DR5.1 | Scabies Treatment Planning — Summary & Reflection

KEY TAKEAWAYS

Scabies is a clinical diagnosis built on burrows, a characteristic web-space/wrist/genital distribution, nocturnal itch and family clustering, caused by the mite Sarcoptes scabiei, with itch arising from type IV hypersensitivity. The treatment plan has four non-negotiable parts: the right scabicide — first-line permethrin 5% cream (safe in pregnancy and infancy, applied neck-down overnight and repeated at 7 days) or oral ivermectin 200 mcg/kg repeated after 1-2 weeks; simultaneous treatment of all close contacts even if asymptomatic; environmental decontamination of clothing and bedding; and counselling that post-scabetic itch persists for weeks and is not failure. Crusted (Norwegian) scabies in the immunocompromised is highly contagious and needs isolation plus combined repeated ivermectin and permethrin. State the ADRs: permethrin and benzyl benzoate cause irritation/burning; ivermectin needs caution in pregnancy and children under 15 kg; sulphur is the safest in neonates.

REFLECT

Think back to a patient — yours or one you observed — who was treated for an itchy rash that did not settle. Knowing what you now know, was the rash given a household plan or just an individual prescription? Was the patient warned that itch outlasts the mite? Reflecting on how often 'treatment failure' is really an incomplete plan, write down the three sentences you will always say to a scabies patient before they leave your clinic, and the one question you will always ask about their household.