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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.
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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
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Treatment: for all types of scabies (except children < 6 months)
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Method for application
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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)
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For children <6 mths, use sulphur 5% cream or crotamiton 10% cream daily for 3 days.
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Norwegian scabies (profuse infestation with crusting)
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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.
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Useful investigations include:
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