Nejm 2006;354:1718

Cause:Sarcoptes scabieivar. hominis:an arthropod mite

Pathophys:

Common: burrows in skin, leading to allergic reaction

Norwegian: no burrowing, but hides beneath skin scales

Norwegian rare in US except in AIDS pts and alcoholics

Sx:

Common: itching, worst at night

Norwegian: no itching

Si:

Common: red papules in intertriginous areas

Norwegian: hyperkeratotic skin hiding mites

Common: even w rx takes 2 wk for sx to subside

Lab:Bact:Mineral oil scraping of burrow shows mite or eggs under low power

Rx:

(Med Let 1993;35:111)

Launder clothes, bedding; hang them outside × 24 h will also kill since can't survive >24 h away from body

Meds:

• 1st: Permethrin 5% (Elimite) cream (Med Let 1999;41:89) × 8-12 h; 30 gm enough to rx adult; 91% cure; safer than lindane
• 2nd: Lindane 1% (Kwell) (Med Let 1997;39:6) once though often may need repeat; 86% cure; crotamiton 10% (Eurax) if above fails; 60% cure; ivermectin 200 µgm/kg po × 1, ii 6-mg tabs for avg adult; very effective, esp w crusting type and/or in immunosuppressed (Nejm 1995;333:26)