Parasitic Infections - Scabies

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Scabies  is  an  intensely  pruritic  and  highly  contagious  infestation  of  the  skin  caused  by  mite  Sarcoptes scabies.  

Clinical presentation 

  • Itchy vesicles and papules. Itching worse at night.
  • Papules in between finger spaces, wrists, penis and scrotum.
  • Someone else in the family is itching.

Non-pharmacological Treatment 

  • Treat all members of the household at the same time to prevent reinfection, regardless of  presence or absence of itching.
  • Advise patients to bath and dress regularly and changing bed linen at the same time of treatment.

Pharmacological Treatment

A: benzyl benzoate emulsion, BBE (25% for adults, 12.5% for children) 

Adults and children over 2 years: Apply with fingers, from neck down to cover the whole-body surface, while paying attention to all skin folds. Leave emulsion in place for 6-8 hours  overnight.  

Repeat the application after 7 days. 

OR 

C: lindane lotion (1%) to be applied as BBE above (do not use in children less than 1 year) 

AND  

C: betamethasone valerate cream (topical) 12hourly for the itch 

AND 

A: cetirizine (PO) 10mg 12hourly for 3- 4weeks  

OR (if extensive, Norwegian scabies) 

A: ivermectin (PO) 200microgram/kg stat then repeat after 1 week 

Should be in combination with the topical above