Scabies: Difference between revisions

Revision as of 20:42, 17 June 2015

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

Scabies

Scabies burrow at high resolution

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

Permethrin 5% cream neck down leave 8-12hrs repeat 1-2wks 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 200mcg/kg PO repeat in 2wks
- 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

Permethrin 5% cream, apply head to toe (avoid mucous membranes), leave 8-12hrs, wash off; repeat in 1-2 weeks
- FDA approved for >2 months of age; also recommended for neonatal scabies
Ivermectin 200mcg/kg PO, repeat in 2 weeks; only for children >15kg

↑ Strong M. Johnstone P. Interventions for treating scabies. Cochrane Database Syst Rev. 2007;(3):CD000320

Authors:

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 ==Treatment==
-===Adults===
+{{Scabies treatment}}
-*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
-**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 <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==