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Scabies  Requires  A Visit to  The Doctor

Dear Dr. Roach: I’m writing because I’ve never seen any mention of scabies in your column. I desperately need help to get rid of it. This has been on my skin for five months. I’ve been to two doctors, but they didn’t help at all. I’m very embarrassed about it. I’m not a dirty person. I’m pretty sure I got it from a camper that we borrowed. Please, please tell me how to take care of this awful thing and make it go away. I’m depending on you. — I.H.

Answer: Scabies is a skin infection caused by a small species of mite. It is very contagious. It may be spread skin-to-skin or by sharing clothing or bedding. After exposure, the mites burrow into the skin and deposit eggs. The burrow looks like a small, dark dot.

The body becomes allergic to these mites after a few weeks, at which point they become very itchy. Itching tends to be worse at night. The most common places on the body to have symptoms include the webs between the fingers, wrists, genitals and abdomen.

Treatment of scabies is with prescription-strength, 5 percent permethrin. The cream is applied to the entire body from the neck down and left on for 12 hours, then washed off. It is very important to sterilize all clothing and bedding at the same time to avoid reinfection. It is very common for multiple family members to be infected, so everybody (and their clothing and bedding) needs to be treated at the same time.

I have seen several cases that needed repeat treatments. Resistant cases, especially in someone with an immune disorder, may need treatment with a pill. Treatment for scabies in all cases needs a visit to the doctor. Itchiness continues after treatment because the allergens are still present, but this should go away within two weeks.

I should caution you that the mind is very powerful. The first few cases of scabies I saw as a doctor caused me to feel itchy all day — even though I knew that it was all in my head, it didn’t stop me from feeling itchy. There are many cases where the person is so convinced they have scabies that they itch and scratch, which itself causes the skin to be itchy, and the cycle continues. You need to be sure you actually have scabies, so a visit with the dermatologist, who may need to do a biopsy to be sure, is the right thing for you to do, given how long it has been going on.

Dear Dr. Roach: As my son matured to about the age of 45, his stomach seemed to get very large and protrude from under his rib cage. Is this due to not getting enough exercise? No one else in the family has this feature. — R.E.

Answer: Abdominal obesity is more common in men. This pattern is sometimes called an “apple” shape, as opposed to women, who more frequently gain weight in their hips and thighs (“pears”).

Abdominal obesity is associated with a much higher risk for heart disease. It also predicts a higher risk of diabetes, high blood pressure and bad cholesterol numbers.

Getting rid of the abdominal fat isn’t easy, and requires both more exercise and better eating for the best chance. Fortunately, even five or 10 pounds of weight loss can reduce the risk of heart disease.

Dear Dr. Roach: I am 88 and in good condition, except for one problem e_SEmD my balance. I haven’t fallen, but I worry about falling. Do you have any exercises to improve balance? — R.M.

Answer: Balance depends on a complex coordination of input coming from the ear’s balance organ, the eyes’ interpretation of the terrain and sensors in the legs and feet. Balance is not as good in older ages as it once was. A simple balance exercise is heel-to-toe walking. When taking a step, put the heel of one foot in front of the toes of the other foot. Keep walking in this manner for at least a couple of minutes. If it makes you wobble, get a partner who can steady you.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at P.O. Box 536475, Orlando, Fla. 32853-6475.