A patient presented with itchy lesions over the wrist,(itching is worse at night)..Which of the following drug can be used orally as a treatment in this case?
The patient in question is suffering from Scabies.
- Infestation caused by Acarus hominis/Sarcoptes scabie.
- Incubation period is 2-4 weeks.
- Itching worse at night is most common symptom.
- Family history of similar itchy eruptions in close contact
- On an average, an adult has 12 mites and an infant 20 mites.
- Serpentine (S-shaped) burrows traversed by parasite in stratum corneum (pathognomic lesion)
- Most common sites involved: Inter digital space, Anterior wrist, Ulnar border of hand
- An imaginary circle intersecting the main sites of involvement—axillae, elbow flexures, wrists and hands and groins – ‘circle of Hebra’.
- In infants and elderly: Scalp, Face, Neck, Palms & Soles, Penis also involved
- Papules & papulo-vesicles: due to hypersensitivity to the mite.
- Fine pin head size follicular papules
- Pustules due to 2° infection is one of commonest form of presentation.
- Eczematized crusted lesion, in infants & children are predominant lesions.
- Nodular lesions are seen on scrotum (most common), groin, and anterior axillary fold (Nodular scabies).
- Crusted or Norwegian scabies
- Most severe form
- The average number of mites in these cases is 2 million
- Seen in immuno compromised, mentally ill patients, GVDH, leprosy, leukemia
- Psoriatiform or warty lesions accompanied by nail hyperkeratosis
- No burrows
- Minimal itching
- Highly contagious
- Ivermectin is the treatment of choice
- Scabies incognetio – wrongly treated with steroids.
- Drug of choice : 5% Permethrin (1st ) BHC (2nd ).
- Oral drug (Only): Ivermectin.
- Other drugs : Benzyl benzoate 25%, Crotamiton 10%, Malathion, Monosulfiram.
- Scabicides should be applied to the whole body (below jaw line in adults) to all members of family whether
symptomatic or not.