Scabies

Question 1

What is scabies

Answer 1

Tiny mites called Sarcoptes scabiei that burrow under the skin causing infection and intense itching. Eggs laid under skin leading to further infection and symptoms
Relatively common & contagious

Question 2

Scabies presentation

Answer 2

Incredibly itchy, small, papular red spots
May have track marks where the mites have burrowed
Itching worse at night and following bathing
Classic location in between finger webs but can spread to whole body
Can take up to 8 weeks after infestation for symptoms to appear

Question 3

Scabies differentials

Answer 3

Insect bites
Atopic eczema
Contact dermatitis
Psoriasis

Question 4

What is crusted scabies

Answer 4

Serious infestation with scabies in patients that are immunocompromised
Extremely contagious
So may bites that they have patches of red skin that turn into scaly plaques (similar to psoriasis)
May not be itchy as do not have an immune response to the infestation

Question 5

Scabies management

Answer 5

Topical Permethrin 5% cream - apply to whole body and leave on for 8-12 hrs then wash off
Repeat a week later to kill all eggs that survived
Wash all bedding and clothing, hoover and clean house
Avoid close physical contact
Oral Ivermectin (200mcg/kg fr 1 dose) for crusted scabies or difficult to treat scabies
Whole household should be treated
Itching can persist or up to 4 weeks after treatment - Crotamiton cream and chlorphenamine at night