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The management of scabies and threadworms
Infection with parasites such as head lice, threadworms and scabies is commonly seen in the community. Primary care nurse prescribers are in an ideal position to manage these conditions appropriately. While this bulletin focuses on scabies and threadworm, head lice infection is discussed in another Prescribing Nurse Bulletin (Vol. 1 No. 4).
SummaryScabies • Scabies is characterised by a widespread, itchy rash caused by an allergic reaction to the waste products of the scabies mite. The mite is spread by close physical contact. • Treatment is by application of either aqueous malathion 0.5% or permethrin 5% cream to the whole of the body from the neck down. In some cases, e.g children under two, or treatment failures, the head should also be treated. • Treatment should be applied to cool, dry skin and NOT after a hot bath. It should be left on the skin for 8 to 24 hours depending on the product. Incorrect application is a common cause of treatment failure. • The infected person, and any of their close contacts within the last two months, should be treated at the same time. • Follow-up after 7-10 days is advised to evaluate treatment success. The itch may persist for a couple of weeks even if treatment is successful. Threadworms • Infection and spread of threadworms is caused by the transfer of threadworm eggs from the perianal area of an infected person to the mouth, usually via the hands. • Breaking this chain of events is essential to prevent spread. Strict hygiene measures should be encouraged in all family members of an infected household for six weeks after the infection is diagnosed. • Drug treatment of choice is mebendazole, although it is not licensed for use in children under two years of age. |
Scabies is caused by the Sarcoptes scabiei mite which burrows under the skin to lay its eggs. It is characterised by an intense itching caused by allergy to the faeces and saliva of the mite, and by a widespread rash (see figure 1).
The number of reported cases of scabies is rising, with about 2-4% of the UK population being infected with the mite at some time in their life.1 Scabies is most commonly seen in teenagers and children and in those living in residential institutions.1
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