Keywords: scabies, prevention, skin

Introduction:

Scabies is a highly contagious parasitic disease caused by Sarcoptes scabiei transmitted through direct skin-to-skin contact and indirectly through fabrics. Certain measures are necessary to prevent host’s reinfection and the spread of infection.

Case:

A 48-year-old woman presented herself to the family doctor's office with itchy, excoriated erythematous papules on the skin of the lower trunk, groin, upper and lower extremities, present for a week. Scabies was suspected and a positive skin scraping for scabies mites confirmed the diagnosis. She was prescribed 5% permethrin cream to apply from head-to-toe (excluding the face) to dry, cool skin. Once the medication had dried, she was instructed to wear clean clothes, change the bedding and wash these items at 60°C or higher. After 12 hours she was to bathe, change clothes and bedding again and repeat the same treatment after 7 days. All household members underwent the same treatment.

Discussion:

Family physicians are essential in the early diagnosis and treatment of scabies. Scabies causes pruritic lesions of the skin which can impact patient’s quality of life. Education on transmission and hygiene is necessary for prevention. To prevent transmission it is necessary to machine wash all fabrics at a temperature over 50 °C. If not possible, fabrics should be kept in a plastic bag for 7 days, as the mites live only 3 days outside the host. Close contacts should be avoided. Prevention includes personal hygiene measures, especially in crowded spaces and limiting sexual partners. All close contact persons, including sexual partners from the past 2 months must be treated. First line of treatment is 5% permethrin cream, applied head-to-toe and remaining on the skin for 12 hours, with the treatment repeated after 7 days. Other recommended treatments include ivermectin orally 200 μg/kg or 10-25% benzyl benzoate lotion. For mass population treatment oral ivermectin is recommended.