Scabies: Difference between revisions
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*Permethrin 5% cream for all family members<ref>Strong M. Johnstone P. Interventions for treating scabies. Cochrane Database Syst Rev. 2007;(3):CD000320</ref> | *Permethrin 5% cream for all family members<ref>Strong M. Johnstone P. Interventions for treating scabies. Cochrane Database Syst Rev. 2007;(3):CD000320</ref> | ||
**Apply from neck down | **Apply from neck down | ||
**Infants may require | **Infants may require application to scalp/face (avoid mucus membranes) | ||
**Leave on for 8-12hr before washing off | **Leave on for 8-12hr before washing off | ||
**Has 95-98% success rate, may reapply in 1-2wks if incomplete effect | **Has 95-98% success rate, may reapply in 1-2wks if incomplete effect | ||
*Ivermectin | *Ivermectin 200 mcg/kg may be necessary for severe infection | ||
**Also viable option in adolescent or adult with insecure social situation | **Also viable option in adolescent or adult with insecure social situation | ||
**Success rate 70%, increases if give repeat dose 2wks after | **Success rate 70%, increases if give repeat dose 2wks after | ||
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*Wash linens/clothes in hot water or bag bulky items and keep sealed for 2wks | *Wash linens/clothes in hot water or bag bulky items and keep sealed for 2wks | ||
*Pruritus may continue for weeks despite successful elimination of infestation | *Pruritus may continue for weeks despite successful elimination of infestation | ||
**Consider steroids for symptom relief | |||
===Infants=== | ===Infants=== | ||
*Permethrin 5% is FDA approved for > 2 months of age although still recommended for neonatal scabies <ref>Subramaniam S. Rutman MS. Wnger JK. A papulopustular, vesicular, crusted rash in a 4-week old neonate. Pediatric Emergency Care. 2013;29:1210-1212</ref> | *Permethrin 5% is FDA approved for > 2 months of age although still recommended for neonatal scabies <ref>Subramaniam S. Rutman MS. Wnger JK. A papulopustular, vesicular, crusted rash in a 4-week old neonate. Pediatric Emergency Care. 2013;29:1210-1212</ref> | ||
===Avoid=== | |||
Lindane - previous treatment but associated with potential for toxic manifestations; seizures | |||
==Source== | ==Source== | ||
Revision as of 12:39, 26 January 2015
Background
- Infestation with the Sarcoptes scabiei mite
- 4-6 week incubation period after initial exposure
- Those previously infected, sx begin in 1-3 days (sensitization)
- Type IV hypersensitivity
- Not a reflection of poor hygiene
Diagnosis
Must elicit history of symptomatic close contacts (human or animal)
- Older children / adults
- Generalized eruption w/ 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
- Infants
- Hyperpigmented nodules, vesiculopustules, papules may be found in axilla and diaper areas
- May be generalized
Differential Diagnosis
Domestic U.S. Ectoparasites
See also travel-related skin conditions
Treatment
Adults
- Permethrin 5% cream for all family members[1]
- Apply from neck down
- Infants may require application to scalp/face (avoid mucus membranes)
- 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
- Wash linens/clothes in hot water or bag bulky items and keep sealed for 2wks
- Pruritus may continue for weeks despite successful elimination of infestation
- Consider steroids for symptom relief
Infants
- Permethrin 5% is FDA approved for > 2 months of age although still recommended for neonatal scabies [2]
Avoid
Lindane - previous treatment but associated with potential for toxic manifestations; seizures