eMedicine Specialties > Dermatology > Parasitic Infections

Scabies: Follow-up

Author: Kelly M Cordoro, MD, Fellow and Clinical Instructor, Department of Pediatric Dermatology, University of California at San Francisco; Assistant Professor (On Educational Leave), Assistant Program Director for Resident Medical Education, Department of Dermatology, University of Virginia School of Medicine
Coauthor(s): Barbara B Wilson, MD, Edward P Cawley Associate Professor, Department of Dermatology, University of Virginia School of Medicine; C Lisa Kauffman, MD, FACP, Professor, Chief, Division of Dermatology, Departments of Medicine and Pathology, Georgetown University Medical Center
Contributor Information and Disclosures

Updated: Nov 12, 2008

Follow-up

Deterrence/Prevention

All household members and close personal contacts older than 2 months and not pregnant should be treated, 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.

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.
  • 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.

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.

Patient Education

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

Miscellaneous

Medicolegal Pitfalls

  • Failure to inform patients about the potential neurotoxicity of lindane and the lack of toxicity data available for crotamiton

Special Concerns

  • Neonates and pregnant women should only be treated if the benefit exceeds the risk and if the diagnosis is confirmed by a positive skin scraping or biopsy result.
 


More on Scabies

Overview: Scabies
Differential Diagnoses & Workup: Scabies
Treatment & Medication: Scabies
Follow-up: Scabies
Multimedia: Scabies
References
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References

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  2. Bezold G, Lange M, Schiener R, Palmedo G, Sander CA, Kerscher M, et al. Hidden scabies: diagnosis by polymerase chain reaction. Br J Dermatol. Mar 2001;144(3):614-8. [Medline].

  3. Johnston G, Sladden M. Scabies: diagnosis and treatment. BMJ. Sep 17 2005;331(7517):619-22. [Medline].

  4. Aubin F, Humbert P. Ivermectin for crusted (Norwegian) scabies. N Engl J Med. Mar 2 1995;332(9):612. [Medline].

  5. Huffam SE, Currie BJ. Ivermectin for Sarcoptes scabiei hyperinfestation. Int J Infect Dis. Jan-Mar 1998;2(3):152-4. [Medline].

  6. Elgart GW, Meinking TL. Ivermectin. Dermatol Clin. Apr 2003;21(2):277-82. [Medline].

  7. Brodell RT, Helms SE. Bedside testing: the diagnostic cornerstone of dermatology. Compr Ther. Mar 1997;23(3):211-7. [Medline].

  8. Burgess I. Sarcoptes scabiei and scabies. Adv Parasitol. 1994;33:235-92. [Medline].

  9. Burkhart CG, Burkhart CN, Burkhart KM. An epidemiologic and therapeutic reassessment of scabies. Cutis. Apr 2000;65(4):233-40. [Medline].

  10. Fitzpatrick TB, Austen KF, Wolff K, et al, eds. Dertmatology in General Medicine. 4th ed. New York, NY: McGraw-Hill; 1993:1812-3.

  11. Elgart ML. Scabies. Dermatol Clin. Apr 1990;8(2):253-63. [Medline].

  12. Fitzpatrick TB, Johnson RA, Wolff K. Inset Bites and Infestations. In: Fitzpatrick TJ, Johnson RA, Wolff K, Polano MK, Suurmond R, eds. Color Atlas and Synopsis of Clinical Dermatology. 3rd ed. New York, NY: McGraw-Hill; 1997:836-61.

  13. Guldbakke KK, Khachemoune A. Crusted scabies: a clinical review. J Drugs Dermatol. Mar 2006;5(3):221-7. [Medline].

  14. Karthikeyan K. Treatment of scabies: newer perspectives. Postgrad Med J. Jan 2005;81(951):7-11. [Medline].

  15. McCarthy JS, Kemp DJ, Walton SF, Currie BJ. Scabies: more than just an irritation. Postgrad Med J. Jul 2004;80(945):382-7. [Medline].

  16. Molinaro MJ, Schwartz RA, Janniger CK. Scabies. Cutis. Dec 1995;56(6):317-21. [Medline].

  17. Orkin M, Maibach HI. Scabies treatment: current considerations. Curr Probl Dermatol. 1996;24:151-6. [Medline].

  18. Paller AS. Scabies in infants and small children. Semin Dermatol. Mar 1993;12(1):3-8. [Medline].

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

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Further Reading

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Keywords

human scabies, seven-year itch, 7-year itch, itch mites, pruritic eruption, Sarcoptes scabiei, S scabiei, Sarcoptes scabiei var hominis, S scabiei var hominis, skin infestation, skin mite, pruritic skin disease, pruritus, crusted scabies, Norwegian scabies, mite infestation

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Contributor Information and Disclosures

Author

Kelly M Cordoro, MD, Fellow and Clinical Instructor, Department of Pediatric Dermatology, University of California at San Francisco; Assistant Professor (On Educational Leave), Assistant Program Director for Resident Medical Education, Department of Dermatology, University of Virginia 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.

C Lisa Kauffman, MD, FACP, Professor, Chief, Division of Dermatology, Departments of Medicine and Pathology, Georgetown University Medical Center
C 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.

Medical Editor

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.

Pharmacy Editor

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.

Managing Editor

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.

CME Editor

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 None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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