to recognize. Children in orphanages actually get used to the itching and discomfort of scabies because they are unable to communicate their feelings. There is not enough staff in orphanages to meet the needs of children who are in discomfort from any illness. Sometimes scabies can cause scaling and it can look like eczema. It is often treated with steroids which then can alter its appearance and then it is called scabies incognito and it is more difficult to diagnose.

The treatment of scabies is a prescription called Elimite 5% cream (permethrin) which should be applied from the head down in a child and from the neck down in an adult. It is applied to all the skin of the body before bedtime and kept on for & 12 hours. It is then bathed or showered off in the morning. One application is quite effective, but if the scabies initially is widespread or if the lesions progress after therapy, then another application one week later is appropriate. Itching can continue for weeks even after effective therapy because this is after all a hypersensitivity reaction which has been ongoing for weeks or months. If the lesions are affected by Impetigo, an antibiotic to be administered by mouth should be prescribed by a physician.

It is essential that the parent (s) traveling with the newly adopted child be simultaneously treated for scabies to prevent ping pong transmission that is so common with scabies. Moisturization of the skin is also beneficial in helping to lessen the itching. Occasionally a child or an adult will need an antihistamine like henadryl or atarax to help ameliorate the intense itching that can interfere with a good sound sleep!

© Copyright Dr. Jane Aronson 2001

Dr. Jane Aronson is a board certified general pediatrician and pediatric infectious diseases specialist and the Clinical Assistant Professor of Pediatric at the Weill Medical College, Cornell University. She is an established international adoption medicine specialist and has treated over 1400 children adopted from abroad. Dr. Aronson reviews pre-adoption medical reports, evaluates videos and photographs, prepares people for travel abroad, and speaks and writes about international adoption for family adoption groups, adoption agencies, and physicians. She can be reached at or visit her website at

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