Scabies (Sarcoptes scabiei)
Treatment: permethrin (Lyclear® Dermal Cream) as first line; malathion (Quellada M®) as second-line treatment and for those female carers who may be breast feeding or pregnant.
When scabies is diagnosed, close household contacts (bed partners and children) will also require treatment. Generally, it requires 5 minutes skin-to-skin contact to acquire the infection. The patient is contagious after a few days of acquiring the infection even though no signs of the infection may be present. Itching, particularly at night, is the main symptom of scabies in otherwise healthy individuals. It is usually delayed one to two months after exposure. However, when the patient has been exposed previously, itching can start after one week. It is important to advise the patient that itching still occurs after treatment and this does not always imply treatment failure.
Treatment should be applied to the whole body including the scalp, neck, face and ears. Particular attention should be paid to the webs of the fingers and toes. Depending on which preparation is used,it should be left on for between 8 and 24 hours. All household members should be treated at the same time. A second application is recommended for both permethrin and malathion. This is best applied after an interval of 7 days.
Crusted, or Norwegian, scabies, affecting mainly immuno-suppressed patients and patients in nursing / residential homes, is more difficult to treat and requires more applications of treatment. Advice should be sought from the Health Protection Unit.
If an outbreak is suspected in a nursing or residential home, it is important to inform the Health Protection Unit to look at mass treatment of staff and residents. Unfortunately, sometimes patients receive a steroid preparation for the treatment of itchy skin / rash rather than being correctly diagnosed as scabies.
Head lice (Pediculus capitis)
Treatment: malathion (Quellada M®); phenothrin (Full Marks® liquid)
Lice eggs hatch within 7 - 10 days of being laid, then the empty egg cases (nits) move further along the hair shaft as the hair grows out. Lice take about 6 - 14 days to become fully-grown, after which they are capable of reproduction. The policy of rotating insecticides on a district wide basis is now considered outmoded.
Treatment should only be considered when live lice are observed on the scalp. It is now recommended that both physical and chemical methods of treatment should be used together. This means wet combing together with insecticides. It is possible to use either method separately but this is less likely to be effective.
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wet combing every 3 days for 2 weeks
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insecticide - 2 applications used 7 days apart to prevent lice re-emerging from any eggs that survive the first application. (Alternatively, wet combing can be used to check for immature lice before re-application at 3 - 5 and 10 - 12 days.)
Hedrin® is a non- parasitical treatment for adult lice. It is less active against eggs and treatment should be repeated after 7 days.
The value of head lice repellents and alternative remedies, which are on sale to the public, is uncertain and, therefore, NOT recommended.
Crab lice (Pthirus pubis)
Treatment: malathion (Quellada M®); permethrin (Lyclear® Dermal Cream)
Crab lice (or pubic lice) can exist in eyelashes, beard hair, axillary hair and the hair on the trunk and limbs, as well as pubic hair. Further advice may be obtained from the Health Protection Unit. 01726 627881.
See also Public Health Medicine Environmental Group www.phmeg.org.uk