Dermatologic Manifestations of Scabies Treatment & Management

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

Medical Care

Treatment for scabies includes administration of a scabicidal agent, an antipruritic agent such as a sedating antihistamine, and an appropriate antimicrobial agent if secondarily infected.

Provision of detailed verbal and written instructions is critical for compliance and complete eradication of scabies.[9]

All family members and close contacts must be evaluated and treated for scabies, even if they do not have symptoms. Pets do not require treatment. All carpets and upholstered furniture should be vacuumed and vacuum bags immediately discarded.

Instruct patients to launder clothing, bed linens, and towels used within the last week in hot water the day after treatment is initiated and again in 1 week. Items that cannot be washed may be professionally dry cleaned or sealed in plastic bags for 1 week.

Patients with crusted scabies or their caregivers should be instructed to remove excess scale to allow penetration of the topical scabicidal agent and decrease the burden of infestation. This can be achieved with warm water soaks followed by application of a keratolytic agent such as 5% salicylic acid in petrolatum or Lac-Hydrin cream. (Salicylic acid should be avoided if large body surface areas are involved because of the potential risk of salicylate poisoning.) The scales are then mechanically debrided with a tongue depressor or similar nonsharp device.

Also see the clinical guideline summary from the British Association for Sexual Health and HIV (BASHH), United Kingdom national guideline on the management of scabies infestation.[10]

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Consultations

Assessment of immune function may be indicated in individuals presenting with crusted scabies.

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Activity

Individuals affected by scabies should avoid skin-to-skin contact with others. Decontamination of clothing, bed linens, and other personal items must coincide with medical treatment of the scabies. Patients with typical scabies may return to school or work 24 hours after the first treatment.

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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

  1. Haubrich WS. Medical Meanings: A Glossary of Word Origins. Philadelphia, Pa: American College of Physicians; 1997:200.

  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].

  3. Mehta V, Balachandran C, Monga P, Rao R, Rao L. Images in clinical practice. Norwegian scabies presenting as erythroderma. Indian J Dermatol Venereol Leprol. Nov-Dec 2009;75(6):609-10. [Medline].

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  6. Phan A, Dalle S, Balme B, Thomas L. Scabies with clinical features and positive darier sign mimicking mastocytosis. Pediatr Dermatol. May-Jun 2009;26(3):363-4. [Medline].

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

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

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

  10. [Guideline] British Association for Sexual Health and HIV (BASHH). United Kingdom national guideline on the management of scabies infestation. National Guideline Clearinghouse. Feb 15 2008.

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

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

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

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  20. 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.

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

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