Pathogenesis
infestation --> immune system sensitised to mite and mite-related products incl eggs
--> symptoms appear
Mite count usually 10-15, but can reach thousands in Norwegian (Crusted) Scabies
Dx
clinical
v itchy
bilateral
wrists, ankles, groin/genitals/buttocks, waist etc
often no burrows to see, especially in warm climate
Rx
2 Rx, one week apart
topical
"Lyclear" (permethrin cream)
OK from 2 months old but must be > 15 kg
Head-to-toe at bedtime. Wash off in the morning.
oral
ivermectin ("Stromectol")
150-200 mcg per kg
100kg = 15 - 20 mg
=> 5 or 7 tablets (each 3mg)
"Ready-reckoner" - adults 15 mg; children 6 mg
Hot wash bed linen, towels, clothing
Rx family and close contacts
(significant incidence of asymptomatic cases => carriers)
Pets don't harbour human mites
=> can't give you scabies; no need to Rx
Response to Rx usually within 3 days (most resolved in 2 weeks),
but pruritus can remain for up to 2 months
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