Scabies
Parasitic Infestations of the Skin
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ICD 10 code: B86
DESCRIPTION
- An infestation with the parasite Sarcoptes scabei
- Commonly occurs in the skin folds. The infestation spreads easily, usually affecting more than one person in the household
- Clinical features include:
- Intense itching, which is more severe at night
- Small burrows between fingers, toes, elbow areas and buttocks where the parasite has burrowed under the skin
- Secondary infection which may occur due to scratching with dirty nails
- Vesicles and pustules on the palms, soles, and sometimes scalp, in small babies
GENERAL MEASURES
- Treat all close contacts simultaneously even if they are not itchy
- Cut finger nails and keep them clean
- Wash all linen and underclothes in hot water
- Expose all bedding to direct sunlight
- Put on clean, washed clothes after medicine treatment
MEDICINE TREATMENT
Children < 6 years of age
- Permethrin 5%, topical, apply lotion undiluted to the whole body from neck to feet
- Leave on overnight (8–12 hours) and wash off the following morning
LoE: IVb16
If permethrin is unavailable for children < 6 years of age:
Benzoyl benzoate 25% lotion:
- Children 0 months to 1 year of age:
- Dilute 1 part of benzoyl benzoate to 3 parts of water to form an emulsion of 6%
- Apply diluted emulsion to the whole body from neck to feet as described above
- Children 1 to 6 years of age:
- Dilute 1 part of benzoyl benzoate with an equal amount of water to form an emulsion of 12.5%
- Apply diluted emulsion to the whole body from neck to feet as described above
LoE:IVb17
Children ≥ 6 years of age and adults
- Benzoyl benzoate 25% lotion, applied undiluted to the whole body from neck to feet
- Allow the lotion to remain on the body for 24 hours, then wash off using soap and water
- Treatment may be repeated after 24 hours once within 5 days for severe infestations
- All infested persons living in the household, or likely to contract the infestation, should be treated at the same time
If benzoyl benzoate is unsuccessful:
- Permethrin 5%, topical, apply lotion undiluted to the whole body from neck to feet
- Leave on overnight (8–12 hours) and wash off the following morning
LoE: IIIb18
Note:
- Benzyl benzoate and permethrin are toxic if swallowed.
- Avoid contact with eyes and broken skin or sores.
- Do not continue if rash or swelling develops.
- Itching may continue for 2–3 weeks after treatment.
- Treatment may need to be repeated again after one week.
− Treat secondary infection with antibiotics. See: Impetigo
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_07 November 2024
Chapter 5: Skin Conditions_5.7.2 Scabies