KARACHI, March 23: Scabies, which is a highly contagious skin infection caused by a certain species of mites, is spreading fast in the city mainly due to lack of awareness about the disease’s mode of transmission, overcrowded living conditions and lack of personal hygiene.

The head of the dermatology department at the Jinnah Postgraduate Medical Centre (JPMC), Dr Azam J. Samdani, told Dawn that the skin infection, known previously as a disease of the poor, was now becoming increasingly common among members of society’s high-income group.

Dr Samdani, who also works as a teaching consultant at the Aga Khan University and Hospital (AKUH), said that if preventive measures were not taken promptly, the country could well see the outbreak of a scabies epidemic in the foreseeable future.

“The infection is spreading at an alarmingly fast rate. Forty per cent of the between 300 and 400 patients who turn up at each out-patient department of the JPMC twice a week report complaints of scabies. At AKUH, I have been seeing scabies patients from well-to-do families also,” he said.

Giving reasons for the alarmingly rapid spread of the disease, he said usually children brought the infection home from schools and madressahs. He added that people avoided the standard procedure of scabies management, which required that all family members – including those that came into contact with the affected person – be treated whether or not they were showing symptoms.

Additionally, he said, the disease was often misdiagnosed because of the wide spectrum of its manifestation.

“In the privileged class, people should show more concern towards the physical wellbeing of their servants who, lacking personal hygiene and living in congested environment, are easily infected by arachnid mite Sarcoptes scabiei,” he said, adding that the mite had developed resistance against treatment which at times needed modification.

About the modes of transmission, he said that an infected person, without showing symptoms, could easily transmit the disease on close contact. For instance, sleeping with a person having scabies or sharing personal clothing is responsible for the spread of the disease. He added that while transmission of the disease was mostly from humans to humans, it could also be from animals – such as, dogs, cattle, sheep and even poultry and birds – to humans.

Explaining the process, he said: “After copulation, the male mite dies while the female burrows into the top layer of the human skin laying two to five eggs every day for four to five weeks before it dies. The cycle from eggs to an adult usually takes about 15 days and keeps repeating until the individual is treated and made mite-free. Although disputed, some believe that one can become infected by indirect contact with personal items or clothing of an affected person because the mite can survive away from the skin for two to five days.”

The diagnosis of scabies, he said, should be considered in all those patients who presented a recent onset of intense night itching followed by an increase in the itching with the duration of the disease. It should also be considered in cases where there was a history of pruritis in family members, sexual partners and close contacts.

“Burrows at finger or toe webs, genitals, breasts and buttocks are another characteristic feature of this condition. The face usually does not become involved,” he said. Shedding light on the disease’s treatment, he said that once diagnosed in one person, the entire family should be asked to apply a specific cream all over the body except the face and the neck. Besides, it was advisable to wash bedlinen, clothing and towels in hot boiling water for five minutes.

Dr Sikandar A. Mahar, Director of the Institute of Skin Diseases, Sindh, told Dawn that about 4,000 patients daily turned up at the out-patient department. Of them, around 3,000 were new and old cases of scabies. “The institute mostly caters to the poor who are provided free medication which is made by our own experts. Patients are advised to avoid sharing pillows, soap, clothing and bedlinen,” he said. About 50 new cases of scabies report at the dermatology department of the Civil Hospital Karachi every day. However, Dr Zarnaz Habib, who heads the department, told Dawn that eczema was more common than scabies. She added that the latter eventually turned into the former.

“In some cases, scabies is self-limiting. It has periodic outbreaks and the only way to eradicate it is to treat all the people in close contact,” she said, stressing the need for ensuring the availability of medication within the reach of the poor.