SCABIES 2

Management

Effective topical applications include:

benzyl benzoate 25% application (Benzemul, Ascabiol);

lindane (gamma benzene hexachloride) 1% cream (Lorexane, Quellada);

sulphur 6% in petrolatum;

monosulfiram 5% soap (Tetmosol).

An effective regimen is to apply lindane cream (Lorexane) to the entire body surface below the jaw. The cream is left on overnight and washed off in the morning. Lindane is absorbed and neurotoxicity has been reported; one application is usually sufficient and excessive use should be discouraged. Bed linen and clothing should be washed in the hot cycle of a washing machine and dried completely in the sun or a hot drier. Blankets do not need to be washed but should not be used for several days.

Lindane should not be used during pregnancy, lactation or childhood. Sulphur in petrolatum or crotamiton should be used instead. Monosulfiram soap may be used in place of ordinary soap for treatment and prophylaxis while risk of infection exists.

Skin irritation may persist for a week or so after treatment and a second course of treatment should not be given unless there is evidence of continuing infestation. If there is secondary infection of skin lesions, systemic antibiotics may be necessary.

Generally, the family and sexual and other close contacts should be treated simultaneously whether or not they show evidence of infestation.

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