OUR BODIES, OUR MINDS

by

Harvey Thompson, M.D. "Mighty Mites"

AIDS is not the only epidemic in the Gay Community. Scabies has even a larger scope: a "pandemic" with world-wide resurgence. The last epidemic of scabies was in the early 6-'s, and the present pandemic began in the last few years.

About every 20 years, Sarcoptes scabiei mites swarm over human skin like locusts to feed, have sex, and drop BM's on the pink pastures that only humans can provide. Dogs and other beasts develope their own dining clientele, and don't seem to exchange this guest on their lists with human hosts.

The itch mite was dicovered in 1687. In fact, scabies was the first disease of man to have its cause microscopically uncovered. Scabies is not the same as crab infestations; Crabs are lice with three legs, while scabies is caused by four-legged mites.

Smaller than the period at the and of this sentence, the mighty mite has an interesting life cycle that's important to understand if you don't want to be a part of it. The mite walks about an inch per minute over the skin. Although mites are blind and have no eyes, they seem to prefer certain crevices of the body: the web spaces of the fingers, the wrists, the genitals, the buttocks, and the belt line.

The young female mite copulates with the male on the skin surface. Perhaps from shame or embarassment, the young bride then burrows into the skin within a hour of copulation. There, she begins the prodigious task of laying two or three eggs per day, each almost half her size.

The population grows from the larvae which hatch from the eggs of the female. These change to young nymphs which soon become adult females who go on to consummate their marriages and continue

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the cycle just as their mothers did. Interestingly, the male seems to be relegated to forever wandering around the surface of the skin looking for blind dates.

Most probably, mites live off intercellular lymph-like fluid and not blood, since capillaries do not extend into the horny stratum corneum level that mites prefer. Fecal pellets (scybala) are left behind as the female mite burrows further and deeper. The burrow must constantly be extended, since the epidermal layer is constantly sloughed off. After thirty days of this domestic routine, Mama mite dies, and since the eggs take only three or four days to hatch, she leaves numerous decendants.

The legacy to the host is itching. Commonly, the itch is intense enough to waken the sufferer from a sound sleep. Scratching can be severe enough to start bleeding."

The amount of itching doesn't necessarily correlate with the density of mite population. Probably, most of the itching is due to an allergic reaction to the mites, their eggs, or their feces.

Scabies diagnosis is difficult, but important clues are: 1) Night-time itching; 2) Symptoms in your bed partner; 3) a slow, rather than sudden onset; and 4) a typical constellation of eruptions. Usually, the rash is never on the face or scalp. A helpful clue is its varied manifestations, all at the same time: popules, burrows, vesicles, crusts, pustules, or excoriations.

The phyician may try to demonstrate the mite, its eggs, or its feces microscopically by scraping a burrow. However, treatment is often begun on strong suspicion because of a typical history and appearance.

The treatment is the simplest part: Lindane applications. Unlike the case for crabs, there is no over-thecounter medication for scabies. Lindane should be left on overnight to kill the mites and their eggs. However, the itching may continue for weeks as the mite pieces persist as

as antigens to continue the established allergy. This prolonged course most likely accounts for the well-known phrase "the seven-year itch".

Scabies is spread by close personal contact, but the transmission is incompletely understood. Sex is not required for human spread: even a handshake might do. Beauty and mites are both only skin deep.

During World War II, volunteers slept in beds used the night before by scabitic patients. The sheets contained as many as fifty adult female mites, but most volunteers never developed the disease. Fomites, or inanimate objects such as bed clothes, may not be good transmitters of the condition. However, it is medicine's party line to have patients run sheets and underclothing through the hot cycle of the laundry. On the other hand, washing all the clothes in the house is unnecessary.

Editor's Note:

Dr. Thompson, and his partner, Dr. Pomerantz, have been very active in alerting the non-Gay community to the AIDS crisis. In recent weeks, they have particiapated in medical conferences and grand rounds at University of California at Davis Hospital and Health Center, Sutter General Hospital, Kaiser Hospital, and Sacramento Medical Assistance Society, Sacramento Oncology Nurses Association, Sacramento Blood Bank, and American River College's Sex Education Classes.

Both have appeared on all TV stations and several radio shows in their area, and work in close cooperation with Gay community groups to make sure that the most recent information is available to all of

Us.

We urge all Gay health care professionals to continue this educational effort.

FUN FACT

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sexes.

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