Recommendations for effective scabies treatment and prevention
International
Journal of Dermatology: June, 2024
After
effective treatment, pruritus usually resolves gradually within 7–10 days, but
complete resolution may take up to 4 weeks.
Scabies
mites can be found anywhere on the skin. Therefore, medication should be
applied to all areas of the body, itchy or not, except for the head:
Special
care should be taken in the armpits, groin, anogenital skin, behind the knees,
inside the elbows, between the fingers and toes, inside the navel, palms and
soles, as well as behind the ears.
Nails
should be trimmed, and watches and rings removed prior to application. A soft
brush should be used to remove mites from the underside of the finger- and
toenails).
In children and the elderly, the medication should be applied all over the body with the exception of the mouth, inside of the nose, and eyes.
The patient
may need help applying the medication to hard-to-reach areas such as the back.
A warm,
soapy bath prior to application may open the burrows, increasing the likelihood
that the mite will come into contact with the medication. The medication should
be washed off after the recommended time, and the patient should change into
clean clothes.
The
duration of treatment is usually 8–12 hours; however, sulfur-based medications
are applied consecutively for 3 days without washing, followed by a bath).
If any part
of the body needs to be washed before the end of the treatment, the medication
should be reapplied to those areas.
Scabies
medications are generally less effective against the eggs. Therefore, treatment
should be repeated a week later to kill newly hatched mites.
Even after successful treatment, itching may continue for up to 4 weeks.
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Washing or
drying bedding, towels, clothing, and laundry at 50 °C for 10 minutes will kill
the parasites.
Items that
cannot be washed or dried and may harbor scabies mites should be sealed in a
plastic bag and stored at 4 °C for 7 days, at 22 °C for 4 days, and at −10 °C
for 5 hours.
Carpets and
upholstered furniture can be vacuumed.
Patients or
their relatives should receive a detailed written explanation of the treatment.
If there
are no active lesions and no nocturnal pruritus 1 week after completion of the
two-course treatment, the patient should be considered effectively treated.
A person
who has had scabies can be re-infected, as there is no lasting immunity.
All
individuals in close contact with the infected person, such as family members,
children's school friends, and sexual partners, should be treated at the same
time, even if they do not have symptoms.
Some
scabicides are contraindicated during pregnancy, lactation, and the newborn
period, and a physician should be consulted.
Since
scabies can also be transmitted through sexual contact, adults diagnosed with
scabies should be screened for sexually transmitted infections, such as HIV,
syphilis, and hepatitis.
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