Scabies

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

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 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.