Internal Medicine

0521779407-19 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:21

Scabies 1323

■children with involvement of head, face, and scalp

➣crusted (Norwegian) scabies in immunocompromised, debili-

tated patients, or patients with neurologic disease

increased number of mites

tests

Basic Microscopic Tests

■skin scrapings or curettage of burrows or papules

■glass slide with drop of mineral oil and cover slip

■specimen examined under low power

■identification of mites, eggs, or fecal pellet

Biopsy

■identification of mites, eggs, or feces

differential diagnosis

■any pruritic dermatosis – atopic dermatitis, papular urticaria, insect

bites, dermatitis herpetiformis

management

General Measures

■treat all close symptomatic contacts

■launder all linens in hot water

■treat pruritus symptomatically with antihistamines

■symptoms may take 4–5 weeks to resolve after appropriate treatment

specific therapy

Treatment Options

■permethrin 5% cream

➣entire cutaneous surface neck down (immunocompetent)

➣entire surface of body with scalp and face (immunosuppressed)

➣apply evening, wash off in AM

➣repeat 1 week

➣most effective topical treatment

■lindane 1% cream, lotion, or shampoo (Kwell)

➣apply for 8 hours, then wash off

➣entire cutaneous surface with scalp and face for immunosup-

pressed, without scalp and face for immunocompetent patients

➣repeat in 1 week

➣CNS side effects

■sulfur ointment 6–10%