Within the hustle and bustle of school buildings, where close contact is inevitable, and shared spaces are the norm, a tiny, eight-legged mite, invisible to the naked eye, can wreak serious havoc: scabies. This persistent parasite doesn't just disrupt learning and cause sleepless nights for students but can lead to social isolation and misunderstanding, significantly impacting entire school communities. However, with keen assessment skills to catch cases early, compassionate communication to inform without alarming, and preventative measures to build a school-wide defense system against infestation, school nurses can break the cycle of scabies stigma and spread.
Understanding Scabies
Scabies is caused by the human itch mite, a microscopic parasite that burrows into the upper layer of the skin to live and lay its eggs. Mainly transmitted through extended direct skin contact with someone who is infested, it can also spread, though less frequently, through the sharing of items such as clothing, towels, or bedding. The mites cannot jump or fly but can crawl and are able to survive for up to 72 hours when separated from a human host. It's essential to highlight, especially when educating your school community, that scabies are not a reflection of poor hygiene and can impact anyone.
Recognizing Signs & Symptoms
When students report to the school health office complaining of persistent itching or present with atypical dermatological manifestations, it's important to consider scabies as a potential etiology. The hallmark symptoms of scabies include severe itching, particularly worsening at night, and the development of a rash resembling small pimples, often with thin, elevated, wavy, grayish-white burrows containing mites and eggs. Common sites for burrows include between the fingers and toes, knees, wrists, elbows, armpits, and in or around the belly button. If scabies is suspected upon assessment, the student should be referred to their primary care provider for further evaluation, treatment, as necessary, and further instructions for cleaning the home environment.
Treatment & Interventions
The primary therapeutic approach for scabies infestation involves the administration of scabicidal agents, available by prescription only. The CDC recommends simultaneously treating all household members and close contacts to prevent re-exposure and re-infestation. Following successful scabicidal therapy, some students may experience persistent itchiness for an extended period, a phenomenon known as "post-scabetic pruritus." In line with school policies, and with appropriate orders in place, school nursing interventions for persistent itchiness may include OTC 1% hydrocortisone cream or cold compresses.
School Management
While state guidelines and school policies may differ slightly, in general, according to the American Academy of Pediatrics (AAP), students should "not be sent home early from school because of scabies," and if treatment is started before the next school day, no exclusion is necessary. For students suffering from "post-scabetic pruritus," school nursing interventions, in accordance with school policies, may include the administration of OTC 1% hydrocortisone cream or application of cold compresses, as well as a firm reminder to students to avoid scratching, which can lead to secondary bacterial infections. Additionally, any symptomatic staff providing hands-on care may need disposable gloves for several days after treatment. School nurses should work closely with their local health department to identify and implement appropriate measures to prevent scabies transmission and determine if broader communication is necessary.
In understanding this common contagious skin infestation and establishing evidence-based scabies management protocols, school nurses once again weave protection, education, and care into the daily lives of the students they serve.
