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Scabies

Key sources
The following summarized guidelines for the evaluation and management of scabies are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2019) and the International Union Against Sexually Transmitted Infections (IUSTI 2017).
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Guidelines

1.Screening and diagnosis

Diagnosis: suspect scabies in patients with a pruritic, papular rash in the typical distribution and pruritus in close contacts. Recognize that the classic burrows in webs and creases may not be present.
B
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2.Diagnostic investigations

Screening for sexually transmitted infections: screen for sexually-transmitted infections (including HIV) in patients with scabies who are sexually active.
B

3.Medical management

First-line therapy: offer one of the following medications as first-line therapy:
permethrin 5% cream applied head to toe and washed off after 8-12 h, repeat after 7-14 days
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ivermectin PO 200 µg/kg taken with food, repeat after 7 days
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benzyl benzoate 10-25% lotion applied once daily at night on 2 consecutive days, repeat after 7 days
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More topics in this section

  • Alternative treatment options

  • Management of crusted scabies

  • Management of sexual partners

4.Nonpharmacologic interventions

Decontamination measures: decontaminate clothing, bedding, towels and other items with one of the following methods:
laundering with a washing machine (≥ 50 °C or ≥ 122 °F)
dry-cleaning
storing in a sealed plastic bag for 1 week
B

5.Specific circumstances

Pregnant patients: consider using benzyl benzoate and sulfur in pregnant patients, given their evidence for safety in this population.
C

6.Patient education

General counseling: provide patients with a detailed explanation of their infestation together with clear written information.
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More topics in this section

  • Close contact precautions

7.Follow-up and surveillance

Follow-up: arrange a follow-up visit 2 weeks after completion of treatment for a test of cure by microscopy examination.
B