Once and for all, this is what you should do when you have scabies

The number of scabies cases diagnosed by Dutch GPs hasn’t been this high in years. According to Nivel, doctors have been diagnosing fifteen to twenty cases a week for every 100,000 inhabitants. In the previous three years, there were ten to fifteen cases per 100,000 inhabitants... a year. The culprit: the scabies mite, a small creature that digs tunnels under our skin, causing irritations. Sounds awful? Well, it is. DUB invited Nadieh Taks, doctor in infectious diseases at GGD Utrecht, and Ben Maijstré, pharmacist at the Nieuw Plettenburgh pharmacy, to explain all the do's and dont's students must be aware of if they want to prevent or treat scabies.

How does one get scabies?
Taks: “You can get it by having more than fifteen minutes of skin on skin contact with someone who has scabies. By that, we don't just mean making out, cuddling and sex: you can also get it from wearing someone else’s clothes, using their towel or sleeping in their bed. Scabies cannot jump from person to person but they can survive outside the human body for up to three days, residing in materials like textiles. Therefore, clothes, bed linen, slippers, hats and scarfs can all be contamination vehicles."

Maijstré: “Or fabric curtains. When they are close to the bed or couch, in theory they can contain scabies mites.”

Taks: “Pets are often forgotten as well. They can act as hosts, which means that the mite can temporarily reside in them, subsequently returning to humans or textiles.”

What causes scabies outbreaks like the one we're witnessing now?
Maijstré: "Covid is to blame for the current peak as bars were closed and people started throwing house parties more often, which means spending time on the same couch or bed. In addition, it wasn't unusual for all roommates in a student home to have to go into quarantine, so they were packed together for a long time. This is really something that arises in the domestic environment. However, the number of scabies cases is still high even though there aren'y any Covid measures anymore. The cream that is used to combat it remains on the list of most sold products at the pharmacy.”

Taks: "There's been a lot of outbreaks in other cities and countries as well.”

What does someone have to do if they get scabies?
Taks: “First, make sure that the diagnosis is set by the GP or GGD (the municipal health services). People often mistake scabies for other skin conditions. The treatment is pretty complex, so you do want to make sure it’s scabies.

“Once that's confirmed, the treatment involves a cream and/or pills. In addition, you should inform everyone you’ve been in contact with that you've got scabies, because they too must be treated. That means your roommates, sex partners, bed partners, people with whom you’ve had more than fifteen minutes of physical contact with or people who have used your clothes or towel.”

Can you tell us more about the treatment?
Taks: "The treatment consists of applying a cream or taking pills. Everyone — especially your roommates — should start the treatment simultaneously. After that, you should wash all your textiles at 60 degrees, regardless of whether or not they have been worn lately. If you have any textiles that cannot be washed at that temperature, put all of them in a bin bag, close it well and store it at room temperature for three days. Your couch, cushions and carpet should be vacuumed.

"This entire ritual should be repeated one week later by you and all your roommates. Again, it's important that everyone does this at the same time. For those not living with you, a single treatment is enough.”

Maijstré: “Thar actually happens quite often, someone coming to the pharmacy to get pills or skin cream for their entire house. Then they'll take twenty tubes at once. It's almost like taking a shot together, except with pills. You can also turn it into a cream party.”

"At the pharmacy, we’ve been emphasizing how vital it is that all roommates are present when the treatment gets started and that everyone repeats it together one week later. If you don’t do this, you’ll get a ping-pong effect.”

Taks: "It's also important to mention that there's no point in applying cream preventively after the treatment. If everyone’s followed the steps well, just wait two weeks. You can still experience some itching in the first weeks after the treatment but that doesn't necessarily mean that you've got scabies."

Some students complain that they still have scabies even after the treatment, though. How come?
Taks: "Little mistakes often sneak into the treatment. The cream has to be applied from top to toe, for example. So, not just on your legs and arms but underneath your fingernails, the genital area and between your buttocks. If you skip just a little spot, eggs can remain. There are also patients who start the treatment too late or skip the second round. If you don’t repeat the treatment in time, you have to do both rounds all over again. Not everyone does that."

Maijstré: "It's also common for one of the roommates not to follow the treatment or not follow it properly, causing everyone in the house to get reinfected.”

Taks: “Last but not least, there’s still a taboo against scabies. A lot of people are afraid to tell others that they think they have scabies and wait too long to see a doctor.”

What’s the difference between the cream and the pills?
Maijstré: “Pills can only be purchased with a doctor’s prescription while the cream is available over the counter. The GP is going to prescribe you one of the two, or both."

Taks: “Up until recently, the cream was thought to be more effective than the pills but now it looks like both of them work equally well.  The advantage of the pills is that you can just take them in one go whereas the cream has to be applied top to bottom, which takes skill. The cream is more affordable than the pills though, not to mention it's available over the counter at any pharmacy or drugstore."

Maijstré: “Pills do have more side effects. Nausea and diarrhoea are the most common ones. Doctors prescribe both the pills and the cream for severe cases."

How much does a treatment cost?
Maijstré: "The cream costs 13.95 euros per tube and is reimbursed by your health insurance when you get it from a pharmacy with a prescription. How many pills are needed depends on the weight of the person. It costs 21 euros per treatment on average. Up until recently, patients had to cover the costs of the pills themselves but now they are insured just like the cream, as long as you've already spent your 'own risk'. Since students often don't spent that entire sum or have opted for higher risk, they often pay for the treatment themselves."

How can someone prevent scabies?
Taks: "Everyone can get scabies. It's not a matter of hygiene: someone who showers every day is just as susceptible to scabies as someone who doesn't. It is true, though, that unsanitary conditions can contribute to infections, such as living too close together or using each other's belongings."

Where can students find more information about scabies?
There is a lot of conflicting information when it comes to scabies. So go by the information on the websites of the National Institute for Public Health and the Environment (RIVM), and GGD. The websites Thuisarts.nl and Apotheker.nl are also useful but they're available in Dutch only.