Scabies

Scabies

What is scabies?

Scabies is a very common, highly contagious but curable skin disease that affect millions of people each year. It is caused by a tiny mite, just barely visible to the naked eye. Scabies is passed on between people through close physical contact, such as between family members, sexual partners, and children playing at school. It is best to treat everyone that has been exposed within the same 24-hour period to avoid reinfestation.

 Common disease
 Rapidly increasing prevalence
 one third of a billion people worldwide
 Often misdiagnosed
 Atypical presentations of common disease
 Easily curable
 Excellent prognosis

Differential Diagnosis:

 eczema
 folliculitus
 drug reaction
 papular urticaria

 animal scabies
 delusions of parasitosis
 neurotic excoriations
 idiopathic pruritus
 other parasitic infestation
 pityriasis rosea

Diagnosis:

 Primary lesions: burrows, vesicles, papules, bullae, nodules
 Burrow essentially diagnostic of scabies
 Secondary skin changes from scratching common
 Diagnostic gold standard remains adult mite on microscopy
 Minimal patient data should include multiple skin scrapings
 Always ask about other family members with itch/rash

Treatment:

 Croatimiton
 Benzyl Benzoate
 Oral Ivermectin ( off- label use)

How to treat Scabies:

1. A bath or shower is not recommended before applying Elimite cream.

2. Before bedtime, thoroughly and gently massage the cream into all skin surfaces, from your neck to the soles of your feet. It is extremely important to apply the cream on every inch of your body, not just where the rash is.

3. Apply cream between fingers and toes creases, in the folds of the wrist and waistline, in the buttock cleft, on the genitals, and in the belly button.

4. Keep your nails trimmed short, because scabies mites can hide under fingernails.

5. Use a toothpick to apply the cream under your fingernails and toenails.

6. Leave Elimite cream on for 8-14 hours, then remove it in the morning by bathing and shampooing. You may notice a mild itching, or stinging sensation after applying Elimite cream. This is usually a temporary reaction to the medication.

7. If you wash your hands or any other area of your body during the treatment period, new cream must be applied immediately.

8. It is not unusual for itching and rash to continue for as long as 2-4 weeks after treatment. These symptoms may be a temporary sensation to the remains of the mites. This does not mean that the medication didn’t work or that it needs to be reapplied.

9. If you feel that the itching and rash are excessive or persistent, talk with your doctor.

10. Special: for infants and younger children, elderly and immunocompromised- apply the cream into the neck, hairline, temples, and forehead.

11. Avoid contact with your eyes- flush immediately if this happens.

12. Hot soapy water laundering of all towels, linens, and all clothes used within the past 48 hours is typically sufficient to clear out the mites. Unworn clean clothes don’t need to be laundered.

13. Your doctor may have you repeat all of the above steps once.

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