By Anonymous
From PHN Issue 54, Fall 2023
Scabies is sadly a fairly common occurrence in the crowded conditions of prisons. Prison officials will state cleanliness or hygiene, but transmission of scabies usually occurs through direct and prolonged skin-to-skin contact, as may occur among family members or sexual partners. Casual skin contact is unlikely to result in transmission.
Scabies is the infestation of the skin by the mite Sarcoptes scabiei var. hominis. Scabies infestations result in intense itching, most notably at night, with wavy and slightly scaly lines from 2 mm to 1.5 cm in length that end in dark bumps where the mite may be visible. Prisoners with dark skin tones may find it harder to detect scabies infestations. Burrows may not be easily visible if the individual has been scratching the area. Classically, scabies affects the spaces between fingers, flexural areas of the wrist or elbow, and folds of skin on the buttocks and beltline.
Proper medical diagnoses can be made by covering burrows with glycerol, mineral oil, or immersion oil. The areas are then scraped with the edge of a scalpel and viewed under a microscope. However, if there are not very many mites on a person’s skin, the providers may not capture enough to see on a microscope. In that case, scabies can also be diagnosed clinically via history and physical exam showing the burrows described above.
First-line treatment is with permethrin cream. It is applied to the whole body and washed off after 8 to 14 hours. Repeat in one week. However, the federal Bureau of Prisons scabies policy (2020) is to treat everyone with an oral medicine called ivermectin. The stated purpose of this is because permethrin cream can be incorrectly or incompletely applied to the skin, which risks an outbreak. Ivermectin is given by mouth and repeated in 7 to 10 days. Although this is the federal BOP policy, this may not be the policy in every state prison.
It may take up to three weeks for the skin to heal. For the itching, a corticosteroid ointment and/or an oral antihistamine can reduce the itch. If lesions develop that are weeping or yellow-crusted, it may indicate a secondary bacterial infection requiring treatment with antibiotics.
So, let us summarize the scabies infestation:
- Affects fingers, wrists, elbows, waist, and buttocks mostly
- Scraping of the skin is helpful to confirm the diagnosis, but not required to diagnose scabies
- First-line treatment is permethrin with something to ease itching
- Anything that has contacted your body should be washed or isolated
- Weeping, yellow-crusted lesions signal a secondary bacterial infection
- Ivermectin can be used to treat troublesome scabies or if there is a confirmed epidemic
- It will take up to three weeks to heal the skin
Do not let the prison dictate the treatment of your body. File grievances, if needed, and stay strong.
Prison Health News 