Case from Dr Ian McColl
These were the fingers of an elderly, bedridden patient in a nursing home, where there was an unexplained outbreak of an itchy rash among the patients and staff. This lady had been thought to have keratoderma due to psoriasis but she had typical scabies elsewhere and examination of scales from her fingers showed scabies mites. This is crusted or Norweigian scabies.
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She required treatment with Ivermectin orally on two occassions one week apart and several whole body applications of Permethrin cream. Everyone in the nursing home, staff and visitors had to be treated to clean up the outbreak.
Nursing home outbreaks are a real challenge trying to co-ordinate everyone being treated at the same time. I have found Ivermectin invaluable in simply treating large numbers of people at once. The Nursing home then has to have a policy of treating any new resident with an itchy rash with a prophylactic application of Permethrin cream to prevent re introduction of the scabies mite.
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