Scabiess requires sensitization to the organism, Sarcoptes scabiei.
It may take weeks before pruritus develps in a child infested for the first time. On the next exposure, however, INTENSE itching will occur within 24 hours.
Burrows in the webs of fingers and toes are common.
Treatment: Firstline is permethrin 5% cream on the entire body from the neck down, and wash off after 12 hours. Alternative is lindane 1% (1oz of lotion or 30g of cream) applied in a thin layer over the entire body from the neck down, and thoroughly washed off after 8 hours OR ivermectin 200ug/kg orally repeated in 2 weeks.
Many avoid lindane because of neurotoxicity. Do not apply it after a bath, or to someone with extensive atopic dermatitis as seizures have been reported.
Decontaminate all bedding and cloting.
Warn patients that the rash and itching may persist for up to 2 weeks after treatment.
References
2006 Report of the Committee on Infectious Diseases. American Academy of Pediatrics.
