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Scabies is a contagious skin infestation caused by the mite Sarcoptes scabiei var. hominis. It spreads through close skin-to-skin contact. The mites burrow into the upper layer of the skin, triggering intense itching and rashes. Scabies is classified as a parasitic infestation, not a bacterial or viral infection.
Prevalence of scabies
Scabies affects all ages and genders, but it is more common in children, the elderly, and immunocompromised individuals. Globally, the World Health Organization estimates over 200 million cases at any time. Outbreaks are frequent in long-term care facilities and nursing homes due to close living arrangements. In Asia, including Singapore, scabies is a recurring issue in eldercare institutions, especially among dependent residents.
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What causes scabies?
Scabies occurs when the female mite (Sarcoptes scabiei var. hominis) burrows into the skin to lay eggs. The body mounts an allergic response to the mites, their eggs, and their waste. Transmission happens through prolonged skin-to-skin contact, or less commonly through infested clothing, bedding, and furniture.
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Signs, symptoms, and why elderly are vulnerable?
The hallmark symptom is severe itching, often worse at night. Other features include small burrows, red papules, blisters, or crusting. Commonly affected areas are the wrists, fingers, elbows, waistline, and buttocks.
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Elderly persons are more vulnerable because:
Weaker immune responses may alter the skin’s reaction, making diagnosis harder.
Cognitive impairment or dementia may limit their ability to report itching.
Frail skin is more prone to secondary infections.
Dependence on caregivers increases exposure risk.
Implications if scabies is not well-managed
If untreated, scabies can lead to:
Secondary bacterial infections like impetigo or cellulitis.
Crusted scabies in immunocompromised elderly, a severe form with thick crusts harbouring thousands of mites, making it highly contagious.
Rapid spread in residential care facilities, resulting in staff shortages, ward closures, and regulatory concerns.
Psychological distress from relentless itching and loss of sleep.
Treatment and management strategies
Effective management includes:
Topical scabicides
Such as permethrin 5% cream applied from neck to toes, repeated after 7 days.Oral ivermectin
For residents with crusted scabies or those unable to tolerate topical therapy.Symptom relief
Antihistamines or topical steroids for itch and inflammation.Environmental measures
Laundering clothes, bed linen, and towels in hot water, or sealing items in plastic bags for at least 72 hours.Mass treatment
May be required in residential settings to control outbreaks, with simultaneous treatment of all contacts, including staff.
Prevention strategies
Preventing scabies in the elderly requires a mix of personal hygiene, environmental cleaning, staff training, and institutional policies. Key strategies include:
Early detection and reporting
Conduct routine skin checks, especially during bathing or dressing.
Train caregivers to recognise itching, burrows, or unexplained rashes.
Encourage immediate reporting to nursing or medical staff.
Resident management
Isolate symptomatic residents until they complete treatment.
Provide individualised care plans, especially for those with dementia or severe mobility limitations.
Monitor closely for recurrence after treatment.
Staff precautions
Use gloves and protective clothing during close contact with affected residents.
Emphasise proper handwashing before and after resident contact.
Restrict staff from rotating between infected and non-infected residents to limit spread.
Environmental cleaning
Launder all clothes, towels, and bedding used within the last 3 days in hot water (at least 60°C) and dry at high heat.
Seal non-washable items such as shoes or cushions in airtight plastic bags for at least 72 hours, as mites cannot survive long without human skin.
Clean and vacuum furniture, mattresses, and rooms thoroughly.
Mass prophylaxis during outbreaks
Treat all residents and staff simultaneously in confirmed outbreaks, even if they have no symptoms, to break the transmission cycle.
Coordinate with public health authorities if large-scale treatment is needed.
Institutional measures
Develop written outbreak protocols that define roles, responsibilities, and timelines.
Keep accurate records of affected residents, treatment dates, and follow-up outcomes.
Provide continuous education sessions for staff and caregivers on scabies recognition and prevention.
Limit group activities temporarily during outbreaks to reduce direct skin contact.
Strong prevention strategies protect residents from prolonged discomfort, reduce the risk of outbreaks, and ensure a safer care environment in eldercare facilities.
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Conclusion
Scabies in the elderly is a serious but preventable problem. Prompt recognition, effective treatment, and strong infection control practices are essential to protect residents and staff.
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In eldercare facilities, coordinated management strategies reduce outbreaks, safeguard vulnerable individuals, and maintain quality of care.
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