Scabies: Difference between revisions
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==Background== | ==Background== | ||
*Infestation with the Sarcoptes scabiei mite | {{Skin anatomy background images}} | ||
*4- | *Infestation with the ''Sarcoptes scabiei'' mite | ||
**Those previously infected, | *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 | *Not a reflection of poor hygiene | ||
== | ==Clinical Features== | ||
[[File:ScabiesD08.JPG| | [[File:PMC3346911 ad-24-194-g002.png|thumb|Traditional infantile scabies.]] | ||
[[File:PMC3346911 ad-24-194-g001.png|thumb|10-X magnification showing numerous scabies heads (arrows).]] | |||
*Older children / adults | [[File:ScabiesD08.JPG|thumb|Scabies]] | ||
[[File:Scabies-burrow.jpg|thumb|Scabies burrow at high resolution]] | |||
* | [[File:Norwegian_scabies.png|thumb|Diffuse, hyperkeratotic, yellowish papules seen in Norwegian Scabies]] | ||
* | ''Seek history of symptomatic close contacts (human or animal)'' | ||
** | |||
* | ===Infants=== | ||
*Hyperpigmented [[pediatric rashes|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== | ==Differential Diagnosis== | ||
*[[Envenomations, bites and stings|Insect bites]] | |||
*[[Impetigo]] | *[[Impetigo]] | ||
*[[Atopic dermatitis]] | *[[Atopic dermatitis]] | ||
*[[ | *[[Drug rash]] | ||
*[[ | *[[Dermatitis herpetiformis]] | ||
* | |||
{{Ectoparasite DDX}} | |||
{{Travel Skin Conditions DDX}} | |||
{{Maculopapular rash DDX}} | |||
==Evaluation== | |||
*Clinical diagnosis, based on history and physical exam | |||
== | ==Management== | ||
=== | ===General Care=== | ||
* | *Wash all 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 | |||
{{Scabies treatment}} | |||
===Avoid=== | |||
*'''[[Lindane]]''' - effective treatment but associated with potential for toxic manifestations (seizures, neurotoxicity) | |||
**Reserved for refractory cases | |||
==Disposition== | |||
*Discharge | |||
==See Also== | |||
*[[General approach to rashes]] | |||
== | ==External Links== | ||
* | *[https://pubmed.ncbi.nlm.nih.gov/16731272/ Heukelbach J, Feldmeier H. Scabies. Lancet. 2006 May 27;367(9524):1767-74. doi: 10.1016/S0140-6736(06)68772-2. PMID: 16731272. Accessed 13 Jan 2021] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | |||
[[Category: | [[Category:Dermatology]] | ||
[[Category:Pediatrics]] | |||
[[Category:ID]] | |||
Latest revision as of 18:13, 11 December 2024
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
- Papules
- Insect bites
- Scabies
- Seabather's eruption
- Cercarial dermatitis (Swimmer's Itch)
- Macular
- Sub Q Swelling and Nodules
- Ulcers
- Tropical pyoderma
- Leishmaniasis
- Mycobacterium marinum
- Buruli ulcer
- Dracunculiasis (Guinea Worm disease)
- Linear and Migratory Lesions
- Cutaneous larvae migrans
- Photodermatitis
See also domestic U.S. ectoparasites
Maculopapular rashes
- Infectious
- Noninfectious
Evaluation
- Clinical diagnosis, based on history and physical exam
Management
General Care
- Wash all 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
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
Avoid
- Lindane - effective treatment but associated with potential for toxic manifestations (seizures, neurotoxicity)
- Reserved for refractory cases
Disposition
- Discharge