Ask a doctor on the topic of Dermatology

Demodex mites or scabies or what could it be

May 30, 2016 | 15,00 EUR | answered by Dr. med. Ive Dr. Schaaf

Good day,
For 2 months now I have been suffering from itching without a rash, pain, or visible "bite wounds". About 3 months ago, I got a puppy, which was infested with Demodex mites in numerous spots about 7 weeks ago (she received bravecto), and she was also very "wormy" which was only fought after a 3-fold worm treatment. My itching started at some point at night in the eyelashes. It was more like a tingling, as if something was moving in the eyelashes (at that time I still didn't know about the dog's illness), but I fell asleep again, it repeated every night, along with this feeling (itching/tingling) in the eyebrows, armpits, ears, nose. I used tea tree oil later neem oil, without success. Now the veterinarian diagnosed me. So appointment with the dermatologist: Diagnosis I would definitely be allergic to the dog + pollen, should take Ceterizine and eye ointment (cortisone), my question whether I have been infected with mites was laughed at. In the following nights, the itching repeatedly woke me up from sleep, now the vaginal and anal area also itched. Ophthalmologist: short-distance diagnosis without, for example, ever folding the eyelid or the like. I had dry eyes, due to menopause (46 years) Should moisturize eyes and not convince myself with the mites (as already mentioned I didn't know anything about the mites when my symptoms first occurred). General practitioner said that this is a matter for the dermatologist. At my own expense, I had a blood test done in the laboratory, IGE slightly elevated, which could indicate an allergy/parasitic infestation. Recommendation from there, worm treatment Mebendazole 3x2 tablets, done, stool without worms. Blood test for dog dander and house dust mites negative. I switched my cosmetics to pH neutral, fragrance-free, etc. Still no improvement. Rugs out, gave away the dog for 2 weeks, everything washed and cleaned. No improvement! In the meantime, these areas tingle/itch so strongly, especially the covered, dark areas and especially at night, that I can't just fall asleep again. When I get up, it eases a bit. The rest of the body is also starting to itch somehow completely, but without this feeling that something is crawling on me. I am considering now to cream on suspicion against scabies: Permethrin or Crotamitex or Benzyl benzoate...... No one prescribes me the medication Ivermectin. I made an appointment at a clinic 300 km away, specializing in itching, but that is only in August and until then I will surely go crazy. Tips/ideas, what I could have. And if so, how do I get rid of it. Thank you very much!

Dr. med. Ive Dr. Schaaf

Hello,

You are obviously aware that it is not possible to make a diagnosis from a distance, so I am hereby fulfilling your request for a tip:

1. It could be Pseudoscabies
Quote (source: http://www.allgemeinarzt-online.de/a/1571730)
As... a differential diagnosis, pseudoscabies should be considered, which is transmitted by "animal mites", especially from dogs and cats. Tunnels are absent and the papules and papulovesicles are very similar to an insect bite reaction. Humans are a false host, so only symptomatic therapy with topical corticosteroids is sufficient.

2. It could be an atypical infestation with scabies
5% permethrin cream is the treatment of choice in all age groups. A second treatment after eight to ten days is recommended.
The ivermectin you inquired about is reserved for difficult cases and is not approved in Germany. It can be obtained as an import from France or the Netherlands under the trade names Stromectol® or Mectizan®.

3. It could be lice, they like to infest the hairy region, although the infestation of all hair except for those on the head that you described is unusual, but it does occur more often with pubic lice for example.
You can make the diagnosis yourself by looking for bugs and especially for eggs. They look like dandruff, but "stick" to the hair and do not come off like normal dandruff.
To find pubic lice, however, you need a magnifying glass or a dermatoscope. The treatment is the same as for head lice.
The eggs are removed mechanically, either with a lice comb or with tweezers or by shaving.

You probably want to know what to do now.
My suggestion:
First check with a magnifying glass to see if you can find any eggs. Then treat for lice.
If no eggs are found, I would probably first use permethrin. It helps with just one application, and if not, then lice are ruled out and pseudoscabies remains as a last option.
You can get hydrocortisone cream over the counter at the pharmacy. This cortisone is relatively weak but also relatively safe in terms of possible side effects. In any case, the face is considered a "forbidden zone" for cortisone, as well as the genital area and other mucous membranes. Cortisone can be applied here, but ONLY a little and only for a short time, because the skin absorbs cortisone much more strongly here than elsewhere.

I hope I could help you further.

Dr. Schaaf