Ewha Med J.  2024 Oct;47(4):e72. 10.12771/emj.2024.e72.

Clinical practice guidelines for the diagnosis and treatment of scabies in Korea: Part 2. Treatment and prevention — a secondary publication

• Park J
• Kwon SH
• Lee YB
• Kim HS
• Jeon JH
• Choi GS
• on behalf of the Scabies Study Group of Korean Dermatological Association

• KMID: 2561425
• DOI: http://doi.org/10.12771/emj.2024.e72

Abstract

Treatment should be initiated for all suspected, clinical, or confirmed cases of scabies. Patients affected should be adequately isolated, and high-risk groups with close contact histories should be treated regardless of their symptoms. Optimal treatment strategies can be selected based on age, clinical subtype, and the patient's health status. In Korea, commercially available preparations for scabies treatment include topical 5% permethrin, topical 10% crotamiton, and oral ivermectin. Topical 5% permethrin is the first-line selective treatment for both classic and crusted scabies. Alternative treatments include topical 10% crotamiton and oral ivermectin. After completing treatment, followup visits at 2 and 4 weeks are recommended to monitor the therapeutic response. Treatment is considered to have failed if scabies mites or burrows are detected, new clinical characteristics develop, or there is an aggravation of pruritus. Scabies itch should be adequately managed with emollients, oral antihistamines, and topical corticosteroids. Preventive measures, including personal hygiene, patient education, and environmental control, should be implemented to reduce the transmission of scabies.

Keyword

Practice guidelines; Prevention and control; Scabies; Therapeutics

Figure

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  Fig. 1. Proposed algorithm for the diagnosis and treatment of scabies in Korea. 1) One of the following: (a) Skin contact with an individual diagnosed with scabies, (b) sexual contact with an individual diagnosed with scabies (especially nodular scabies), (c) brief direct contact with linens (such as towels, clothing, and bedding) used by an individual diagnosed with scabies (especially crusted scabies); 2) One of the following: (a) Typical erythematous papules or vesicles in a typical distribution including the periumbilical area, inner thigh, buttock, axilla, inner forearm, (b) multiple nodules in genital area or axilla, (c) multiple papules, vesicles, or pustules in the palmoplantar distribution of an infant; 3) Light microscopy, dermoscopy, or other high-resolution imaging techniques including could be used; 4) In general, apply on the whole body, except the face and scalp, at least 30 minutes after taking a shower. For treatment of infants and older adults, it should be applied to the lesion on the scalp and face; the recommended doses are as follows: 25–30 g (1 tube) for adults, 15 g (1/2 tube) for ages 6–12 years, and up to 7.5 g (1/4 tube) for ages 2–5 years; cleansed out after at least 8–12 hours of application. Application is repeated after 7–10 days. For crusted scabies, 5% permethrin cream should be applied daily for a week, then twice weekly until any mite or egg is not identified. However, 5% permethrin cream is not permitted for use in patients aged <2 years and pregnant or lactating women in Korea; therefore, Centers for Disease Control and Prevention guidelines recommend using 5% permethrin cream in patients older than 2 months and pregnant or lactating women; 5) For classic scabies, the recommended dose is 200 μg/kg twice weekly; For crusted scabies, ivermectin is administered on days 0, 1, 7, 8, 14, 21, and 28. Safety in patients who are pregnant or weigh <15 kg is not established; 6) Apply repeatedly for 3–5 days (i.e., days 1, 2, 3, and 8), and leave on for at least 8 hours; it can be used for children and pregnant or lactating women cautiously; 7) Emollients, H1 antihistamines, topical or systemic steroids (in selected cases), topical calcineurin inhibitors, and narrow-band ultraviolet B could be used.

Reference

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