Scabies: A Case Study

What would you consider as differential diagnoses and why? Based on the presentation here, what would you consider being the final diagnosis, and what is your recommended plan of treatment and management? What physical exam findings support your final diagnosis?

Scabies is a contagious skin infestation that is spread from individual to individual by close contact, coming in contact with the host’s clothes and sheets, or by sexual contact. The scabies burrows its eggs and fecal pellets into the stratum corneum (dermis) of the host. The larvae in the skin will hatch, mature, and the cycle repeats itself (Blosser, Brady, Burns, Dunn, Starr, 2013). The pruritic rash is from the skin being hypersensitive to scabies. In this case scenario, the

Medication –Benadryl or Vistaril but not both together at the same time. Benadryl for the itching, 25mg PO every 4-6 hours PRN with a maximum dose of 15 ml in 24 hour period, best given at night to aide in sleeping. Vistaril for the itching, 2mg/kg/q 6-8 hours during the day. Permethrin 5% cream or Elimite is the first line treatment for scabies, onetime dose to the neck on down of body, left on for 8-14 hours, and then rinsed off (CDC, 2010). Although, this medication can be used for patients who are two months and older, yet not recommended for ophthalmic use. Infants and children with a history of malnutrition, prematurity, and history of seizures are more prone to toxicity with the cream. If there is need for treatment due to a secondary infection, such as a bacterial infection, the patient will need treatment with Keflex BID 25-50mg/kg/day (CDC, 2010). As a provider, hydrocortisone cream is not recommended as it contains additives that may make the rash worse. As well, skin infections, such as impetigo can occur when bacteria, Staphylococcus, break the dermis with a cut or crack in dry skin. Thus, resulting in a boil or abscesses pus-filled lumps on the surface or just under the skin that can be tender. According to Lawton (2015), the lesion can lead to a crust on the skin or impetigo with redness, swelling, and pain called cellulitis (Lawton,

No lotions or fragrance and artificial ingredients should be used and can irritate the dermis similar to the use of the steroid cream applied by the mother.

4. There is a need to bag all clothes, blankets, towels, and household cloth objects since in contact with the patient within the last two weeks, then washed in hot water before reusing. As well, it is recommended that all individuals in contact with the patient within the last month should be treated. As a provider, the foster family should be treated including their household items.

5. Contact the shelter the child was in to notify that there is an active spread of scabies.

6. After treatment with the Permethrin cream is completed, the patient may take a lukewarm baths and soak with oatmeal bath, such as Aveeno to sooth the skin. Although, avoid the use of bubble baths.

7. Apply Aquaphor lotion to aide in soothing the dry, itchy skin and lessen the irritation of the dermis. “Regular application of emollients at least twice daily and preferably after bathing helps to hydrate the skin even when the skin is clear” (Watkins, 2014, p. 592).

8. Follow up with the provider in two weeks to reassess for a secondary infection and assure that scabies are