Scabies: a review of diagnosis and management based on mite biology.
ABSTRACT Scabies is a contagious parasitic dermatitis that is a significant cause of morbidity, especially outside of the United States. Scabies is diagnosed most often by correlating clinical suspicion with the identification of a burrow. Although scabies should be on the differential for any patient who presents with a pruritic dermatosis, clinicians must consider a wide range of diagnostic possibilities. This approach will help make scabies simultaneously less over- and underdiagnosed by clinicians in the community. Atypical or otherwise complex presentations may necessitate the use of more definitive diagnostic modalities, such as microscopic examination of KOH prepared skin scrapings, high-resolution digital photography, dermoscopy, or biopsy. Scabies therapy involves making the correct diagnosis, recognizing the correct clinical context to guide treatment of contacts and fomites, choosing the most effective medication, understanding how to use the agent properly, and following a rational basis for when to use and reuse that agent. Although the development of new therapeutic agents is always welcome, tried and true treatments are still effective today. Permethrin is the gold standard therapy, with malathion being an excellent topical alternative. Ivermectin is an effective oral alternative that is especially useful in crusted scabies, patients who are bed ridden, and in institutional outbreaks. Despite the availability of effective therapeutics, treatment failures still occur, mostly secondary to application error (ie, failure to treat the face and scalp or close contacts, failure to reapply medication) or failure to decontaminate fomites. Because increasing resistance to scabies treatments may be on the horizon, we propose that standard of care for scabies treatment should involve routine treatment of the scalp and face and re-treating patients at day 4 on the basis of the scabies life cycle to ensure more efficient mite eradication. Practitioners should attempt to treat all close contacts simultaneously with the source patient. To eradicate mites, all fomites should be placed in a dryer for 10 minutes on a high setting, furniture and carpets vacuumed, and nonlaunderables isolated for a minimum of 2 days, or, for those who wish to be rigorous, 3 weeks.
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ABSTRACT: Scabies is commonly seen worldwide, in its usual classic form when afflicting older children and adults. However, neonatal scabies is described as its own entity in the literature. We present a case of a 4-week-old infant with a generalized papulopustular, vesicular, and crusted rash who was diagnosed with scabies. We contrast the differing clinical features of neonatal and classic scabies, describe possible mimickers of this diagnostic dilemma, and review current treatment options available for scabies in this very young age group.Pediatric emergency care 11/2013; 29(11):1210-2. DOI:10.1097/PEC.0b013e3182aa1411 · 0.92 Impact Factor
Article: Scabies Infection in a NeonateJournal of Pediatrics 09/2014; DOI:10.1016/j.jpeds.2014.07.061 · 3.74 Impact Factor
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ABSTRACT: Abstract Objective: Treatment of scabies is an important issue in infectious dermatology. The aim of this study was to specify whether permethrin is effective for the treatment of human scabies and to compare its effectiveness with that of 1% lindane by topical application. Methods: 220 patients with scabies with the mean age of 44 ± 12/24, attending the study. Patients were divided into two groups randomly. The first group and their family contacts received 5% permethrin cream and the other received 1% lindane lotion. Treatment was evaluated at intervals of 2 and 4 weeks. Results: Of 254 patients, 220 completed the study. 110 in the group treated with lindane and 110 in the group treated with permethrin. Permethrin provided an improvement rate of 92 (83.6%) after two weeks, whereas lindane was effective only in 54 (49%) of patients. After four weeks improvement rate was 96.3% (106 of 110) in permethrin group since it was only 69.1% (76 of 110) in lindane group. Conclusion: Permethrin (5%) cream was found to be significantly more effective in the treatment of scabies in comparison with lindane in this study. There were no adverse effects with either permethrin or lindane.Journal of Dermatological Treatment 08/2012; DOI:10.3109/09546634.2012.723122 · 1.76 Impact Factor