Q: My daughter picked up scabies at her day care center. How should I treat it? And what can I do to make sure she doesn't get infected again?

A: Scabies is a skin infestation by tiny, parasitic insects called mites. It causes intense itching. When a person catches scabies, female mites lay eggs in the person's skin. The eggs hatch, mate and lay more eggs, continuing the cycle.

Basically, the person is the new home for the scabies mites. The person's skin becomes the "nest" where the mothers raise their babies. However, the mothers are not very loyal; they're always looking for a new home. In other words, scabies is very contagious.

Scabies mites can be spread by direct skin-to-skin contact with an infected person. They can also be transmitted through clothing, blankets, sheets, towels or furniture that has touched an infected person's skin. It's common for kids to catch scabies in day care centers or schools.

Your daughter's doctor can perform diagnostic tests. Usually, though, the visual appearance of the skin and the severe itching are the circumstantial evidence that leads to treatment. If there have been other cases of scabies in your daughter's day care center, that makes the diagnosis even more likely.

The doctor can prescribe various topical medications to apply to treat your daughter's scabies. These include permethrin (Nix, Elimite), lindane (Kwell, Scabene) and crotamiton (Eurax). If your daughter is an infant or otherwise sensitive to these medications, her doctor may recommend sulfur in petroleum.

Topical scabies medications should be applied from neck to toes after bathing, left on the skin for 8 to 14 hours, and then washed off. In some cases, a second application may be necessary.

Your daughter should stop being contagious within 24 hours. Her symptoms should improve noticeably within two days. In the meantime, to help control her itching, apply calamine lotion. If itching keeps her awake, ask her pediatrician about giving her diphenhydramine (Benadryl) by mouth. But some pediatrician colleagues of mine don't like to prescribe this medicine to kids younger than 4 years old.

You and other family members must be treated for scabies as well, even if you have no symptoms.

In addition, you should wash all of your daughter's clothing, bedding and towels in hot water and dry these items in a hot dryer. This should kill all scabies mites and eggs. Clothing that cannot be washed should be sealed and stored for one week.

To help prevent your daughter from catching scabies again, do not allow her to share clothing or towels at her day care center. Also, provide a pillow and blanket from home that your daughter can use at the day care center.
