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Scabies

Guidelines

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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Screening and diagnosis

Diagnosis: as per AAFP 2019 guidelines, 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.
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Diagnostic investigations

Screening for STIs: as per IUSTI 2017 guidelines, screen for sexually-transmitted infections (including HIV) in patients with scabies who are sexually active.
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Medical management

First-line therapy: as per IUSTI 2017 guidelines, 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 mcg/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

Nonpharmacologic interventions

Decontamination measures: as per IUSTI 2017 guidelines, 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.
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Specific circumstances

Pregnant patients: as per IUSTI 2017 guidelines, consider using benzyl benzoate and sulfur in pregnant patients, given their evidence for safety in this population.
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Patient education

General counseling: as per IUSTI 2017 guidelines, 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

Follow-up and surveillance

Follow-up: as per IUSTI 2017 guidelines, arrange a follow-up visit 2 weeks after completion of treatment for a test of cure by microscopy examination.
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