Updated: 6/19/2019

Scabies

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Questions
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Evidence
3
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Topic
Snapshot
  • A 21-year-old male college student presents to the health clinic complaining of intense itchy, painful, red streaks between his fingers and in the groin area. The patient reports that the itchiness seems to be worse at night. Several other students have presented with similar problems over the last couple of weeks.
Introduction
  • Superficial skin infection caused by arthropod Sarcoptes scabiei (mite)
  • Severe itching at night
  • Too small to be seen by naked eye
  • Pathognomonic sign
    • burrows linear markings in skin due to mites’ movements
  • Risk factors
    • close contacts with scabies
Presentation
  • Symptoms
    • hallmark feature
      • itching worse at night
  • Physical exam
    • adults
      • burrows, especially in between finger web spaces
      • erythematous, inflamed pustules and papules
      • linear markings in skin with some scale
      • commonly on wrist, finger webs, axillae, chest, umbilicus, and genital area
    • children
      • generalized pruritic rash
      • scalp may also be involved
    • immunocompromised
      • commonly on scalp and head
      • extremely high mite burden
      • "crusty"
      • secondary bacterial infection
Evaluation
  • Diagnosis based on clinical exam and history
  • Diagnosis confirmed with simple office procedure
    • skin scraping with mineral oil prep
      • can see mites under microscopy
Differential
  • Chiggers
  • Bedbugs 
    • live in old mattresses
    • painless bites with pruritic and purpuric macules
    • treatment is symptomatic (triamcinolone) 
  • Contact dermatitis
Treatment
  • Topical permethrin   
    • apply to entire body for 8-10 hours
    • repeat in one week
  • If extensive involvement (immunocompromised individuals)
    • oral ivermectin
  • Sterilize laundry
    • wash/dry all clothing with high heat or throw away
Prognosis, Prevention, and Complications
  • Prognosis
    • very good with treatment
  • Prevention
    • avoid those with known scabies
    • treat all known contacts
    • sterilize laundry
  • Complications
    • secondary bacterial infections

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Questions (4)
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(M2.DM.17.4692) A 37-year-old woman with a history of systemic lupus erythematosus, on prednisone and methotrexate, presents to the dermatology clinic with three weeks of a diffuse, itchy rash. Physical exam is remarkable for small red papules in her bilateral axillae and groin and thin reddish-brown lines in her interdigital spaces. The following skin biopsy is obtained. Which of the following is the most appropriate treatment?

QID: 107666
FIGURES:
1

Hydrocortisone cream

0%

(0/2)

2

Nystatin cream

0%

(0/2)

3

Permethrin cream

100%

(2/2)

4

Ketoconazole cream

0%

(0/2)

5

Capsaicin cream

0%

(0/2)

M 7 C

Select Answer to see Preferred Response

(M2.DM.13.6) A 19-year-old college student presents to the emergency department complaining of an itchy rash on her hands and in her groin for 2 days. The itching is worse at night. The patient has traveled recently for spring break to South America, London, and Spain. She went hunting while on vacation and hunted animals including rabbits, deer, and foxes. She participated in a rabbit taxidermy course as well during this time. Her temperature is 97.0°F (36.1°C), blood pressure is 120/74 mmHg, pulse is 80/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam is notable for the finding in Figure A. Which of the following is the most appropriate treatment for this patient?

QID: 104217
FIGURES:
1

Amoxicillin-clavulanic acid

8%

(5/66)

2

Lindane

68%

(45/66)

3

Nystatin

6%

(4/66)

4

Permethrin

9%

(6/66)

5

Streptomycin

3%

(2/66)

M 7 E

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Evidence (3)
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