Review Question - QID 104217

This patient is suffering from scabies given her pruritic rash in the web spaces of her hand and groin which should be treated with permethrin cream.

Scabies is transmitted from human to human. Rarely, it may be transmitted via fomites or contracted from dogs or cats. In young adults, transmission is typically sexual. Treatment of scabies is with topical anti-mite creams such as permethrin along with sterilization of laundry. Permethrin should be applied to the whole body for 8-10 hours and application should be repeated in 1 week if refractory. Lindane is used as a second-line agent. Oral ivermectin can be used in moderate to severe infections as well. The diagnosis is made clinically; however, it can be confirmed by scraping the organism out of the burrows.

Figure A shows the papular rash with excoriations in the finger web spaces typical of scabies.

Incorrect Answers:
Answer 1: Amoxicillin-clavulanic acid is appropriate management of a "fight bite" where a human bites another human on the hand. A laceration will be seen between the knuckles. Patients should have the wound explored, irrigated, and be given amoxicillin-clavulanate and the TDAP vaccine.

Answer 2: Lindane is a second-line agent in the treatment of scabies and would only be indicated if refractory to 2 applications of permethrin.

Answer 3: Nystatin is used to treat candidal infections. A candidal infection may present in between a patient's pannus with a pruritic/painful, red, and inflamed rash.

Answer 5: Streptomycin is the appropriate treatment for tularemia. Tularemia is the disease classically associated with rabbit taxidermy; however, it is also transmitted by deer ticks and mosquitoes. It presents with flu-like symptoms and painful lymphadenopathy (both of which are absent in this patient).

Bullet Summary:
The treatment of scabies is permethrin as the first-line agent.