Paeds Vivas · paediatric-dermatology
Scabies, lice and infestations — viva
Branching clinical structured oral on the recognition, pathophysiology and household-based management of a child with scabies, including the 2020 IACS criteria, the permethrin regimen and crusted scabies.
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RACP DCEMRCPCH Clinical
Prompt
A 3-year-old boy is referred by his general practitioner with a six-week history of intense itching that keeps the whole family awake at night. His parents have noticed 'tracks' between his fingers and around his wrists, and over the last two weeks his mother, father and older sister have all begun to scratch. On examination there are serpiginous burrows in the finger-webs and wrists, excoriated papules on the waist and genitalia, and several honey-coloured crusts. You are asked to assess and manage him.
Opening (2 minutes)
The candidate should recognise the classic picture of scabies: a nocturnal itch out of proportion to the visible lesions, serpiginous burrows in the finger-webs and wrists, the characteristic distribution around the waist and genitalia, secondary impetiginisation, and simultaneous onset across several household members. The diagnosis is clinical, and the candidate should commit to it and to excluding the common mimics rather than waiting for a scraping in an obvious case. [1]
References3ShowHide
- [1]Engelman D, Fuller LC, Steer AC The 2020 International Alliance for the Control of Scabies Consensus Criteria for the Diagnosis of Scabies. Br J Dermatol, 2020.PMID 32034956
- [3]Currie BJ, McCarthy JS Permethrin and ivermectin for scabies. N Engl J Med, 2010.PMID 20181973
- [6]Aung PTZ, Cuningham W, Hwang K Scabies and risk of skin sores in remote Australian Aboriginal communities: A self-controlled case series study. PLoS Negl Trop Dis, 2018.PMID 30044780