Lice and Scabies: Treatment Update

Karen Gunning, PharmD; Bernadette Kiraly, MD; Karly Pippitt, MD

Disclosures

Am Fam Physician. 2019;99(10):635-642. 

In This Article

Diagnosis

Scabies should be considered in patients with a history of a pruritic, papular rash in the typical distribution and pruritus in close contacts.[27,29–31] Finding mites, eggs, or fecal pellets using microscopy confirms the diagnosis. Evaluation of a skin scraping is the diagnostic standard for detecting mites.[32] A skin scraping suspended in oil allows for microscopic identification of mites, eggs, and fecal pellets; however, dermoscopy has fewer false negatives and may be preferable.[26,32]

A recent study showed that scabies is misdiagnosed in 45% of cases, highlighting the need for improved clinician education and diagnostic methods.[32] Misdiagnosis may be due to reliance on history and physical examination findings alone rather than using microscopy, although there is evidence supporting empiric treatment if a patient presents with pruritus and he or she has lesions typical of scabies on at least two body sites or other household members also have pruritus.[27,30] The differential diagnosis of scabies is presented in Table 2.[5,32]

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