Scabies: Diagnostic and Therapeutic Update.

Area of Science:

• Dermatology
• Infectious Diseases
• Public Health

Background:

• Scabies is a widespread parasitic skin infection, posing significant challenges in institutional settings and resource-limited areas.
• Topical treatments for scabies are often difficult to administer in large populations and for non-adherent individuals.
• Oral ivermectin has become available for off-label scabies treatment in Canada since 2018.

Purpose of the Study:

• To review the diagnostic approaches and management strategies for scabies.
• To outline dosing regimens and concurrent management for scabies simplex and crusted scabies.
• To detail the use of oral ivermectin in scabies treatment.

Main Methods:

• Literature review utilizing Medline database.
• Discussions with colleagues and review of clinical practices.
• Experience gained from managing institutional scabies outbreaks.

Main Results:

• Oral ivermectin demonstrates superior safety, ease of use, cost-effectiveness, and efficacy compared to topical agents.
• It is particularly advantageous for widespread institutional scabies, non-adherent patients, and crusted scabies cases.
• The oral route simplifies treatment administration and improves patient compliance.

Conclusions:

• Oral ivermectin is the preferred treatment for scabies in large populations, non-adherent individuals, and crusted scabies.
• Recommended dosage for non-crusted scabies is 200 µg/kg once, with a repeat dose in 10-14 days.
• Merck Canada produces oral ivermectin as Stromectol 3 mg.