Patients with typical scabies may return to school or work 24 hours after the first treatment. Itching may persist for up to a month, even following successful treatment.
Patients with crusted scabies or their caregivers should be instructed to remove excess scale in order to allow penetration of the topical scabicidal agent and decrease the burden of infestation. This can be achieved with warm-water soaks followed by application of a keratolytic agent, such as 5% salicylic acid in petrolatum or Lac-Hydrin cream. (Salicylic acid should be avoided if large body surface areas are involved because of the potential risk for salicylate poisoning.) The scales are then mechanically debrided with a tongue depressor or similar blunt/smooth device.
All household members and close personal contacts older than 2 months and not pregnant should be treated for scabies, even if they have no symptoms or signs of infestation. Pets do not require treatment. Detailed directions regarding treatment and environmental control measures should be provided verbally and in writing.
For more on the treatment of scabies, read here.
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