Scabies

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Caused by mites, transmitted by skin-to-skin contact. The lesion is a "burrow" (a whitish ziz-zag channel), the resting place of the female mite.

Main sites:

• between the fingers
• on the wrists
• in the axilla
• around the navel
• genitals
• inner sides of feet.

Treat all close contacts, especially children in the same household. Wash clothing and bedding and leave in the sun to dry.

After normal bathing, apply:

	Medicine	Dose	Frequency	Duration
	permethrin 5% cream	apply from the neck down	once and wash off after 8-12 hours*	once only
or	gamma benzene hexachloride 1% lotion	apply from the neck down	once and wash off after 24 hours	once only

*Caution: In prepubertal children the gamma benzene hexachloride is washed off after 12 hours. Hot baths and scrubbing should be avoided to prevent systemic absorption.

Alternative in pregnancy, lactating mothers or children < 6 months:

Medicine	Adult Dose	Frequency	Duration
benzyl benzoate 25% emulsion* [irritant] *Dilute with one part water (1:1) for adults.  *Dilute with three parts water (1:3) for children.	Apply from neck down	Once at night, wash off next morning	3 nights, repeat if necessary within 10 days
or sulphur ointment 5-10% [in children]	Apply	2 times a day	1-2 weeks

If there is secondary bacterial infection ("septic sores"), treat as for impetigo for 4-5 days. Only apply scabicide once lesions are closed.

Advise that the itch may continue for several weeks. This can be relieved by applying:

	Medicine	Adult Dose	Frequency	Duration
	calamine lotion	apply	as needed	as required
and	chlorpheniramine po	4mg [Paed = 0.1mg/kg]	3 times a day	3 days