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Microscopic insect infestation, ruled out lice and scabies, prescribed permethrin, not a delusion

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I have an infestation of some kind of mircroscopic insect on my body. It bites, is VERY active at certain times of the day but generally I am aware of its presense most of the day. Its all over my body with excess activity in my eyebrows, eyelashes, nostrils and ears and at the corners of my mouth--initially it was like legions of the little things swarming in those areas--less so now because I clean myself at least 2x/day, i bag in tight plastic all bedding, clothing and towels until I can wash them which is about 3x/week in the hottest and longest wash cycle at the laundromat and dried on high for 30-50 minutes. I clean the floors a couple times/ week and have just started treating my cat with selamectrin since he now seems to have what I have.
I rule out lice and a naturpathic doctor ruled out scabies but said it was some kind of mite; he provided me with some herbs that have curbed the infestation but I'm not sensing it to be very effective. A dermatologist couldn't get a sample and discredited the samples I brought in which i suspect are egg sacs acquired after a home remedy treatment (I slather myself with mayo and keep it on 1-3 hours) that appears to force them out of hair folliculs--soffocation perhaps. These things show up as white, almost rice-like sacs and XXXXXXX granules after this treatment. The dermatologist prescribed 5% permethrin but it only seems to stun them and very temporarily--early on I used 3 tubes as prescribed over 3 weeks---this has now been going on for 6 full weeks.
Initially I think the source was from the basement of my home from which I was moving and sorting through boxes of very old (some 30 yrs old) paper stuff, condencing it or preparing it for shredding. Unfortunately I brought it to my new place, an apartment, as I didn't have time to sort through it all at the old house.
Help!! This IS NOT a delusionary experience--some doctors can't say they don't know what is happening so they slap on the diagnosis 'delusions of parisitosis' or whatever. My body is now covered with bites, red pin prick marks, odd tiny bruises, and black specs embedded in my skin, in addition to the sensations.
Currently my line of thinking is that everything topical and all the cleaning only maintains some bit of control over the population and that if I can change the pH balance in my body--increase oxygen--I may be able to make myself less inviting (I'm just learning pH balance). Online there are discussions about demodex mites-- suffers of which seem to have very similar symptoms to mine---also they have few answers that help.
Any tips I deeply appreciate. Thank you.
Posted Mon, 25 Jun 2012 in Skin Hair and Nails
Answered by Dr. Anil Grover 10 hours later
Thanks for writing in. I am a medical specialist with a sub specialty degree in cardiology. I read your email with diligence and I agree with you that this not delusional experience.

With a previous suspected diagnosis of Scabies, that is my number one possibility. Let me review it for you. Please postpone sorting of old house for few weeks and concentrate on treatment of this malady.

A small, eight-legged mite called Sarcoptes scabiei causes scabies. Scabies spreads by close physical contact and is common in school-age children. The mites and their eggs may live on clothes or bed linen for 1-2 days.
Signs and symptoms:
It is often difficult to diagnose scabies because the symptoms vary and the signs can be very subtle. Commonly, the symptoms include:

1. Bullae - raised, clear fluid-filled spot or lesion that are bigger than 1cm in diameter
2. Papules - solid, raised areas of skin with distinct borders less than 1cm in diameter
3. Pustules - raised, fluid-filled spot that appear yellow
4. Vesicles - raised, clear fluid-filled spots
Lesions or spots are areas of skin disease and are generally small.

A number of mites burrow into the skin, particularly between the fingers, around the wrists and elbows, the armpit, nipples and penis. In infants and young children, there are often vesicles and pustules on the palms and soles and sometimes on the scalp. The allergic reaction to these mites causes the rash and symptoms.

Sometimes the only symptom is an itch, without a rash. Usually the itch is worse at night and after a hot bath or shower. Bathe in warm water as hot water may make the itching worse.
Your doctor may make a diagnosis by scraping a burrow and looking at that skin under a microscope. Scabies may be easier to diagnose by rubbing a black marking pen over a suspected burrow and then wiping it off with an alcohol swab. This leaves a burrow outlined with the ink from the pen.
You and all your close contacts should be treated at the same time.
5% permethrin cream is recommended and should be applied to all body surfaces from the neck down (paying particular attention to hands, under the nails and the genitals) and left on overnight. This medicine can be bought from a pharmacy.
Treatment should be repeated a second time, 1 week later.
To an uncommon situation you have are the lesions above neck:
In central and northern Australia (rather uncommon in the USA), in older people (older than babies), scabies above the neck is common. This means treatment should also be applied to the face and hair (carefully avoiding the eyes, nose and mouth), you can paint eyebrows, face avoiding lips and inside of mouth and nose.
Bedding and clothing should be washed in hot water and if possible, dried in a machine on a hot setting.
Items that cannot be washed and dried this way can be put in air-tight containers or bags for 36 hours or in the freezer for a couple of days.
Infected children can return to school when two treatments - one each week for two weeks - have been completed.
Do not apply the initial treatment more than twice. The itching caused by scabies may take up to three weeks to go away after treatment. In fact, the treatment itself may cause some irritation. Your doctor can prescribe a corticosteroid cream for this if needed.

Sometimes nodules (raised, solid lesions) caused by scabies can last for months, even with the corticosteroid cream. If this happens, see your doctor for further treatment.

Key points to remember:

Scabies is spread by close physical contact.
The mites and their eggs may live on clothes or bed linen for 1-2 days
5% permethrin cream is recommended and should be applied to all body surfaces.
Treatment should be repeated a second time, 1 week later.

With prescription from your doctor, you can try this before switching to Naturopathy if not cured.

With Best Wishes.

Dr Anil Grover
Above answer was peer-reviewed by
Follow-up: Microscopic insect infestation, ruled out lice and scabies, prescribed permethrin, not a delusion 22 hours later
Thanks for your response Dr. XXXXXXX However, I have already used 3 tubes of 5% Permethrin as prescribed by the dermatologist. I realize that itchiness and sensations of bugs can continue well after the treatment.....but this is not a residual, allergic type sensation that I experience---this is a very active/alive crop of pests undaunted by the Permethrin.
I really don't have any of the 'burrow' marks associated with scabies. Do you have any other ideas of what this can be? Thanks in advance.
Answered by Dr. Anil Grover 23 minutes later
You have had scabies in past, this time your signs and symptoms were not inconsistent with scabies and your dermatologist thought the same therefore scabies was kept as first possibility. Some features may not be visible to naked eye hence the use of magnifying glass (as looking for burrows) is helpful, and allergic type reaction can mimic practically any skin lesion. The list of other drugs, which you can get prescribed are as follows:

1. Ivermectin is an oral medication is effective in eradicating scabies. It is the treatment of choice for crusted scabies and is often used in combination with a topical agent. Topical ivermectin preparations have been found to be effective.
2. Benzyl benzoate
3. Crotamiton
4. Malathion, and
5. Sulfur preparations

If your dermatologist thinks that it is not scabies, following is the text book differential diagnosis of diseases which can mimic some of your symptoms. Your doctor will be in best position to make a final call on these two issues (whether it is scabies resistant to drug Premethrin or it is something else like

1. Dermatitis- non specific
2. Urticaria-related syndromes,
3. Allergic reactions
4. Ectoparasites such as lice and fleas; lastly- unlikely in your case
5. Syphilis

I hope this information will be helpful. If you have a followup question, I will be most happy to answer.

Dr Anil Grover
Above answer was peer-reviewed by
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