dermatologic disorders
Scabies
Treatment of Scabies
Topicalpermethrin, or other topical scabicides Sometimes oralivermectin Primary treatment is topical or oral scabicides ( Treatment references ) (see table is no longer recommended because it can be neurotoxic ( Treatment references ). Treatments should be repeated in 7 days. For infants and young children,permethrinshould be applied to the head and neck, avoiding periorbital and perioral regions. Special attention should be given to intertriginous areas, fingernails, toenails, and the umbilicus. Mittens on infants can keeppermethrinout of the mouth. 0.9% topical suspension should be applied to the entire cutaneous surface from the neck down, including the soles and feet. In bald patients, the suspension should be applied to the scalp, forehead, hairline, and temples. The suspension should be allowed to dry for 10 minutes before getting dressed and then left on the skin for 6 hours before showering or bathing. Treatment should be repeated in 1 week ( Treatment references ). Precipitated sulfur 6 to 10% in petrolatum is an alternative therapy typically reserved for infants < 2 months of age or pregnant individuals. It is applied for 24 hours for 3 consecutive days, is safe and effective. Ivermectinis indicated for patients who do not respond to topical treatment, are unable to adhere to topical regimens, or are immunocompromised with Norwegian scabies.Ivermectinhas been used with success in epidemics involving close contacts, such as nursing homes. Close contacts should also be treated simultaneously, and personal items (eg, towels, clothing, bedding) should be washed in hot water and dried in a hot dryer or isolated (eg, in a closed plastic bag) for at least 3 days. Pruritus can be treated with corticosteroid ointments and/or oral antihistamines (eg,hydroxyzine25 mg orally 4 times a day). Secondary infection should be considered in patients with weeping, yellow-crusted lesions and treated with the appropriate systemic or topical antistaphylococcal or antistreptococcal antibiotic. Symptoms and lesions take up to 3 weeks to resolve despite killing of the mites, making failed treatment due to resistance, poor penetration, incompletely applied therapy, reinfection, or nodular scabies difficult to recognize. Skin scrapings can be done periodically to check for persistent scabies. 1.Al-Dabbagh J, Younis R, Ismail N: The current available diagnostic tools and treatments of scabies and scabies variants: An updated narrative review.Medicine102(21): p e33805. doi: 10.1097/MD.0000000000033805 2.Nolan K, Kamrath J, Levitt J:Lindanetoxicity: A comprehensive review of the medical literature.Pediatr Dermatol29(2):141-146, 2012. doi: 10.1111/j.1525-1470.2011.01519.x 3.Seiler JC, Keech RC, Aker JL, et al:Spinosadat 0.9% in the treatment of scabies: Efficacy results from 2 multicenter, randomized, double-blind, vehicle-controlled studies.Am Acad DermatolAug 12:S0190-9622(21)02290-8, 2021. doi: 10.1016/j.jaad.2021.07.074 