Scabies is a contagious skin infestation by the mite identified as Sarcoptes scabiei. The mites reside on the surface of the skin but create burrows in the skin to lay eggs. Patients present with intense itching (particularly at night) and redness of skin. Often scabies is associated with secondary bacterial infection from skin damage due to scratching and skin infection may be the presenting condition due to poor reporting. It is endemic in tropical areas.
Medications:
- Cream Permite 5% (Permethrin 5% w/w) at bedtime, massage into the skin from the neck to the soles of the feet for 3 consecutive nights and reapply after 1 week.
- Soap Permed (Permethrin 1% w/w) to be used daily.
- Tab. Okacet (Cetirizine 10 mg) 1 tablet at bedtime for 7 days.
For resistant cases
- Tab. Ivermectol 12 (Ivermectin 12 mg) – For mild cases – 1 tablet on day 1, 2 and 8. For moderate cases – 1 tablet on day 1,2,8,9 and 15. For severe cases – 1 tablet on day 1,2,8,9,15,22 and 29 (contraindicated in pregnancy).
General advice:
- Careful personal hygiene is paramount.
- Treat the whole family as it is highly infectious.
- Wash in hot water and dry all clothing and bedding used in the last 48 hours.
- Items that cannot be washed can be placed in a plastic bag for 72 hours.
- Disinfection of whole house including furniture.
- Warn the patient about risks of re-infections.
Investigations:
Diagnosis is mainly clinical. Microscopy from skin scrapping can show scabies mites.
Further referral:
Refer to dermatologist in resistant cases or when diagnosis is in doubt.