Clothing and bedding of persons with scabies should be washed in hot water and dried in a hot dryer. First-line treatment for scabies is permethrin 5% cream. In infants, the rash can also be vesicular, pustular, or nodular. Scabies in adults presents as a pruritic, papular rash in a typical distribution pattern. Body lice infestation should be suspected in patients with pruritus who live in crowded conditions or have poor hygiene. In adults, the presence of pubic lice should prompt an evaluation for sexually transmitted infections. Extensive environmental decontamination is not necessary after pediculosis is diagnosed. Noninsecticidal agents, including dimethicone and isopropyl myristate, show promise in the treatment of pediculosis. Newer treatments are available but costly, and resistance patterns are generally unknown. First-line pharmacologic treatment for pediculosis is permethrin 1% lotion or shampoo. A “no-nit” policy for return to school is not recommended because nits can remain even after successful treatment. Nits (lice eggs or egg casings) alone are not sufficient to diagnose a current infestation. Head and pubic lice infestations are diagnosed with visualization of live lice. Pruritus is the most common presenting symptom. Skin sores that become infected should be treated with an appropriate antibiotic prescribed by a doctor.Pediculosis and scabies are caused by ectoparasites. If itching still is present more than 2 to 4 weeks after treatment or if new burrows or pimple-like rash lesions continue to appear, retreatment may be necessary. Always contact a doctor or pharmacist if unsure how to use a particular medicine.īecause the symptoms of scabies are due to a hypersensitivity reaction (allergy) to mites and their feces (scybala), itching still may continue for several weeks after treatment even if all the mites and eggs are killed. The instructions contained in the box or printed on the label always should be followed carefully. All persons should be treated at the same time to prevent reinfestation. Both sexual and close personal contacts who have had direct prolonged skin-to-skin contact with an infested person within the preceding month should be examined and treated. Clean clothing should be worn after treatment. The lotion or cream should be applied to a clean body and left on for the recommended time before washing it off. Only permethrin or sulfur ointment may be used in infants. In addition, when treating infants and young children, scabicide lotion or cream also should be applied to their entire head and neck because scabies can affect their face, scalp, and neck, as well as the rest of their body. Scabicide lotion or cream should be applied to all areas of the body from the neck down to the feet and toes. Always contact a doctor or pharmacist if unsure how to use a particular medicine. No “over-the-counter” (non-prescription) products have been tested and approved to treat scabies. Scabicides used to treat human scabies are available only with a doctor’s prescription. Products used to treat scabies are called scabicides because they kill scabies mites some also kill mite eggs. Use of insecticide sprays and fumigants is not recommended. Scabies mites generally do not survive more than 2 to 3 days away from human skin. All persons should be treated at the same time to prevent reinfestation.īedding, clothing, and towels used by infested persons or their household, sexual, and close contacts (as defined above) anytime during the three days before treatment should be decontaminated by washing in hot water and drying in a hot dryer, by dry-cleaning, or by sealing in a plastic bag for at least 72 hours. In addition to the infested person, treatment also is recommended for household members and sexual contacts, particularly those who have had prolonged direct skin-to-skin contact with the infested person. Symptoms can typically take 4-8 weeks to develop after they are infested however they can still spread scabies during this time. It is important to remember that the first time a person gets scabies they usually have no symptoms.
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