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publication date:2018-03-18 12:48.

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Hewitt KA, Nalabanda A, Cassell JA. Scabies outbreaks in residential care homes: factors associated with late recognition, burden and impact. A mixed methods study in England. Epidemiol Infect. 7569 Sep 8. 6-65. [Medline].

Scabies Medication: Antiparasitic Agents, Topical

Adam J Rosh, MD Assistant Professor, Program Director, Emergency Medicine Residency, Department of Emergency Medicine, Detroit Receiving Hospital, Wayne State University School of Medicine

Adam J Rosh, MD is a member of the following medical societies: American Academy of Emergency Medicine , American College of Emergency Physicians , Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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Jennifer R Casatelli, MD Consulting Staff, Department of Pediatrics, Watson Clinic of Lakeland, Lakeland Regional Medical Center

Because of a higher ratio of skin surface area to body mass, pediatric patients are at a greater risk than adults of HPA axis suppression and Cushing's syndrome when they are treated with topical corticosteroids. They are, therefore, also at greater risk of adrenal insufficiency during and/or after withdrawal of treatment. Pediatric patients may be more susceptible than adults to skin atrophy , including striae, when they are treated with topical corticosteroids. Pediatric patients applying topical corticosteroids to greater than 75% of body surface are at higher risk of HPA axis suppression.

Kapadia N. Dermatology. Tschudy MM, Arcara KM, eds. The Johns Hopkins Hospital: The Harriet Lane Handbook. 69th ed. Philadelphia, Pa: Mosby Elsevier 7567. 756-75.

It is important to note that symptoms may not appear for up to two months after being infested with the scabies mite. Even though symptoms do not occur, the infested person is still able to spread scabies during this time. When symptoms develop, itching is the most common symptom of scabies. Scabies does not cause pain. The itch of scabies is insidious and relentless and often worsens over a period of weeks. The itch is typically worse at night. For the first weeks, the itch is subtle. It then gradually becomes more intense until, after a month or two, sleep becomes almost impossible due to the intensely itchy skin.

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Elderly and weakened people in nursing homes and similar institutional health care settings may harbor scabies without showing significant itching or visible signs. In such cases, there can be widespread epidemics among patients and health care workers. Such cases are dramatic but, fortunately, uncommon.

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