Sarcoptes scabiei infestation; intensely itchy worse at night, burrows in web spaces, wrists, genitals.
History taking
- • Onset, duration, progression, severity
- • Aggravating / relieving factors
- • Past history, drugs, allergies, comorbidities
- • Family & social history relevant to presentation
Examination
- • General: vitals, pallor, icterus, oedema, lymphadenopathy
- • Focused system examination
- • Look for red-flag findings
Red flags
- • Haemodynamic instability
- • Rapid deterioration
- • Severe pain or new neurological deficit
Differential diagnosis
- • See differentials section per chief complaint
Recommended investigations
- • CBC, basic metabolic panel as indicated
- • Targeted disease-specific tests
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Treat underlying cause
- • Symptomatic relief
- • Patient education
Drug therapy
- • Permethrin 5% cream neck-to-toes, wash off after 8–12 h, repeat after 7 days
- • Treat all household contacts simultaneously
- • Oral ivermectin 200 µg/kg if crusted / outbreaks
Follow-up advice
- • Review in 2–4 weeks or earlier if worsening
- • Monitor response to therapy and adverse effects
Patient counselling
- • Wash bedding / clothes at 60°C or seal in bag 72 h
- • Itch may persist 2–4 weeks despite cure
Referral criteria
- • Refer if diagnostic uncertainty, complications, or failure of first-line therapy
References
- • Harrison's Principles of Internal Medicine, 21e
- • NICE / WHO guidelines (current edition)
Educational outpatient guide — verify against local guidelines before clinical use.
