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.
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
Treatment: for all types of scabies (except children <6 months)
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 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)
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 S1 Scrotal pain/discomfort: diagnostic strategy model
Trauma, incl. haematoma, haematocele
Torsion of a testicular appendage
Serious disorders not to be missed
Pitfalls (often missed)
Referred pain (e.g. spine, ureteric colic, abdominal aorta)
Useful investigations include:
urine analysis, M&C
Chlamydia detection test
Torsion of the testis versus epididymo-orchitis
With torsion of the testicle there is pain of sudden onset, described as severe aching, sickening ...