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Certainly Lars. Fortunately in this community there are options for certain caregivers. There is support available not just throught support groups, but home care support, as well as respite care. One must also evaluate one's constitution and level of patience in deciding whether you can walk this path. I agree, it is not always an easy choice. It does force you to look into your soul, to see if you have "what it takes" and go from there. EAch of us must decide for ourselves. Having been through this four times in my life, I know it only too well. We all have to decide what we can live with. Unfortunately in this disposable society, many decide to take the sanitized, less humanitarian way out. It is sad, but it is so.

-- Aunt Bee (Aunt__Bee@hotmail.com), October 28, 2001


Traditional Prescription for Scabies: Treatable following a Diagnosis

Scabies is common in the United States and should not be a cause for embarrassment. It is due to an infestation with a very small organism, the human variety of the mite, Sarcoptes scabiei, and is found worldwide, in both sexes, and in all age groups. The intense itching caused by scabies leads to vigorous scratching and rapid destruction of the blisters that are characteristic of the condition. As a result, the condition can end up looking like eczema, insect bites, or other rash conditions.

Usually persons with scabies have a widespread, symmetrical rash, with itchy, red elevated burrows between and on the sides of the fingers. These burrows are the tunnels made in the skin by the mite. Other commonly affected areas are the wrists, the backs of the elbows, the armpits, the abdomen, the buttocks, and the area surrounding the nipple of the breast in women. In males of all ages, the genitalia tend to be involved as well. In patients over the age of two, affected areas are typically below the neck, and not on the face or scalp. However, in tropical climates and in infants in all climates, the face and scalp can be heavily infected.

Scabies can be contagious within a family, and your doctor will probably ask if others in your family are affected. However, since itching usually starts two to six weeks after a person has become infected, many people who have scabies may not be aware of it for a while. Your doctor will most likely make the diagnosis of scabies by examining your skin.

The treatment possibilities for scabies have changed significantly over the last eight years since the introduction of permethrin 5% dermal cream (Elimite). This medication cures patients as well as another medication called lindane, but it is safer because it has not caused toxic nerve reactions that have occurred with the use of lindane. In addition, resistance to lindane has developed, especially in nursing homes and hospitals, so that the drug no longer works in some cases. However, in every instance where cases of scabies were resistant to lindane, permethrin 5% worked as a cure. A general trend has emerged favoring permethrin for the treatment of children under the age of two, infants, and in heavily infected persons in whom excessive absorption of the medication through the skin might be a concern.

A disadvantage of permethrin treatment, however, is that it is slightly more irritating to the skin than lindane and can temporarily make the itch worse. Lindane can also cause skin irritation, but generally not as much. Permethrin also costs more than lindane.

Certain household measures should be taken when there is a diagnosis of scabies. First, all household contacts should be treated with the medication the same day to avoid the ping-pong effect of new cases developing in untreated family members. Do not bathe just before applying the product because this may cause a large amount of the medication to be absorbed by the skin, which may be harmful. In patients over two years of age, apply the medication to the entire skin surface from the neck down. Cover every inch of skin, especially under the nails of the fingers and toes where intact mites might be protected. Leave the medication on for eight to 13 hours. Take a shower or bath only the next day. Wash all bedding and clothing worn in the last 48 hours. It is not necessary, however, to thoroughly clean your home. The focus of treatment should be on the skin.

Your doctor will tell you what to expect in terms of improvement or cure. Killing of all the scabies mites will not dramatically improve the itching, and it may take as long for the itch to disappear (two to six weeks) as it did for it to appear. An indication of treatment failure is not continued itching, but the re-emergence of new affected areas two weeks after treatment. In one scabies studies, many patients with continued itching four weeks after treatment were ultimately cured with the permethrin application.

Because the medication may temporarily worsen itching, your doctor may also prescribe topical corticosteroids and antihistamines. The outlook for ultimate cure of scabies is excellent -- about 90 percent. A diagnosis by your doctor together with safe and effective medications can eliminate scabies from your family and control ongoing community epidemics.

-- klsmnfureyhnwpdj (feygc@jro.mi4qhj), March 25, 2002.

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