Home' Australian Pharmacist : January 2011 Contents Vol. 30 -- January #01
Continuing Professional Development
The articles in this series are independently researched and compiled by PSA commissioned authors and peer reviewed.
1. Which statement is incorrect
with regard to crusted
a) Crusted scabies predominantly
affects the elderly,
b) Patients with crusted scabies are
infested with the Sarcoptes scabiei
mite, as are patients with classic
c) Patients with crusted scabies are
treated with both ivermectin and a
d) A patient with crusted scabies is
generally infested with twice as
many mites as patients with classic
2. Which statement is correct with
regard to the symptoms of a
a) Scabies is characterised by
intense itching, red papules and
thin, wavy grey-white burrows may
also be present.
b) Scabies nodules do not develop on
the elbows, penis and scrotum.
c) The itching associated with scabies
is due to the presence of the mite,
and ceases three to seven days after
application of a scabicide.
d) Thick scaling and weeping nodules
are characteristic of crusted
3. Which statement is correct with
regard to transmission of the
a) Scabies can be caught from animals.
b) Crusted scabies can be transmitted
via brief, close contact and fomites.
c) Dislodged scabies mites use sight
and hearing to find a new host, and
therefore close contact is required
for these stimuli to be strong
d) The scabies mite can jump from one
person to another.
4. Which statement is correct with
regard to treatment options
a) Poor patient compliance is a
limitation to the use of benzyl
benzoate 25% emulsion.
b) Permethrin is approved for use in all
c) Treatment should be reapplied
21 days after initial application of
a scabicide to ensure complete
eradication of the scabies mite.
d) Permethrin is not a suitable treatment
for pregnant and lactating women.
5. Which statement is not an
appropriate counselling point
a) Reapply treatment to hands if they
are washed during treatment period.
b) Pay particular attention when
applying treatment to hands and
genitalia. A nailbrush should be used
to ensure medicament is applied
c) In most cases treatment needs
to be applied to the entire body,
including face, scalp, neck and ears
and left on for an advised period of
time (permethrin: 8--12 hours; benzyl
benzoate: 24 hours).
d) All family members and likely
contacts should be treated
simultaneously to reduce chances of
counselling in practice
scabies in an attempt to determine
the source of the outbreak. Mrs GW
should treat herself and her family
with topical permethrin, and wash all
fomites in a warm wash cycle. She
should also be advised that anyone
who has had close contact with her
family since she visited her mother
should be notified and advised to
discuss the need for treatment with
Key learning points
Scabies infestations are quickly
spread through prolonged,
direct contact. Therefore,
immediate identification of
cases is imperative, as is correct
adherence to prescribed treatment.
Permethrin is the treatment of
choice due to its high level of
efficacy and low level of toxicity,
and is suitable in pregnant and
lactating patients. Once identified,
everyone who has had close
physical contact with the infested
patient or their fomites must be
treated immediately, even if they
are asymptomatc. This prompt
action will reduce the chance
of further transmission, and of
previously treated patients being
reinfected. Closed community
settings, such as residential
care facilities and hospitals, are
common settings for scabies
outbreaks because transmission is
fast, and the majority of residents
fall into the risk category for
1. Department of Health, State Government of Victoria.
Scabies. [Online] 2008 [cited 2010 Oct 6]. At: www.
2. Chosidow O. Scabies. NEJM 2006 Apr
20;354(16):1718--27. At: www.nejm.org/doi/
3. Heukelbach J, Feldmeier H. Scabies. Lancet 2006
4. McCarthy JS, Kemp DJ, Walton SF, Currie BJ.
Scabies: more than just an irritation. Postgrad
Med J 2004;80:382--7. At: http://pmj.bmj.com/
5. Division of Parasitic Diseases, CDC. Scabies -- risk.
[Online] Centres for Disease Control and Prevention
2008. At: www.cdc.gov/scabies/risk.html [cited 2010
6. Melbourne Sexual Health Centre. Scabies. [Online]
Better Health Channel 2010. At: www.betterhealth.
[cited 2010 Oct 06].
7. Department of Health, State Government of Victoria.
Scabies information sheet. [Online] 2008 [cited 2010
Oct 6]. At: www.health.vic.gov.au/ideas/bluebook/
8. Department of Health, Government of South Australia.
Scabies: Prevention and treatment. [Online] 2008 [cited
2010 Oct 11]. At: www.health.sa.gov.au/pehs/PDF-
9. Therapeutic Guidelines. Scabies (Sarcoptes scabei
var. hominis). [Online]. 2009. Available from: eTG31;
2010. [cited 2010 Oct 06].
10. eAMH: Scabies monograph. Australian Medicines
Handbook; Jan 2010.
11. Commens C, Sullivan JR. A-Z of skin: Scabies. [Online].
Australasian College of Dermatologists; 2001. At: URL:
[cited 2010 Oct 06].
12. Department of Health, State Government of Victoria.
Guide to scabies management in residential care
facilities. [Online] 2008 [cited 2010 Oct 6]. At: www.
13. Therapeutic Guidelines. Impetigo. [Online]. 2009.
Available from: eTG31. Therapeutic Guidelines; 2010.
[cited 2010 Oct 26].
14. Division of Parasitic Diseases, CDC. Scabies -- Health
care providers -- Control. [Online] Centres for Disease
Control and Prevention 2008. At: www.cdc.gov/
scabies/hcp/control.html [cited 2010 Oct 06]
15. Division of Parasitic Diseases, CDC. Scabies -- Health
care providers -- Crusted scabies cases. [Online] Centres
for Disease Control and Prevention 2008. At: www.cdc.
gov/scabies/hcp/crusted.html [cited 2010 Oct 06]
A score of 4 out of 5 attracts 1 CPD credit.
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