DERMATOLOGY
TREATMENT
■ Permethrin1% rinse or 5% cream is first-line therapy. All close contacts
should be treated. Clothing, linens, hairbrushes, carpets, sofas, and similar
items should be heated to temperatures of 65°C for 15–30 minutes. Expo-
sure to infested items should be avoided for 2 weeks before reuse.
■ Lindane 1% lotion is second-line therapy. There is concern about neuro-
toxicity causing seizures in children.ScabiesETIOLOGY
■ Scabies is a highly contagious, pruritic skin disorder caused by mite, Sar-
coptes scabiei.
■ The disease is transmitted through direct contact with an infected individ-
ual but less commonly occurs from contact with contaminated objects,
which scabies can live on for 2–3 days.SYMPTOMS/EXAM
■ Mites live within the epidermis of the skin and make tunnels within
the skin for laying eggs. Burrowsare wavy, threadlike, grayish white and
1–10 mm in length is a pathognomonic sign.
■ Intense pruritus and small erythematous papules with associated excoria-
tions are also common.
■ Typical sites of involvement include the interdigital web spacesof hands
and feet. Penile and scrotal lesions are common in men. Areolae, nipple,
and genital areas are commonly affected in women.
■ If mite burden becomes high (millions) a form called crusted scabies
develops and an immunocompromised state should be suspected.TREATMENT
■ Topical scabicides should be applied from head to toe, excluding scalp.
Fingernail areas, web spaces, and the umbilicus should be thoroughly
treated.Permethrin,5% cream or lindane, 1% lotion are equally effective
if left on overnight. Lindane is neurotoxic in infants, children, and preg-
nant mothers. All close contacts should be treated and linens washed and
dried in a drier on high heat. A second treatment should be done 7 days
after the first to kill any nymphs that have hatched from eggs.
■ 5–10% precipitated sulfur in petrolatum base has been used in pregnant
women because of its presumed low toxicity.
■ Pruritus and lesions can persist for 2–4 weeks after successful treatment
due to irritant reactions against residuum of dead mites.