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SCABIES\

Complication

Secondary impetiginization may occur and poststreptococcal glomerulonephritis has resulted from scabies-induced pyodermas caused by Streptococcus pyogenes. Lymphangitis and septicemia have also been reported in crusted scabies. Scabies infestation can also trigger bullous pemphigoid.

Prognosis

If left untreated, the condition can persist for many years. In immunocompetent individuals, the number of mites may decrease over time.

Treatment

Scabies is treated by a combination of a scabicide and fomite control. Usually a week after the initial treatment, a second application is required to reduce the potential for reinfestation from fomites as well as to kill any nymphs that may have hatched after treatment. Topical scabicides are applied overnight to the entire skin surface with special attention to finger and toe creases, cleft of the buttocks, belly button, and beneath the fingernails and toenails. In adults, one can exclude treating the scalp and face. Most treated individuals experience relief from symptoms within 3 days, but patients must be informed that even after adequate scabicidal therapy, the rash and pruritus may persist for up to 4 weeks (postscabetic itch). Patients should be educated that excessive washing of the skin with harsh soap wil aggravate their skin irritation. Oral antihistamine and emollients can be beneficial.

Pregnant females, breast-feeding mothers, and children under 2 years should limit their two applications (1 week apart) to 2 hours only when using permethrin. In crusted scabies, the combination of oral ivermectin and a topical scabicide are recommended as the oral medication will not penetrate into the thickness of the keratinous debris under the nails.

Prevention

Because of the common occurence of asymptomatic mite carriers in the household, all family members and close contacts should be treated simultaneously. After treatment, treated individuals should wear clean clothing, and all clothing, pillow cases, towels and bedding used during the previous week should be washed in hot water and dried at high heat. Nonwashables should be dry-cleaned, ironed, put in the clothes dryer without washing, or stored in a sealed plastic bag in a warm area for 2 weeks. Floors, carpets, upholstery (in both home and car) play areas, and furniture shoul be carefully vacuumed. Fumigation of living spaces is not recommended. Pets also do not need to be treated becuse they do not harbor the human scabies mite.

Reference:Fitzpatricks Dermatology in General Medicine, 8th Edition1