SCABIES -------------------------------------------------- A patient of mine recently asked me whether RID shampoo would work as well as Elimite cream for treatment of scabies. The cost difference is considerable (about $30 for a 60gm tube of Elimite, compared to $4 for a 60ml bottle of RID shampoo). Is RID shampoo or Nix cream rinse an OTC alternative for treatment of scabies? Walter H. Wood, M.D. -------------------- I would think that the Elimite cream is better than the RID shampoo. 1. the shampoo would not cover the other sites of predilection of scabies for example, axilae, genital area, finger and toe webs. The Elimite cream you can apply to these sites of predilection. Even if you tell the patient to apply the rid shampoo all over the body it might not work as well as Elimite cream. 2. As i recall the RId shampoo is better for pediculosis capitis and just used as adjunct for treatment of scabies. Jonathan Yu, MD Skin & Cancer Foundation Makati, Philippines ------------------- I would like to ask the group for any suggestions on how to handle scabies in a pregnant woman in her first trimester. I don't know what scabicide is "safe" to use and the dosage. Is Diphenhydramine really safe for first trimester pregnancy ? Is there any non-sedating anti-histamines safe for the pregnant woman? In treating pregnant woman , sometimes I find it helpless.. Susan Tan ------------- 5% sulfur in petrolatum applied TID x 3 days is the regimen I use. Ben Treen ---------- I use 15 to 20% ppt sulfur in a white petrolatum base TID for 10 days. 5% permethrin works very well but cost more. Usually a single application is enough. To control the itch, chlorpheniramine maleate TID is better than diphenhydramine and is safe for pregnant women. As I recall it is a Category B drug. Jonathan Nevin Yu,MD I use Elimite times one in a pregnant woman, and treat the rest of family the same. I do not believe that either the efficacy nor the safety of sulfur has ever been shown, nor am I aware of any danger from Elimite. Enlighten me if I am wrong. Jerry Eisner --------- I have no hesitation using Kwellada or Nix (or for that matter ivermectin) in pregnancy and on neonates and nursing mothers. >From a CYA point of view I'd rank the 3 treatments: 1. Nix (5% permethrin) 2. Kwellada 3. ivermectin In terms of effectiveness, I think ivermectin would probably be most effective, but usually Nix or Kwellada are perfectly adequate. Kevin C. Smith MD ------------ The safety of 10% sulfur topically has stood the test of time--Elimite has not. Gary Salenger M.D. ----------- I have found "Skin Changes and Diseases in Pregnancy", c1996, edited by Marwali Harahap and Robert C. Wallach to be an excellent reference in the office when treating pregnant patients - discussion of the commonly used derm drugs and their use in pregnancy is quite useful. This is published by Dekker, and you can possibly obtain it at your medical bookstore or online at the amazon.com bookstore, where I have been quite pleased buying many medical and nonmedical books. (I have no financial interest) Mike Crowe, M.D. -------------- Do antihistamines really help with the itch of scabies, either alive or dead?I like to kill the mite, and then once it is dead, treat the itch from the dead with topical steroids for a week or so. By the way, having had chicken pox at age 31, antihistamines don't work in that either-even soporific doses. Diane Thaler ---------- Pt soaks in warm tub until fingertips wrinkle then scrubs areas of persistent itch with washcloth or loofah. The idea is to remove the dead mites and their by-products more quickly than waiting for normal epidermal turnover. Usually, doing this once or twice is sufficient. Ben Treen --------- I have always considered scabies treatment, in some cases, a very delicate point, for one has to be very thorough exploring this issue, because if any contactant is missed, there remains the problem. I have seen families over here struggle more than 6 months this boring parasite, causing much distress to all.So, I always sought: 1- (as Ivermectin was still unavailable here)--> another systemic therapy. 2- as sometimes we miss scabies ( the burrows don't appear, the ink test fails )- and, if you decide the small patient has scabies, you have to initiate a war operation towards the whole family --> a more definite way to diagnose the presence of the parasite, Therefore, I imagined that 1 ) as sulfam/trimethopim works for lice, why wouldn/t it work as well for scabies? 2 ) wouldn't a blood test,like IGM/IGG for viral diseases be reliable for scabies? I exposed the above to Dr Shelley, he liked the ideas and even suggested the RAST TEST could work for that. Since then, I have been giving Bactrim to the youngest patients as possible, considering the pediatric limitations, and to their families, and I believe it has worked so far. But I would like to observe more,in order to obtain a pattern. It seems that Bactrim 's metabolites destroy these parasites, paralleling its indication for lice. George Leal -------------- For an adult I'd give a double strength tablet bid for a week, until dose ranging studies become available. If you want to try topical Bactrim, maybe "apply to all skin from the ears down HS, wash off in AM, and repeat procedure in 7 days" as for Kwellada. Kevin C. Smith MD ------------ Not that I'm advocating it in pregnancy, and I would consider it only under duress and possibly only in a case of Norwegian scabies, but I recall a case report of, believe it or not, Methotrexate being used to treat scabies. I'll try to dig up the reference. Bill Danby ---------- The living mite has been recovered from dust one week after humans were treated. That is why I don't understand spot treating. Besides the fact that humans can have it with no symptoms. But what about dogs and cats. Diane Thaler ----------- I believe the adult scabies mite dies of thirst after about 36 hours in usual indoor temperature and humidity situations. I was unaware that someone had documentation of longer survival. If more durable critters exist, are they hatchlings from eggs which survived longer than the adults? If so they must be little buggers, lacking nourishment upon which to feed and grow. As I recall, the WWII volunteer studies (Mellanby?) demonstrated only about 3% of persons exposed to infested sheets actually came down with the disease, so I don't make a big issue of fomite control the first time around. If previous treatment has failed, then I get more compulsive with environmental control. Mark Valentine --------------- I was under the impression that human scabies can only survive a couple of hours off of host. I am also under the impression that the mite that causes scabies in dogs, while remarkably similar in appearance to the human variety, is relatively species specific and cannot reproduce on humans. I recall a case of a localized eczematous patch on an abdomen not typical for scabies that yielded a mite upon microscopic exam. The patient habitually held his lapdog in that location, and the dog had recently developed a skin disorder. Ben Treen -------- In scabietic infestations the females never leave their burrows. The males hike around from place to place fertilizing the occupants of these homebodiess. Spot treating is like mining the harbor. If the males have to traverse an area of scabicide to get to the females eventually the population dies out. Haines Ely ---------- It was recovered from nursing home dust. People in nursing homes seem to be aware of this study, and get quite frantic about it. It was done because it was so hard to get rid of the mite in nursing home populations. If memory serves. Diane Thaler -------------