Scabies: The Daily PANCE Blueprint
A 55-year-old female presents to an urgent care from a homeless shelter complaining of itching of her fingers and wrist. On physical exam, you note thin, small curvy lines in the finger webs. There are also erythematous papules scattered on her bilateral hands, wrists, and elbows. Which of the following is the treatment of choice for the most likely diagnosis?
A. Permethrin cream (1%)
B. Permethrin cream (5%)
C. Ivermectin
D. Hydroxychloroquine
E. Topical steroids only
Answer and topic summary
The answer is B. Permethrin cream (5%)
Scabies is a contagious parasitic infection of the skin; it is usually caused by the mite Sarcoptes scabiei. Risk factors include overcrowding, tropical climate, poverty/homelessness, and immunosuppression. It is mostly spread via prolonged human-to-human direct skin contact. Clinical features include itching (worse at night), erythematous papules (usually in finger webs, flexor surfaces of wrists, elbows, buttocks), burrows (thin, curvy lines), and excoriations from scratching. Diagnosis is made by examining the skin with dermoscopy; you can also place mineral oil over a lesion then scrape the lesion w/ a blade and examine scrapings under a microscope and look for mites/eggs. The patient and household members should be treated, clothing plus bedding should be washed in hot water, and non-washable items should be sealed in a plastic bag (for 3-5 days). The first-line medical treatment is permethrin 5% cream.
View blueprint lesson
Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint Dermatology ⇒ ⇒
Also covered on the Family Medicine, Emergency Medicine, and Pediatrics PAEA rotation content topic list
