Scabies

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Contagious skin disease associated with severe itch

Cause

• A parasitic mite, Sarcopterus scabiei hominis
• Transmitted by direct skin contact with infected person

Clinical features

• Intense itching, especially at night
• Wheals, papules, vesicles, and thread-like burrows
  • Common in flexural areas, e.g. wrists and inter-digital creases, axillae, nipples, buttocks, and genitalia
• Scratching spreads mites to other areas leading to widespread, intensely pruritic eruption
• Secondary infection is common

Differential diagnosis

• Papular urticaria, atopic or seborrhoeic dermatitis
• Drug eruptions
• Onchocerciasis

Investigations

• Microscopic identification of mites, their eggs or faeces obtained from the vesicles or mite burrows

ManagementTreatment

General measures

• Close contacts and all family members in the household should be treated
• Wash and iron all linen which has touched the infected skin

Medicine treatment

• Wash (scrub) the body well
• Apply benzyl benzoate lotion 25% to the whole body from the scalp to the soles of the feet but taking care to avoid contact with the eyes. Leave on for 24 hours, rinse and reapply. Repeat 2 times except in pregnant women
• Give an antihistamine to relieve itching: tablet chlorpheniramine 4 mg every 8 hours for 3 days
  • Child: 1- 2 mg per dose

If treatment ineffective or unsuitable

• Ivermectin 200 micrograms single dose (avoid in pregnancy, and in children <15 kg)
• For complete eradication of mites, repeat the dose after 7 days

If secondary infection is present

• Give an antibiotic as in Boils 

Prevention

• Personal hygiene (washing clothes and regular bathing)
• Avoid close contact with infected people