Pediatric Scabies Follow-up

  • Author: Camila K Janniger, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: May 5, 2011
 

Further Inpatient Care

Patients with scabies may need to be reexamined at 2 weeks and again one month after treatment.

Persistent pruritus after treatment does not necessarily reflect treatment failure.

Hypersensitivity reaction may outlast the presence of live parasites.

Antihistamines and topical corticosteroids may be used to control pruritus until symptoms resolve.

If a patient has persistent lesions at the 1-month check-up, reinfection or persistent infection should be suspected. In this case, treatment should be reinitiated. The family or any close contacts should also be examined to check for a source of reinfection.

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Further Outpatient Care

All family members and close contacts should be treated, even if asymptomatic, to prevent reinfection. All bed linen and clothing should be washed in order to remove eggs and mites. Fomites can persist for 2-3 days without a host. Articles that cannot be washed should be kept in sealable plastic bags for 3 days.

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Deterrence/Prevention

Mass screening and treatment of all affected individuals gives the greatest reductions in scabies prevalence.[3] However, once ended, prevalence rates quickly escalate. One approach is to treat a predetermined number of randomly chosen affected individuals more frequently. Sometimes, as a result of nonlinearity, treatment densities do not have to be impractically high to produce significant reductions in scabies burden.

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Complications

Secondary lesions may occur from scratching and include excoriated papules and crusted areas. These lesions may become secondarily infected. Topical antibiotics can be used to treat minor superinfection and oral antibiotics may be required in patients with more extensive infection. The most common infectious agents are skin flora, including Staphylococcus and Streptococcus species.

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Prognosis

If one medication is ineffective, sequential use of agents can be curative.

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Patient Education

Education is extremely important. The mode of transmission is via human contact, as well as via fomites. All close contacts must be treated, or reinfection will occur.

For excellent patient education resources, visit eMedicine's Infections Center and Children's Health Center. Also, see eMedicine's patient education articles Scabies and Skin Rashes in Children.

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Contributor Information and Disclosures
Author

Camila K Janniger, MD  Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, New Jersey Medical School

Camila K Janniger, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Coauthor(s)

Giuseppe Micali, MD  Head, Professor, Department of Dermatology, University of Catania School of Medicine, Italy

Giuseppe Micali, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Mudra Kumar, MD, MBBS, MRCP  Associate Professor, Department of Pediatrics, University of South Florida College of Medicine

Mudra Kumar, MD, MBBS, MRCP is a member of the following medical societies: American Academy of Pediatrics and American Society of Hematology

Disclosure: Nothing to disclose.

Specialty Editor Board

Kevin P Connelly, DO  Clinical Assistant Professor, Department of Pediatrics, Division of General Pediatrics and Emergency Care, Virginia Commonwealth University School of Medicine; Medical Director, Paws for Health Pet Visitation Program of the Richmond SPCA; Pediatric Emergency Physician, Emergency Consultants Inc, Chippenham Medical Center

Kevin P Connelly, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi

Disclosure: Nothing to disclose.

Merrily P M Poth, MD  Professor, Department of Pediatrics and Neuroscience, Uniformed Services University of the Health Sciences

Merrily P M Poth, MD is a member of the following medical societies: American Academy of Pediatrics, Endocrine Society, and Lawson-Wilkins Pediatric Endocrine Society

Disclosure: Nothing to disclose.

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.

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Scabies mite. Courtesy of William D. James, MD.
Scabies mite scraped from a burrow (400 X). Courtesy of Audra Malerba, DO.
Scabies. Courtesy of William D. James, MD.
In patients with crusted scabies, sections show multiple mites (arrows) within the hyperkeratotic stratum corneum. The epidermis is spongiotic (hematoxylin and eosin [H&E], 100 X). Courtesy of Audra Malerba, DO.
In patients with routine scabies, a single mite is observed. Eosinophilic spongiosis may be present (hematoxylin and eosin [H&E], 400 X). Courtesy of Audra Malerba, DO.
In patients with scabies, erythematous vesicles and papules are present on torso extremities, some with adjacent linear excoriations. Courtesy of Audra Malerba, DO.
Scabies on hand. Courtesy of William D. James, MD.
Norwegian scabies. Courtesy of William D. James, MD.
Scabies on leg. Courtesy of William D. James, MD.
Scabies on buttocks. Courtesy of William D. James, MD.
Scabies on penis. Courtesy of William D. James, MD.
Scabies on penis. Courtesy of Hon Pak, MD.
 
 
 
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