Scabies and the Potential Aftermath of Acropustulosis
Someone requested that I write a post about scabies and acropustulosis a LOOOOONG time ago, but at the time, I didn’t think it was relevant to very many of my readers since scabies has been written about often and acropustulosis is considered to be pretty uncommon. I think it was probably more relevant than I realized, and I just got another request to write on this topic. Sorry to whomever made the initial request that I ignored until now! Better late than never, right?
Hopefully this post will be useful to those readers who have adopted, or will adopt from an orphanage with the oh so familiar scabies epidemic. Jackson’s orphanage in Vung Tau was pretty much crawling with them, and every baby we knew coming out of there had a decent to bad case of scabies. Shane’s orphanage, on the other hand, in Que Son, was TOTALLY scabies-free. It was amazing. Shane left that place with GORGEOUS skin, and still has gorgeous skin. Jackson, on the other hand, still suffers from his post-scabies skin problems, along with his eczema.
Most people already know you should bring a few tubes of Elimite with you, which is a prescription topical cream that gets rid of the scabies mite. Ok, I’ll back up. Scabies is a dermatologic condition that results from the body’s immune response to the eggs of the scabies mite. It’s commonly found in unclean conditions where people tend to be crowded together (prisons, orphanages, homeless shelters, etc.). The mites burrow under the skin, lay their nasty eggs, which causes the body to react with itching and red “bumps.”
Here’s a picture of a scabies rash:
In case that didn’t already gross you out, here’s a microscopic picture of what the mites look like:
They love to burrow in the creases between fingers, toes, and in the natal cleft (butt crack), so those are good places to check if you’re not sure if your child has scabies. Because live mites and eggs are involved, scabies is a contagious condition. However, it’s not nearly as contagious as everyone treats it unless your child has the most severe infestation (Norwegian Scabies) and you have a lot of contact with his/her skin before you treat it with Elimite. You’re most likely not going to catch it from holding your baby that first day. But if you want to be extra careful anyway, put your clothes with your baby’s clothes in a separate bag to take home and wash on high heat. Anyway, here’s my advice:
- The first night you come home from the orphanage with your child, you should cover them head to toe (avoiding the eyes) with Elimite. I would do this even if you aren’t sure of the diagnosis, but see red bumps that seem to itch. It’s a pretty benign treatment, and imo, the potential of getting scabies or having your child continue to suffer with them in the midst of his/her transition into your care is worse than the treatment. The guidelines are to “treat all contacts,” but unless you’ve waited to initiate treatment with Elimite and have been co-sleeping or living in very close quarters with your child longer than just that first day, it’s highly unlikely you get scabies if you treat right away. So, imo, if you slather your child in Elimite the first night, you shouldn’t need to treat the other family members who were present that first day.
- Put the clothes they were wearing in a separate baggie to wash with high heat when you return home (most people keep that orphanage outfit as memorabilia for their child).
- When your child wakes up, which hopefully doesn’t happen until the next morning (HAHAHA, yeah right!), bath them to remove the Elimite. This should be sufficient to get rid of the scabies. VERY rarely will a child require a 2nd application of Elimite.
However, successfully getting rid of the mite does not ensure you are totally done with this issue. I’m talking about a skin condition called infantile acropustulosis, which is commonly reported after a bout of scabies has been treated. It doesn’t require scabies to have ever been present, but it does often follow a known case of scabies. Initially, it was thought to be a persistent immune response despite the mite having been eradicated. It’s now known that it is not an immune problem, and it’s not a result of the mite recurring. The etiology is unknown and it’s a pretty poorly understood and under-recognized condition. It’s also not contagious. It is more common in darker skinned people and usually presents with vesicles, or fluid-filled bumps, on the palms of the hands and soles of the feet (here are 2 good pictures), although in rare cases the vesicles can be on the trunk, face, or scalp as well. The vesicles itch like hell, and probably cause your baby/child a lot of discomfort. They also seem to be cyclic, so they’ll come and go. Sometimes they last a few days, sometimes longer, and they tend to recur every few weeks. The outbreaks are self-limited, meaning they resolve on their own and there’s really nothing you can do to hasten the resolution. You can treat the symptoms with a topical steroid (like hydrocortisone cream), or an antihistamine. Occasionally, pediatric dermatologists will use dapsone for really severe, refractory cases. Your child will eventually grow out of the outbreaks altogether, thankfully! Most doctors are NOT familiar with acropustulosis, and it’s believed to be underreported because there’s not much awareness about it. Also, many doctors misdiagnose this as a scabies recurrence because they’ve just never heard of it, in which case they’ll have you using Elimite over and over with no results. I had to tell our doctor about the condition, and she’s a really informed physician!
Jackson has acropustulosis, although he hasn’t had a flare in a few months and I’m praying he’s finally outgrown it. During the flares, the itching bugs (no pun intended) the heck out of him. He sometimes comes hopping towards us with 1 foot in the air saying “itch, itch!” On occasion, he even has a hard time falling asleep because his poor little feet itch so badly. On those nights, we give him Benadryl and apply a topical steroid. We’ve learned to cover the hydrocortisone cream with a layer of aquaphor to seal it in so it doesn’t just rub off. That helps a little bit, but it still really stinks when he has an outbreak.
Just out of curiosity, how many of your kids out there have acropustulosis? If so, what did you have to go through to end up at that diagnosis (was your child given several rounds of scabies treatment? skin scrapings? etc.)?