Scabies

• Scabies, a mite infestation is contagious and spreads within a family, school or nursing home.
• Clinical features include intense itch, especially at night, burrows and a non-specific excoriated eruption especially in web spaces of hands, genitalia, buttocks and areola of the breasts.

• Atypical presentation including head/neck, palms and soles may be seen in young children and immunocompromised.

• Consider in high risk occupations e.g. nursing.
• Crusted scabies in the elderly/immunocompromised may be mistaken for dermatitis or psoriasis and itch may be less prominent.

• Patients with scabies should generally be managed in Primary Care
• Treat all household members and other contacts whether symptomatic or not
• Treat from the neck down (head and neck should be treated in the immunocompromised, children under 2 years and the elderly)
• Permethrin 5% Dermal Cream should be applied all over and left on for 8 hours
• Malathion aqueous lotion left on for 24 hours
• Reapply treatments to hands on washing
• Repeat any treatments in 7 days
• Advise patients to change and wash all bed linen, clothes/underwear

Dermatology Referral Criteria

• Diagnostic uncertainty
• Crusted (Norwegian) scabies