A 65-year-old woman comes to the physician with a 5-day history of rash and generalized itching. She initially developed a rash on her hand that spread to her feet, abdomen, and groin area. The patient also has intense pruritus that is worse at night. Her husband started having similar symptoms approximately 3 days ago. She works as a patient aide in a nursing home and has no other medical conditions. The patient had chickenpox when she was 7 years old. Her vital signs are within normal limits. Skin examination (image below) shows multiple small erythematous papules on her palms, sides of the fingers, wrists, lateral aspect of the feet, and periumbilical area. Her husband has similar lesions on the same body parts and also over the shaft of his penis. The remainder of her examination is within normal limits. The patient's test results confirm the suspected diagnosis. Which of the following is the treatment of choice for this condition?

Question

A 65-year-old woman comes to the physician with a 5-day history of rash and generalized itching.  She initially developed a rash on her hand that spread to her feet, abdomen, and groin area.  The patient also has intense pruritus that is worse at night.  Her husband started having similar symptoms approximately 3 days ago.  She works as a patient aide in a nursing home and has no other medical conditions.  The patient had chickenpox when she was 7 years old.  Her vital signs are within normal limits.  Skin examination (image below) shows multiple small erythematous papules on her palms, sides of the fingers, wrists, lateral aspect of the feet, and periumbilical area.  Her husband has similar lesions on the same body parts and also over the shaft of his penis.  The remainder of her examination is within normal limits.  The patient's test results confirm the suspected diagnosis.  Which of the following is the treatment of choice for this condition?

Quizplus · Accepted Answer

Explanation: Treatment of scabies includes eradicating the mites, decreasing pruritus due to the dermatitis, and prescribing oral antibiotics for any secondary bacterial skin infections. Topical application of 5% permethrin cream over the whole body (excluding the head) is preferred for eradicating the mites. The cream should be massaged thoroughly from the neck down and then removed by thorough washing after 8-14 hours. Common adverse reactions of permethrin cream include local burning and pruritus. Oral ivermectin is also a treatment option, especially for outbreaks in nursing homes and other facilities where it may be difficult to use topical therapy. Oral antihistamines can help decrease the dermatitis and associated itching, and topical steroids may be used for persistent dermatitis after mite eradication (Choice B). All family members and close contacts should be treated at the same time as the index patient to prevent re-infestation. Bedding and clothing should be cleaned or placed in a plastic bag for at least 3 days as the mite can only live away from human skin for 2-3 days. (Choices A and E) Antiviral treatment with valacyclovir is indicated for patients with herpes zoster (within 72 hours of lesion eruption) and in all patients with ophthalmic involvement. Topical acyclovir cream is indicated for herpes simplex virus infection. (Choice C) Topical application of 1% terbinafine cream is indicated in patients with localized tinea infections. Educational objective: Topical application of 5% permethrin cream over the whole body (excluding the head) is the treatment of choice for eradicating the mites of scabies. Oral ivermectin is an acceptable alternative. References: Scabies. (http://www.ncbi.nlm.nih.gov/pubmed/19580575)

A 65-Year-Old Woman Comes to the Physician with a 5-Day