Scratching the itch: management of scabies in A&E

Epidemics of scabies seem to occur in 20-25-year cycles. One of the resultant problems is that few A&E nurses practice through more than one epidemic and with each new outbreak of scabies, the latest generation of A&E nurses have to learn how to recognize and manage the disease. This article describes scabies, how to recognize it and the treatment options available. Although uncertainty remains, Permethrin is the first treatment of choice and should be used in the 5% cream form, not the 100% lotion. Crusted Norwegian scabies requires prompt and careful attention along with Specialist advice. The challenge for A&E staff is to recognize scabies, treat it appropriately and to help educate those most at risk.