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4. Skin diseases
Treatment
In all cases
– C lose con tacts of th e p atien t are treated sim ultan eously, even in th e absen ce of
sym p tom s.
– C lothin g an d bed d in g (in clud in g that of con tacts) are chan ged after each treatm en t.
T hey are w ashed at ≥ 6 0 °C then d ried in the sun , or exp osed to sun light for 7 2 hours,
or sealed in a p lastic bag for 7 2 hours.
Ordinary scabies
Topical treatment
T op ical scabicid es are ap p lied over the en tire bod y (in clud in g the scalp , p ost-auricular
areas, um bil4icus, p alm s an d soles), avoid in g m ucous m em bran es an d face, an d
th e
breasts in breastfeed in g w om en . P articular atten tion sh ould be p aid to com m on
in festation sites. T he recom m en d ed con tact tim e should n ot be shorten ed or exceed ed ;
the p atien t m ust n ot w ash his han d s w hile the p rod uct is in use (or the p rod uct should
be reap p lied if th e h an d s are w ash ed ) . I n in fan ts, th e h an d s m ust be w rap p ed to
p reven t accid en tal in gestion of the p rod uct. T op ical scabicid es should n ot be ap p lied to
brok en or in flam ed sk in . T reatm en t of secon d ary bacterial in fection , if p resen t, should
be in itiated 2 4 to 4 8 hours before use of top ical scabicid es (see Impetigo, p age 1 0 5 ).
T he p referred treatm en t is 5% permethrin (lotion or cream ):
C h ild > 2 m on th s an d ad ult: on e ap p lication , w ith a con tact tim e of 8 h ours, th en
rin se off. P erm eth rin is easier to use ( n o d ilution req uired ) , an d p referred over
ben z yl ben z oate in ch ild ren , an d p regn an t/ lactatin g w om en . On e ap p lication
m ay
be sufficien t, but a secon d ap p lication 7 d ays later red uces th e risk of treatm en t
failure.
or, if n ot availabCleh,ildbreennzy
Children > 12 years
and adults
Dilution 1 p aLrto2tio5n%m luostitobne d iluted bef1orep uasret :2 5 % lotion
U se un d iluted 2 5 % lotion
+ 3 p arts w ater 2 4 ho+urs1, thpeanrt rwinasteeroff 2 4 hours, then rin se off
Contact 1 2 hours (6 hours for in fan ts
time < 6 m on ths), then rin se off
A secon d ap p lication of ben z yl ben z oate ( e.g. after 2 4 hours, w ith a rin se betw een
the
2 ap p lication s; or tw o successive ap p lication s, 1 0 m in utes ap art, w h en th e first
ap p lication h as d ried , w ith a rin se after 2 4 h ours) red uces th e risk of treatm en t
failure.
S econ d ap p lication s are n ot recom m en d ed in p regn an t w om en an d child ren < 2
years.
Oral treatment
T reatm en t w ith ivermectin P O (2 0 0 m icrogram s as a sin gle d ose) is an altern ative: it is
m ore p ractical than top ical treatm en t (e.g. in the case of an ep id em ic or for treatin g
con tacts) an d can be started right aw ay in th e case of secon d ary in fection . A sin gle
d ose m ay be sufficien t; a secon d d ose 7 d ays later red uces th e risk of treatm en t
failure.
Treatment
In all cases
– C lose con tacts of th e p atien t are treated sim ultan eously, even in th e absen ce of
sym p tom s.
– C lothin g an d bed d in g (in clud in g that of con tacts) are chan ged after each treatm en t.
T hey are w ashed at ≥ 6 0 °C then d ried in the sun , or exp osed to sun light for 7 2 hours,
or sealed in a p lastic bag for 7 2 hours.
Ordinary scabies
Topical treatment
T op ical scabicid es are ap p lied over the en tire bod y (in clud in g the scalp , p ost-auricular
areas, um bil4icus, p alm s an d soles), avoid in g m ucous m em bran es an d face, an d
th e
breasts in breastfeed in g w om en . P articular atten tion sh ould be p aid to com m on
in festation sites. T he recom m en d ed con tact tim e should n ot be shorten ed or exceed ed ;
the p atien t m ust n ot w ash his han d s w hile the p rod uct is in use (or the p rod uct should
be reap p lied if th e h an d s are w ash ed ) . I n in fan ts, th e h an d s m ust be w rap p ed to
p reven t accid en tal in gestion of the p rod uct. T op ical scabicid es should n ot be ap p lied to
brok en or in flam ed sk in . T reatm en t of secon d ary bacterial in fection , if p resen t, should
be in itiated 2 4 to 4 8 hours before use of top ical scabicid es (see Impetigo, p age 1 0 5 ).
T he p referred treatm en t is 5% permethrin (lotion or cream ):
C h ild > 2 m on th s an d ad ult: on e ap p lication , w ith a con tact tim e of 8 h ours, th en
rin se off. P erm eth rin is easier to use ( n o d ilution req uired ) , an d p referred over
ben z yl ben z oate in ch ild ren , an d p regn an t/ lactatin g w om en . On e ap p lication
m ay
be sufficien t, but a secon d ap p lication 7 d ays later red uces th e risk of treatm en t
failure.
or, if n ot availabCleh,ildbreennzy
Children > 12 years
and adults
Dilution 1 p aLrto2tio5n%m luostitobne d iluted bef1orep uasret :2 5 % lotion
U se un d iluted 2 5 % lotion
+ 3 p arts w ater 2 4 ho+urs1, thpeanrt rwinasteeroff 2 4 hours, then rin se off
Contact 1 2 hours (6 hours for in fan ts
time < 6 m on ths), then rin se off
A secon d ap p lication of ben z yl ben z oate ( e.g. after 2 4 hours, w ith a rin se betw een
the
2 ap p lication s; or tw o successive ap p lication s, 1 0 m in utes ap art, w h en th e first
ap p lication h as d ried , w ith a rin se after 2 4 h ours) red uces th e risk of treatm en t
failure.
S econ d ap p lication s are n ot recom m en d ed in p regn an t w om en an d child ren < 2
years.
Oral treatment
T reatm en t w ith ivermectin P O (2 0 0 m icrogram s as a sin gle d ose) is an altern ative: it is
m ore p ractical than top ical treatm en t (e.g. in the case of an ep id em ic or for treatin g
con tacts) an d can be started right aw ay in th e case of secon d ary in fection . A sin gle
d ose m ay be sufficien t; a secon d d ose 7 d ays later red uces th e risk of treatm en t
failure.
