Treatment and Prevention of Scabies

Treatment

Medical Management

Medical therapy is directed to elimination of the itch mite and treatment of complications

Scabies treatment (patient, all family members)

1. Lindane (Kwell, Scabene)

Apply at bedtime in a thin layer over the entire body from neck down.
Wash off in 8 to 12 hours.
Give a second treatment in 24 hours if prescribed.

2. Crotamiton 10% (Eurax)

Crotamiton 10 % is less effective than Lindane
Bathe before initial application and after each treatment
Repeat treatment as prescribed.

3. Benzyl benzoate

Give two overnight treatments 1 week apart as prescribed.
Not widely available; apply as directed by physician

The patient is bathed thoroughly with soap and water, and 1 percent gamma benzene hexachloride cream or lotion 0r 25 percent benzyl benzoate lotion is applied to the entire body at prescribed intervals. Treatment is irritating to the average skin and will not quickly relieve the pruritus. Patients should be made aware that they are likely to be uncomfortable for a week or more. Triamcinolone ointment may be prescribed for the pruritus.

As with pediculosis, patient education is the primary education. Because scabies spreads within families, the patient and family members need to know the nature of the disease and the need for all family members to receive treatment, even if they are asymptomatic. Some patients experience shame and guilt feelings when they learn the diagnosis; a nonjudgmental attitude with explanations of methods of control may help these patients cope with their feelings.

Despite controversy about the potential for spread of the disease by clothing or linens, preventive measures are still being recommended. Teaching the patient with scabies includes the following:

All family members should be treated simultaneously, whether or not symptoms are present.
Be sure that all external body areas below the neck are covered by the prescribed scabicide
Wash underclothing and bed and bath lines in hot water on the day of treatment; dry in dryer or iron after dry; change linens daily.
Signs and symptoms may not disappear until one or two weeks after treatment; pruritus of hands and feet may persist for up to 3 months.

Treatment

The whole family should be examined before undertaking treatment, as long as member of the family remains infected, other members will get the diseases
Treatment is entirely limited to the skin area
Benzyl Benzoate emulsion (Burroughs, Welcome) is cleaner to use and has more rapid effect.

Prevention and Control

Practice good personal hygiene- Take a daily bath; washing the hands before and after, and after using the toilet; cut or always keep fingernails short
Regular changing of clean clothing, beddings, linens, and towels.
Eating the right kind of food rich in Vitamin A and Vitamin C such as green leafy vegetables, squash, and plenty of fruits and fluids (drink 2-3 liters of fluid unless contraindicated).
Keeping the whole house clean as much as possible.
Improving the sanitation of the surroundings.