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SCABIES

Complication

If left untreated, the condition can persist for many years.

In immunocompetent individuals, the number of mites
may decrease over time.

Treatment

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.

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

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).

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.

Dila Larasati
130110110173 | B3

Pets also do not need to be treated becuse they do not

harbor the human scabies mite.

Reference:
Fitzpatricks Dermatology in General Medicine, 8th Edition