Special Operations Forces Medical Handbook

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wound care to minimize scarring; Dapsone 100 mg po to decrease the necrotic reaction; treat for shock as
needed (see Shock chapter).

Patient Education
General: Most patients recover fully in 2-3 days from a BW bite, but it has been fatal in children.

Follow-up Actions
Evacuation/Consultation Criteria: Urgently evacuate unstable patients including those with systemic
reaction to BR bite. Advanced treatment of bites, including antivenin, requires evacuation to a medical
treatment facility.

Skin: Scabies

MAJ Daniel Schissel, MC, USA

Introduction: Scabies is a transmissible parasitic skin infection caused by the mite (Sarcoptes scabiei) and
is characterized by superficial burrows, intense pruritus and secondary infections. The female mite tunnels
into the epidermis layer and deposits her eggs along the burrow. Scabies is most commonly transmitted by
skin-to-skin contact with an infected person and has a worldwide distribution.

Subjective: Symptoms
Continuous low-grade pruritus of the genital areas (to include nipple region in females) with increased itching
at night.

Objective: Signs
Using Basic Tools: Papules, vesicles, and linear burrows intermingled with or obliterated by scratches, dried
skin, and secondary infection. The burrow is the home of the female mite, the papules are the temporary
invasion of the developing larvae, and the vesicular response is believed to be a sensitization to the invader.
The primary locations of invasion include the web spaces of the ngers and toes, the axillae, the exures
of the arms and legs, and the genital regions (to include the nipple region of females). The head and face
are commonly spared. The papules of the genital region may persist for weeks to months after the mite
has been cleared.

Assessment: Diagnosis based on clinical exam and laboratory/provider isolating evidence from the
patient of an infestation-"scabies prep".
Differential Diagnosis - irritant or allergic dermatitis, arthropod bite reaction, eczematous dermatitis (see
appropriate sections).

Plan:
Treatment
Primary:

1. Apply permethrin 5% cream (Elimite) from the neck down and leave on the skin overnight.


2. Clip the nails and scrub under the distal nail to dislodge any excoriated mites.


3. Change and wash all undergarments and bedding in hot water prior to showering off the permethrin
   cream. Dry-clean (or seal in an airtight bag for 2 weeks) clothing items that cannot be washed.


4. Treat all family members and personal contacts at the same setting.
   Alternative: 6-10% sulfa in Vaseline, 10 % crotamiton (Eurax), 1.0% gamma benzene hexachloride
   (lindane/Kwell); oral Ivermectin has recently been approved.
   Secondary: Relieve pruritus with oral antihistamines, cool baths or compresses, and topical steroids. Topical
   antipruritics like saran lotion or prameGel are alternatives.

Patient Education
General: Do not clean the hair or body excessively, as this can lead to excessively dry skin and a