Management of scabies

HOW COMMON IS THIS IN MY PRACTICE?Scabies is a common infection affecting individuals of any age and socioeconomic status.The worldwide prevalence is estimated to be 100 million people.(1) Lim et al conducted a review of 114 patients who were treated for scabies at the National Skin Centre in 1982-1989.(2) The data showed that with increased modernisation in Singapore, the prevalence of scabies was higher in institutions such as intermediate and long-term care facilities rather than in residential homes.The authors postulated that this was because of improvements in housing facilities, resulting in less crowding.With the increase in travel and humanitarian work by our local population, particularly in developing countries, the risk of contracting scabies from people living in compromised housing has correspondingly increased.(3) Clinical manifestationsThe two major clinical variants of scabies are classic scabies and crusted scabies.Symptoms typically appear 2-6 weeks after infestation.Classic scabies (Fig. 1), the most common presentation, is associated with a relatively low mite burden of approximately 10-15 mites on the body.Crusted scabies (Fig. 2), on the other hand, usually occurs in older or immunocompromised individuals and is associated with a higher mite burden (up to millions of mites on the body).(4) It is also more often seen in disabled and institutionalised patients.This infestation often presents as generalised dermatitis with crusted hyperkeratoses on the palms, soles, under the fingernails, and on the ears, trunks and extremities.Pruritus may