Scabies
Scabies is an infestation of the skin by the mite Sarcoptes scabiei that is especially common in resource-limited regions and crowded conditions such as refugee camps. Therefore, newly arrived refugees are at risk.
It is transmitted through prolonged skin-to-skin contact which means that family members and sexual partners are at risk. After a primary infestation, it may take up to 8 weeks before the symptoms appear.
SIGNS AND SYMPTOMS
The main symptom is severe pruritus that is worse at night. On exam, multiple small erythematous papules can be found, and mite burrows (small serpiginous lines) can sometimes be seen. The head is usually spared.
Here are the common locations of the scabies rash as well as an example of the typical rash:
DermNet NZ. Scabies.
Creative Commons Attribution-NonCommercial-NoDerivs 3.0 (New Zealand)
A definitive diagnosis is made by microscopy of skin scrapings from high-yield locations (fingers, sides of hands, flexural wrists, elbows, axillae, groin, breasts, and feet). However, considering that this test lacks sensitivity and that it might take a few days to obtain the results, treatment should be initiated in any patient with typical pruritus and skin lesions.
TREATMENT
The first-line therapy for scabies is topical permethrin 5% (30g per application for adults). Patients with scabies as well as any close contact (even if asymptomatic) should be treated simultaneously. Patients should be instructed to apply the cream everywhere from the neck to the soles of the feet (including under the nails) and leave it on the skin overnight for at least 8 hours. In young children, the cream should also be applied to the scalp and the face (sparing the eyes and mouth). We recommend a second permethrin application 1-2 weeks after the first one to ensure eradication of the mites.
Permethrin is safe in pregnant and lactating women and in infants ≥2 month of age.
Pruritus and active skin lesions should cease 1 week after successful treatment, but can sometimes persist for up to 1 month.
Oral ivermectin (200 mcg/kg single dose followed by a repeat dose 1-2 two weeks later) is an alternative to permethrin that can be considered in patients who have failed treatment with permethrin or who are not compliant with the topical permethrin regimen. As for strongyloidiasis, patients from a loa loa endemic country (see Map) should not take ivermectin unless loiasis has been excluded (see Strongyloidiasis).