Infestations

Question 1

6.1 scabies

Answer 1

symptoms:
• intense itching, worse at night
• pimple-like rash
• small thread-like grey lines
referral:
• secondary bacterial infection caused by
scratching
• treatment failure
• unclear diagnosis
• babies and children
OTC products:
• permethrin cream 2+ years (lyclear) -
adult single application = 30-60mg of cream, leave on for 8-12 hours before washing off
• malathion 6+ months (derbac-M) - adult single application = 100ml lotion, leave on for 24 hours before washing off
1. two treatments - 7 days apart
2. apply to the entire body
3. treat all close contacts
advice:
• avoid close contact with others
• adults and children can return to work or
school after the first treatment
• itch will not stop straight away
• wash clothes and ben linen >50 degrees
at time of treatment

Question 2

6.2 head lice

Answer 2

symptoms:
• live lice - grey-brown insects
• nits - empty cream-coloured egg shells stuck to hair
• itchy scalp

OTC products:
• dimeticone (hedrin) - traps and
suffocates lice
• permethrin (lyclear)/malathion (derbac-
M) - two applications 7 days apart to treat hatched lice
choice of formulation
• alcoholic preparations (more effective) -
avoid in asthma and eczema; aqueous
is safer
• lotions or liquids for 8-12 hours/
overnight - avoid shampoo, diliuted too much during use
advice:
• wet-combing method - wash hair with
usual shampoo and apply plenty of
conditioner
• treat all affected at the same time • detection combing

Question 3

6.3 threadworms

Answer 3

• enterobius vermicularis
  symptoms:
  • perinanal itching, worse at night • white cotton thread-like worms
  referral:
  • recent travel abroad
  • secondary bacterial infection • treatment failure
  OTC:
  • mebendazole 2+ years (ovex)
  • 100mg single dose - repeat dose 14
  days later to prevent re-infection
  • treat all family members at the same
  time
  • contraindicated in pregnant women
  advice:
  • good hygiene measures - cut nails short, wash hands, shower in the morning, regular wash/iron, do not share towels
  • pregnant and breastfeeding women and children under 2 years should follow strict hygiene measures for at least 6 weeks