Crusted Scabies in an Immunocompromised Host When Initial Combined Therapy Has Not Achieved Cure
Clinical Scenario
Crusted scabies arising in an immunocompromised host — a population in which pruritus may be mild or entirely absent. Skin lesions present as generalized, poorly defined, erythematous, fissured plaques covered by scales and crusts.
Why This Protocol Applies: Prior Treatment Did Not Achieve Cure
This protocol addresses cases in which an initial regimen combining a topical scabicide (permethrin or benzyl benzoate lotion) with oral ivermectin failed to reach the required endpoint: cure confirmed by no live mites on skin scrapings. Persistent live mites on follow-up scraping indicate that escalation is warranted.
Next-Line Approach (Partial Overview)
The protocol calls for additional oral ivermectin administered according to a structured extended schedule beyond the initial course.
The full schedule, eligibility criteria, and sequencing are defined in the complete protocol →
Treatment Goal
Cure confirmed by no live mites on skin scrapings. A follow-up visit after treatment completion is recommended for test of cure by microscopy examination.
References
DOI: 10.1111/jdv.14351
- Crusted scabies occurs in immunocompromised hosts and may be associated with reduced or absent pruritus.
- Skin lesions consist of generalized, poorly defined, erythematous, fissured plaques covered by scales and crusts.
- For severe cases, based on persistent live mites on skin scrapings at follow-up visit, additional ivermectin treatment might be required on days 9 and 15 or on days 9, 15, 22 and 29.
- A follow-up visit 2 weeks after completion of treatment is recommended for a test of cure by microscopy examination.
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