Scabies: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
[[File:PMC3346911 ad-24-194-g002.png|thumb|A 2-month-old infant with scabies.]] | [[File:PMC3346911 ad-24-194-g002.png|thumb|A 2-month-old infant with scabies.]] | ||
Seek history of symptomatic close contacts (human or animal) | [[File:PMC3346911 ad-24-194-g001.png|thumb|10-X magnification showing numerous scabies heads (arrows).]] | ||
''Seek history of symptomatic close contacts (human or animal)'' | |||
===Infants=== | |||
*Hyperpigmented nodules, vesiculopustules, papules may be found in axilla and diaper areas | |||
*May be generalized | |||
*Norwegian | ===Older children / adults=== | ||
*Generalized eruption with linear burrows, papules, pustules | |||
*Predominance in web spaces of the fingers, flexor aspect of the wrists, axillae, groin, nipples, and the periumbilical region | |||
*[[Pruritus]] is classically worse at night | |||
===Norwegian Scabies=== | |||
*In immunocompromised | |||
*Severe disease with diffuse scabies | |||
*Requires multiple treatments | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 22:56, 25 June 2019
Background
- Infestation with the Sarcoptes scabiei mite
- 4-6 week incubation period after initial exposure
- Those previously infected, symptoms begin in 1-3 days (sensitization)
- Type IV hypersensitivity
- Not a reflection of poor hygiene
Clinical Features
Seek history of symptomatic close contacts (human or animal)
Infants
- Hyperpigmented nodules, vesiculopustules, papules may be found in axilla and diaper areas
- May be generalized
Older children / adults
- Generalized eruption with linear burrows, papules, pustules
- Predominance in web spaces of the fingers, flexor aspect of the wrists, axillae, groin, nipples, and the periumbilical region
- Pruritus is classically worse at night
Norwegian Scabies
- In immunocompromised
- Severe disease with diffuse scabies
- Requires multiple treatments
Differential Diagnosis
Domestic U.S. Ectoparasites
See also travel-related skin conditions
Evaluation
- Clinical diagnosis, based on history and physical exam
Management
Adults
- Permethrin 5% cream for all family members[1]
- Apply from neck down
- Leave on for 8-12hr before washing off
- Has 95-98% success rate, may reapply in 1-2wks if incomplete effect
- Ivermectin 200 mcg/kg may be necessary for severe infection
- Also viable option in adolescent or adult with insecure social situation
- Success rate 70%, increases if give repeat dose 2wks after
- Contraindicated in lactating women and children < 15kg
Infants
- Permethrin 5% is FDA approved for > 2 months of age although still recommended for neonatal scabies[2]
- May require application head to toe (avoid mucus membranes)
- Leave on for 8-12 hours, then wash off
Disposition
- Discharge