- Keywords > Clinical Practice Guidelines (CPGs)
- Keywords > criteria of medicines selection
- Keywords > HIV infection and STIs
- Keywords > opportunistic infections and other HIV-related
- Keywords > reproductive tract infections
- Keywords > sexual and reproductive health
- Keywords > sexually transmitted infections (STIs)
- Keywords > treatment guidelines
- Keywords > treatment protocols
(2004; 88 pages)
Scabies is often sexually transmitted in adults. However, there clearly are situations in which scabies is transmitted through close body contact not related to sexual activities. This is true in circumstances in which people are living in very close quarters such as in schools, poor housing complexes and in institutions such as nursing homes and psychiatric hospitals. The labelling of scabies as a sexually transmitted infection should be avoided when the likely cause is close body contact, in order to prevent stigmatization. In addition, the management recommendations are different for patients presenting with sexually acquired scabies (i.e. young adult living in good housing conditions). Management of such patients should include treatment of all sexual partners. For outbreaks of scabies related to non-sexual close body contact, treatment of all people involved is critical.
Adults, adolescents and older children: recommended regimen
• lindane 1% lotion or cream applied thinly to all areas of the body from the neck down and washed off thoroughly after 8 hours.
• permethrin cream (5%)
• benzyl benzoate 25%, lotion, applied to the entire body from the neck down, nightly for 2 nights; patients may bathe before reapplying the drug and should bathe 24 hours after the final application
• crotamiton 10%, lotion, applied to the entire body from the neck down, nightly for 2 nights and washed off thoroughly 24 hours after the second application; an extension to 5 nights is found necessary in some geographical areas (crotamiton has the advantage of an antipruritic action).
• sulphur 6%, in petrolatum applied to the entire body from the neck down, nightly for 3 nights; patients may bathe before reapplying the product and should bathe 24 hours after the final application.
• Lindane is not recommended for pregnant or lactating women.
• Resistance to Lindane has been reported in some areas.
Infants, children under 10 years of age, pregnant or lactating women
• crotamiton 10%, as above
• sulphur 6%, as above
• permethrin 5%, cream, applied in the same way as the sulphur regimen described above.
Sexual contacts and close household contacts should be treated as above.
Pruritus may persist for several weeks after adequate therapy. A single treatment after 1 week may be appropriate if there is no clinical improvement. Additional weekly treatments are warranted only if live mites can be demonstrated. If reinfection can be excluded and compliance assured, topical anti-inflammatory therapy may be considered as an allergic reaction may be the reason for clinical manifestation.
Clothing or bed linen that may have been contaminated by the patient in the 2 days prior to the start of treatment should be washed and well dried, or dry-cleaned.