Scabies: A Review of Diagnosis and Management Based on Mite Biology
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.
- "Clinical diagnosis was the method used to diagnose scabies patients for recruitment into this study, and this is a common and acceptable method that has been used in many studies and in clinical practice.  ,  The 210 patients each had at least 3 of the 5 criteria which was a requirement to qualify for a clinical diagnosis. Indeed, all the patients (100%) had a history of pruritus and contact with a case of similar scabies rash, though in reality, it is still possible to contact the infestation without being aware of the source; moreover the source might be animals or fomites. "
- [Show abstract] [Hide abstract] 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.0Comments 5Citations
- [Show abstract] [Hide abstract] ABSTRACT: Scabies, caused by mite Sarcoptes scabiei var. hominis, is one of the most common parasitic skin diseases. Classic manifestations of scabies include highly itch papular eruption, involving interdigital webs of hands, skin folds and flexure creases. The disease affects all age and social groups, although its prevalence vary in different countries and regions of the world. New IUSTI/WHO guidelines reflect significant progress made both in diagnostics and treatment of the disease over the last decades. Epidemiology, variety of clinical presentation, possible complications, as well as modern diagnostic and treatment methods were described in our article.0Comments 0Citations