Scabies: Difference between revisions
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==Background== | ==Background== | ||
*Infestation with the Sarcoptes scabiei mite | *Infestation with the ''Sarcoptes scabiei'' mite | ||
*4-6 week incubation period after initial exposure | *4-6 week incubation period after initial exposure | ||
**Those previously infected, sx begin in 1-3 days (sensitization) | **Those previously infected, sx begin in 1-3 days (sensitization) | ||
| Line 6: | Line 6: | ||
*Not a reflection of poor hygiene | *Not a reflection of poor hygiene | ||
[[File:ScabiesD08.JPG|thumb|Scabies]] | |||
[[File:ScabiesD08.JPG| | |||
[[File:Scabies-burrow.jpg|thumb|Scabies burrow at high resolution]] | [[File:Scabies-burrow.jpg|thumb|Scabies burrow at high resolution]] | ||
==Clinical Features== | |||
Must elicit history of symptomatic close contacts (human or animal) | Must elicit 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 | *Older children / adults | ||
**Generalized eruption w/ linear burrows, papules, pustules | **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 | **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 | **Pruritus is classically worse at night | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*[[Envenomations, bites and stings|Insect bites]] | |||
*[[Impetigo]] | *[[Impetigo]] | ||
*[[Atopic | *[[Atopic dermatitis]] | ||
*[[Drug rash]] | |||
*[[Drug | *[[Dermatitis herpetiformis]] | ||
*[[ | |||
{{Ectoparasite DDX}} | {{Ectoparasite DDX}} | ||
== | ==Diagnosis== | ||
*Clinical diagnosis, based on history and physical exam | |||
==Management== | |||
{{Scabies treatment}} | {{Scabies treatment}} | ||
== | ==Disposition== | ||
*Discharge | |||
==References== | |||
<references/> | <references/> | ||
[[Category:Derm]] | [[Category:Derm]] | ||
[[Category:Peds]] | [[Category:Peds]] | ||
Revision as of 02:39, 11 August 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
Clinical Features
Must elicit 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 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
Differential Diagnosis
Domestic U.S. Ectoparasites
See also travel-related skin conditions
Diagnosis
- 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