Advice from our GP on how to treat scabies and on the prevention of bunions.
Q. I can't seem to get rid of a scabies infection I picked up a couple of months ago. I've gone through two bottles of a cream the GP prescribed and although using the cream gives me some relief, the red marks and itching ultimately return after finishing each bottle. It's driving me nuts and the discomfort is becoming unbearable. How can I get rid of the infection once and for all?
Dr Nina replies: Scabies is caused by a mite sarcoptes scabiei hominis. This mite passes from person to person by direct skin-to-skin contact and it burrows under the skin to live and feed. Intense itching occurs due to the immune system's reaction to the mite's body parts and faeces.
Scabies is species-specific, so you cannot contract this from animals and mites cannot live for prolonged periods away from the human body, usually dying within 24 to 72 hours.
Scabies affects people of all ages, races, and income levels. It is not hygiene-related, and those who are very clean and neat can develop infestation. It tends to spread easily among those in close physical contact. The good news is that with proper treatment, scabies need only last a short time. A brief hug or handshake won't normally spread scabies, but contact such as hand-holding can.
Burrows can be hard to see. They occur most commonly on the hands, in finger web spaces, around the umbilicus, on the sides of the wrists and around genitalia. Once the mite burrows, it is the immune response that causes symptoms. For those infected for the first time, it may be up to six weeks after infestation that symptoms occur. In recurrent infection, symptoms tend to occur within a few days to two weeks.
Intense itch is the most common symptom. The itch can be distracting and distressing and is usually the reason people seek medical advice. Babies and young children may become irritable with disturbed sleep due to itch. As skin is scratched and becomes irritated, an eczematous rash may occur. If the skin is broken down from scratching, infection may set in. This can make the diagnosis more difficult. Treating the infection or eczema sometimes reveals the underlying scabies infection.
Treatment involves the use of topical creams or lotions. Permethrin is the most effective and commonly used. It is considered safe in pregnancy but shouldn't be used on those under two months of age. Malathion and Crotamiton cream are also an option, though considered less effective. These are not recommended in pregnancy.
The lotion must be applied covering the whole body from the neck down and left on for 24 hours. Scabies rarely affects the face so treating here is not necessary. If hands are washed after application, the lotion should be reapplied. Bed sheets and underwear should be washed but, as the mite can't live for long away from the body, a deep clean of the whole house is not necessary. Cleaning mites from under the nails is important. All household contacts must be treated whether they itch or not.
Skin will stay itchy for several weeks after. This does not mean infection is ongoing. The lotion kills mites but itch can persist until body parts and mite faeces are shed from the skin in the normal way over several weeks. If eczema has occurred secondary to scratching, taking an antihistamine and using steroid creams may help.
Don't keep applying lotion as this could ultimately irritate skin leading to eczema and an on-going itch-scratch cycle. If the treatment wasn't applied correctly or if household contacts aren't treated, then reinfection may occur.
Q. Are bunions hereditary and is there anything I can do to prevent them from forming?
Dr Nina replies: The foot may seem like a simple structure, but this really isn’t the case. It contains 26 bones, 33 joints, 126 muscles and multiple nerves. We are rarely born with foot problems. These are usually acquired as we age and in the majority of cases, it is due to a lifetime of wearing ill-fitting shoes and not giving our hard-working feet the tender loving care they deserve.
Pain in the foot can occur through the toes, forefoot, mid-foot, heel and arch. Poor-fitting shoes are a common culprit. Shoes with a narrow toe push the toes together and, over time, can damage the structure of the toes. High-heeled shoes push a lot of weight and strain on to the ball of the foot and are a major cause of foot pain. Obesity, poor posture or balance can alter the body’s centre of gravity, leading to pressure through the feet and, lastly, high-intensity exercise that involves jumping or running also puts a strain on the structures of the foot. Bunions are very common. They can run in families and 15pc are felt to be genetic. However, the other 85pc are once again due to ill-fitting or high-heeled shoes. A bunion occurs when the base of the large toe moves away from the other joints of the foot at the same time the top of the large toe moves towards the other toes. This creates an angle at the base of the toe and this joint can become inflamed and tender. The skin on the outside can become thickened and red, creating the classic angled red appearance that we all dread. Bunions can be painful and can also make it difficult to wear certain shoes. Bunions are most common in women due to the shoes we wear, but they can also occur in those with diabetes or flat feet.
Applying ice, raising the foot and taking over-the-counter painkillers may help relieve the pain from bunions, and of course, avoid high heels.