Dermatologic Manifestations of Scabies Follow-up

  • Author: Kelly M Cordoro, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Dec 9, 2009
 

Deterrence/Prevention

All household members and close personal contacts older than 2 months and not pregnant should be treated for scabies, even if they have no symptoms or signs of infestation. Detailed directions regarding treatment and environmental control measures should be provided verbally and in writing.

Patients must be evaluated within 2-4 weeks after treatment to ensure compliance and adequate response to therapy. Patients may experience pruritus up to 2 weeks after successful treatment. If itching persists beyond this time, the patient must be reevaluated to ensure correct diagnosis, adequate treatment, and simultaneous treatment of contacts and environment. A second treatment course may be indicated.

Rarely, individuals with a history of atopy may require a tapered dose of prednisone for the treatment of severe pruritus. Intranodular injection of dilute corticosteroids may be necessary in cases of nodular scabies.

Because of the heavy mite burden, cases of crusted scabies may require repeated applications of topical scabicides or simultaneous treatment with a topical agent such as permethrin and oral ivermectin.

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Complications

  • Treatment failures are uncommon if guidelines are followed.
  • Residual pruritus may require antihistamines or a short course of topical or oral corticosteroids.
  • Secondary infection requires the use of antibiotics based on culture and sensitivity data. One report describes methicillin-resistant Staphylococcus aureus bacteremia in a patient with crusted scabies.[14]
  • Scabietic nodules may require intranodular corticosteroid injection for complete resolution.
  • Flaring or reactivation of preexisting eczema or atopic dermatitis requires the use of standard eczema treatments.
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Prognosis

Prognosis is excellent with proper diagnosis and treatment in otherwise healthy individuals. Immunocompromised or institutionalized individuals are at an increased risk for crusted scabies, which is associated with a less favorable outcome.

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Patient Education

For excellent patient education resources, visit eMedicine's Infections Center, eMedicine's patient education article Scabies, and the American Academy of Dermatology.

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Contributor Information and Disclosures
Author

Kelly M Cordoro, MD  Assistant Professor of Pediatric and Adult Dermatology, Department of Dermatology, University of California, San Francisco School of Medicine

Kelly M Cordoro, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Association of Professors of Dermatology, Dermatology Foundation, Medical Society of Virginia, National Psoriasis Foundation, Society for Pediatric Dermatology, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Coauthor(s)

Barbara B Wilson, MD  Edward P Cawley Associate Professor, Department of Dermatology, University of Virginia School of Medicine

Barbara B Wilson, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Medical Society of Virginia, and Sigma Xi

Disclosure: Nothing to disclose.

Catharine Lisa Kauffman, MD, FACP  Georgetown Dermatology and Georgetown Dermpath

Catharine Lisa Kauffman, MD, FACP is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Royal Society of Medicine, Society for Investigative Dermatology, and Women's Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel J Hogan, MD  Clinical Professor of Internal Medicine (Dermatology), NOVA Southeastern University; Investigator, Hill Top Research, Florida Research Center

Daniel J Hogan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Contact Dermatitis Society, and Canadian Dermatology Association

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Paul Krusinski, MD  Director of Dermatology, Professor, Department of Internal Medicine, Fletcher Allen Health Care, University of Vermont

Paul Krusinski, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Department of Dermatology, Geisinger Medical Center

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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  2. Makigami K, Ohtaki N, Ishii N, Yasumura S. Risk factors of scabies in psychiatric and long-term care hospitals: a nationwide mail-in survey in Japan. J Dermatol. Sep 2009;36(9):491-8. [Medline].

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  26. Schleicher SM, Stewart P. Scabies: the mite that roars. Emerg Med. 1997;6:54-8.

 
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Scabies mite scraped from a burrow (original magnification, 400X).
A typical linear burrow on the flexor forearm. Courtesy of Kenneth E. Greer, MD.
A subtle linear burrow accompanied by erythematous papules on the sole of the foot in a child with scabies. Courtesy of Kenneth E. Greer, MD.
Erythematous papules and papulovesicles on the flexor wrist. Courtesy of Kenneth E. Greer, MD.
Scabies on the penile shaft and glans. Courtesy of William D. James, MD.
Scabietic papules on the penile shaft and scrotum. Courtesy of Kenneth E. Greer, MD.
Widespread eruption on the back of an infant with scabies. Courtesy of Kenneth E. Greer, MD.
Nodular scabies in an infant. Courtesy of Kenneth E. Greer, MD.
Nodular scabies. Courtesy of Kenneth E. Greer, MD.
Crusted scabies. Courtesy of William D. James, MD.
Crusted scabies. Courtesy of Kenneth E. Greer, MD.
Scabies preparation demonstrating a mite and ova. Courtesy of William D. James, MD.
Scabies. Erythematous vesicles and papules are present on torso extremities, some with adjacent linear excoriations.
In routine scabies, a single mite is seen. Eosinophilic spongiosis may be present (hematoxylin and eosin; original magnification, 400X).
Scabies mite in the stratum corneum. Courtesy of William D. James, MD.
In crusted scabies, sections show multiple mites (arrows) within the hyperkeratotic stratum corneum. The epidermis is spongiotic (hematoxylin and eosin; original magnification, 100X).
Scabies. Courtesy of William D. James, MD.
Scabies in the interdigital web spaces. Courtesy of William D. James, MD.
Papulovesicles and nodules on the palm in a patient with scabies. Courtesy of Kenneth E. Greer, MD.
 
 
 
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