SCABIES

DIAGNOSIS
The combination of a history of pruritus (especially at night), a classic rash, and itching in household or sexual contacts is adequate for the diagnosis of scabies. Mites seen on microscopic examination of skin scrapings confirm the diagnosis

TREATMENT OF CLASSIC SCABIES
Topical Agents. In adults and children over five years of age, 5 percent permethrin cream (Elimite) is standard therapy for scabies

When a scabicide is prescribed, the patient (or a parent or other caregiver) should be informed that itching may persist for up to four weeks after successful treatment. It may take that long for the skin to slough residual mite debris and for the allergic reaction to subside. Itching may be managed with antihistamines and, if necessary, the addition of a topical steroid. However, steroids should not be prescribed before the completion of primary therapy

Because some developing louse larvae may survive initial treatment, a second course of

treatment is recommended seven to 10 days latter

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Environmental Measures.

Once scabies has been diagnosed, the physician should explain its basic epidemiology. Otherwise, medication alone might be relied on to eradicate the infestation. If environmental control measures are not instituted, treatment failure will occur, because mites are able to survive and reinfest the patient. Thus, it is critical to decontaminate all linens, towels, and clothing used in the previous four days by hot-water washing (60°C) and heated drying. Items that cannot be washed in hot water should be dry cleaned or sealed in a plastic bag for five days. Even if household and sexual contacts have no symptoms, they should follow the same cleaning

procedures. Treatment must be simultaneous for al

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