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Feature Article

Could it be scabies?

Nina Wines, Stephen Shumack

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Abstract

Scabies can present in atypical ways, making the diagnosis challenging. This article describes the various forms of presentation and discusses treatment options.

Key Points

  • The scabies mite is an obligate human parasite transmitted by skin to skin contact or by contact with contaminated objects.
  • Consider the diagnosis in any patient who has generalised pruritus with nocturnal exacerbations.
  • The presentation is variable and is influenced by age, immune status, hygiene and previous treatment.
  • Permethrin, applied topically, is the first line therapy.
  • The itch can persist for two to three weeks after treatment.
  • Oral ivermectin is currently approved to treat special forms of scabies only.

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