SCABIES

Scabies is an infection caused by the mite Sarcoptes scabiei, which lives
and moves in the skin producing burrows (S-shaped ridges), small blisters
and papules. Itching is especially severe at night, and causes scratch
marks and very commonly secondary infection with pustules and crusts.
Lesions occur preferentially between the fingers, on the sides of the
hands and feet, on the flexor sides of the wrists, in the armpits and on
the genitals and buttocks. In infants and small children palms, soles,
head and neck are often affected. Scabies is primarily spread through
close personal contact but may be transmitted through clothing, linen, or
towels.
Management of scabies
Whichever treatment is chosen, it is essential to treat all close contacts of the
patients, e.g. people sharing the same household. Also linen and clothing should be
washed or aired for at least 24 hours at the time of treatment. Secondary infection
should be treated like impetigo for 5 days. Lesions should be closed before applying
scabies treatment.
- Gamma benzene hexachloride (GBH) 1% lotion or cream. Apply from the neck down.
Allow to dry and wash off after 24 hours. Give 10 ml for adults and 5 ml for children
over 12 years. Do not use in pregnancy, breastfeeding mothers or babies < 6 months.
- Treat children with benzyl benzoate 25% emulsion diluted with one part water (1:1).
Dilute with 3 parts water (1:3) for infants. Apply for 3 nights, wash off each morning.
- Sulphur 5-20% ointment twice daily for 1-2 weeks.
- Scabies epidemics in institutions (prison, army camp, boarding school) may be
treated with ivermectin.
- Post-scabies itch often occurs. This can be mistaken for inadequately treated
scabies. Treat with topical steroids.