Skip to Main Content


This is defined as age-related decline in skeletal muscle mass with low muscle strength and physical performance. Apart from ageing, it is a result of illness, sedentary lifestyle and poor diet. It is associated with increased disability, poor hand-grip strength, slow walking speed, susceptibity to infection, falls and fracture risk. In the presence of obesity, there is an increased impact on musculoskeletal and cardiometabolic health. Treatment strategies include exercise, especially resistance training, protein supplements in diet and vitamin D.


Clinical features

  • Intense itching (worse with warmth and at night)

  • Erythematous papular rash

  • Usually on hands and wrists

  • Common on male genitalia

  • Also occurs on elbows, axillae, feet and ankles, nipples of females

  • Diagnosis by microscopic examination of skin scrapings

Treatment: for all types of scabies (except children < 6 months)

  • Permethrin 5% cream or

  • Benzyl benzoate 25% emulsion (dilute 50:50 with water if under 10 yrs; if <2 yrs dilute 1:3)

Method for application

  • Apply to clean, dry cool skin of whole body from jawline down (preferably at night time)—include under nails, flexures, umbilicus and genitalia; also apply to the scalp, neck, face and ears in children < 2 years, elderly or immunocompromised people

  • Leave permethrin overnight (min 8 hrs) and benzyl benzoate 24 h and wash off

  • Repeat in 1 wk

  • Complete change of clothes and bed linen: wash in hot water after treatment and hang in sun; wash any soft toys

  • Treat all family members and contacts even if free of symptoms

  • A topical antipruritic (e.g. crotamiton cream) can be used for persistent itch (usu. up to 3 wks)

For children <6 mths, use sulphur 5% cream or crotamiton 10% cream daily for 3 days.

Norwegian scabies (profuse infestation with crusting)

  • Add ivermectin 200 mcg/kg (o) as 2 doses, 7 days apart plus topical treatment; consult dermatologist.


Serious problems include testicular torsion, strangulation of an inguinoscrotal hernia, a testicular tumour and a haematocele, all of which require surgical intervention. A varicocele can cause discomfort—examine in standing position.

Table S1Scrotal pain/discomfort: diagnostic strategy model
Key investigations

Useful investigations include:

  • FBE

  • urine analysis, microscopy and culture

  • Chlamydia detection test

  • ultrasound

  • technetium-99m scan.

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.