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Scabies – Information for GPs

Definition

Scabies is an itchy rash caused by the mite Sarcoptes Scabeii which is nearly always spread by skin to skin contact.

There are intensely itchy red papules and burrows may be seen on fingers, wrists, ankles and feet. It affects the entire skin but the face and scalp are usually only involved in infants and bed bound elderly patients.

Exclude Red Flag symptoms

Consider crusted (Norwegian) scabies in patients with dementia, neurological disease or immunosuppression.

Management

Topical insecticides:

  • As per local antimicrobial guidance
  • 1st line - apply 5% permethrin dermal cream. Repeat application after 7 days. Current guidance is to treat the whole body, including the scalp and face in all patients, a larger quantity of treatment will be needed to ensure this is possible (average sized adult will require a total of 3 x 30g tubes to cover 2 applications)
  • Alternative – Malathion 0.5% aqueous liquid. Repeat application after 7 days
  • Treat all household members and any other significant contacts e.g. childcare, boyfriend, girlfriend etc.
  • Repeat treatment after 7 days
  • Clothes, towels and bedding should be washed after first application
  • Failure of treatment is usually due to non-adherence to instructions for using insecticide or failure to treat a contact
  • Remember contacts may be infected but remain asymptomatic for weeks
  • The itch of scabies may persist for at least a month after eradication of the mite. Treatment with crotamiton 10% cream or lotion helps to relieve the itch and is also a mild insecticide

Referral criteria

Refer to Dermatology if:

  • Diagnostic uncertainty

Discuss with Dermatology if:

  • Crusted scabies
  • An outbreak in nursing or care home

Information to include in referral letter

  • How long the rash has been present
  • Treatments that have been tried
  • Relevant past medical / surgical history
  • Current regular medication
  • BMI/Smoking status

Investigations prior to referral

None

Patient information leaflets

References

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