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Scabies - Management
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Definition
- Scabies is an intensely itchy skin infestation caused by the human parasite Sarcoptes scabiei.
How should I manage someone presenting with scabies?
- Simultaneously (within 24 hours) treat all members of the household, close contacts, and sexual contacts with a topical insecticide (even in the absence of symptoms).
- Apply the insecticide twice, with applications one week apart.
- Consider symptomatic treatment for itching.
- Machine wash (at 50°C or above) clothes, towels, and bed linen, on the day of application of the first treatment.
- Advise to avoid close body contact with others until their partners and close contacts have been treated.
In depth
Which insecticide should I use?
- Use permethrin 5% dermal cream as a first-line treatment.
- Use malathion 0.5% aqueous liquid if permethrin is inappropriate (e.g. if the person has an allergy to chrysanthemums).
In depth
How should I advise someone to apply an insecticide?
- Apply the treatment to the whole body from the chin and ears downwards. Pay special attention to the fingers and toes and under the nails.
- People who are immunosuppressed, the very young and elderly should apply the insecticide to the whole body including the face and scalp.
- Apply the treatment to cool dry skin (i.e. not after a hot bath).
- Allow the lotion or cream to dry before dressing.
- Wash the treatment off after prolonged contact with the skin:
- Permethrin — 8 to 12 hours.
- Malathion — 24 hours.
- Reapply treatment if it is washed off during the treatment period (e.g. after hand washing).
In depth
What drug treatments can I recommend for itching?
- Treat itching with topical crotamiton or topical hydrocortisone 1%.
- Avoid corticosteroid creams if the diagnosis is not certain.
- Consider an oral sedating antihistamine (e.g. chlorphenamine or hydroxyzine) at night if the itch is interfering with sleep.
In depth
What follow up is necessary?
- Follow-up is not generally required for people with classical scabies.
- Review if symptoms have not cleared within 6 weeks after the first application of treatment.
In depth
When should I refer or seek specialist advice?
- Refer if:
- The diagnosis is in doubt, or after two treatment failures.
- There is a history of risk behaviour for sexually transmitted infections.
- There is an outbreak of scabies in an institution (e.g. school, prison, or nursing home): report to the Health Protection Agency.
- Seek specialist advice for:
- Children under 2 months of age (e.g. from a paediatric dermatologist).
- The management of crusted scabies (e.g. from a consultant dermatologist).
In depth
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