Paediatric Acute care Guidelines PMH Emergency Department

Scabies is a skin condition resulting from the infestation of Sarcoptes scabies mites. 

Background

  • Sarcoptes scabiei mites are transmitted by prolonged direct human contact, and rarely by fomites
  • Pruritus is cased by hypersensitivity to the eggs, faeces and mites
  • A person may have mites and transmit them without having symptoms or signs

Assessment

  • Diagnosis is usually clinical
  • The clinical picture of pruritus and primary lesions (burrows, papules, vesicles and pustules) develops at 4-6 weeks after infestation
  • Burrows (long tracks) are commonly not seen in children
  • Pruritus is worse at night, and may manifest as irritability in infants
  •  Distribution:
    • Facial involvement is uncommon in children < 5 years
    • Infants – usually palms, soles, axillae and scalp
    • Children – usually involve web spaces of fingers, flexor surfaces of arms/wrists/axillae and waistline 
  • Persistent lesions at 1 month suggest reinfection or persistent infection
  • Secondary excoriation and bacterial infection is frequent
  • Lichenification may occur with chronic infection 

Management

Initial management

  • Mainstay of treatment is topical antiparasitics
    • Treatment failure is relatively common and is usually due to noncompliance
    • A second treatment with permethrin 5% 1-2 weeks later is reasonable
  • Children under two years old must be treated all over with antiparasitic preparations: include skin folds and face, avoid mouth and eyes
    • Apply over entire body to cool, clean, dry skin
  • Older children should be treated from chin down; this includes ears and nape of neck into hairline for best results
  • Asymptomatic family members and close contacts (babysitters, grandparents) should be treated at the same time

 

  • Pruritus frequently takes one week or more to resolve after treatment
    • Eurax or Calamine lotion (both available without prescription) may be indicated to control itch until symptoms resolve
  • Consider treatment of secondary infection: Mupirocin (Bactroban), or oral antibiotics if more extensive

Further management

  • Bed linen and clothing should be washed in hot washed and sun dried
  • For clothes where this is not possible, items should be ironed or stored in a plastic bag for 72 hours

Medications

Permethrin 5% (e.g. Lyclear)
Application:
  • Cream disappears when rubbed gently into skin
  • Reapply to hands if washed within 8 hours of application
  • Rinse after 8-14 hours with warm soapy water
  • Repeat after 7 days
  • Most lesions clear after a single application
  • May cause a mild, transient stinging sensation
Amount:
  • Children >12 years apply up to one 30g tube
  • 5-12 years up to 1⁄2 tube
  • 1-5 years up to 1⁄4 tube
  • 2-12 months up to 1/8 tube
  • Adults may occasionally require more than a single tube for coverage
Safety:
  • Limited data regarding use in pregnancy, but suggests risk of fetal toxicity is minimal. This is the current KEMH recommendation for treatment of pregnant and breast feeding women.
  • Australia product information recommends use in infants 6 months or older, however , the equivalent US information confirms both safety and efficacy in infants 2 months of age and older. Safety and efficacy below this age is not established.
 
Note that PMH pharmacy will fill scripts for adult contacts of paediatric patients – Scabies Prescription for Patient Contacts

Nursing

  • Contact Precautions – gloves and long sleeve gowns
  • Place all linen in a plastic bag and then into the usual laundry bag

References

  1. WA Health OD 2043/06 – Insecticide Treatments For Scabies, Head Lice, Body Lice, Pubic Lice. Thursday, 30 March 2006
  2. Australian Medication Handbook Children’s Dosing Companion, Australian Medicines Handbook Pty Ltd, 2015. Online at: https://children’s.amh.au
  3. WA Health. Child and Adolescent Health Service Infection Control Manual – Lice and Scabies, March 2014

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