SCABIES INCREASING, DIAGNOSIS OFTEN MISSED

Marcus Conant, M. D., a dermatologist and a leading AIDS expert in San Francisco, alerted patients at his February monthly public meeting that he has seen a major increase in scabies in the last few months, with 20 cases since Christmas. Scabies is caused by a mite, a small spider which burrows into the skin. It is very contagious, often transmitted by sexual contact, and often particularly severe in persons with immune deficiencies.

Scabies is not difficult to treat. The biggest problem is getting it diagnosed, as physicians often do not look for it. Historically, scabies becomes widespread periodically; clearly a major increase is starting now, at least in San Francisco. (We do not know about other cities.)

Symptoms include severe itching, which may be worse at night. Itching and rash often start in the web between the fingers. Other areas likely to be affected include the genitals, underarms, elbows, and buttocks. Usually the head is not affected -- but it may be in people with immune suppression.

Treatment requires a prescription cream or lotion (such as Kwell), often applied everywhere from the neck down and left on overnight, then washed off in the morning, for four successive nights. Instructions must be followed carefully; sometimes, for example, physicians forget to tell patients not to wash their hands at night, after they have applied the medication. The mites are often found on the hands, and they can survive there and re-infect the rest of the body if the hands are not treated.

In addition, clothing and bedding must be collected and properly cleaned, and all sexual contacts must be treated simultaneously, to avoid reinfection.