This Presentation Contains Infectious Dermatoses i.e. bacterial, viral, fungal and parasitic skin Infections. For Comments write to juma.sammy2@gmail.com

1. INFECTIOUS DERMATOSES
JUMA WEKESA
BSN

2. INFECTIOUS DERMATOSES.
Bacterial Skin Disorders.
IMPETIGO
Impetigo is a superficial infection of the skin caused by staphylococci, streptococci, or
multiple bacteria. Bullous impetigo, is a more deep-seated infection of the skin caused by S.
aureus, is characterized by the formation of bullae (large, fluid-filled blisters) from original
vesicles. The bullae rupture, leaving raw, red areas.
The exposed areas of the body, face, hands, neck, and extremities are most frequently
involved. Impetigo is contagious and may spread to other parts of the patient’s skin or to
other members of the family who touch the patient or use towels or combs that are soiled
with the exudate of the lesions.
Impetigo is seen in people of all ages. It is particularly common in children living in poor
hygienic conditions. It often follows pediculosis capitis (head lice), scabies (itch mites),
herpes simplex, insect bites, poison ivy, or eczema.
Predisposing factors
• Chronic health problems,
• Poor hygiene
• Malnutrition may predispose an adult to impetigo.
• Excessive use of antibacterial soaps may create resistant bacteria and contribute to the
problem
Clinical Manifestations
• Mild itching and soreness followed by eruption of small vesicles and pustules that
rupture and crust
• Generally develops in body folds that are subject to friction

3. Medical Management
• Systemic antibiotic therapy is the usual treatment. It reduces contagious spread, treats
deep infection, and prevents acute glomerulonephritis (kidney infection), which may
occur because of streptococcal skin diseases. In nonbullous impetigo, benzathine
penicillin or oral penicillin may be prescribed. In bullous impetigo, a penicillinase
resistant penicillin (eg, cloxacillin [Cloxapen], dicloxacillin [Dycill]) may be used. In
penicillin allergic patients, erythromycin is an effective alternative.
• Topical antibacterial therapy (eg, mupirocin [Bactroban]) may be prescribed when the
disease is limited to a small area. The medication must be applied to the lesions
several times daily for a week; this treatment regimen may be impossible for some
patients or their caregivers to follow.
• Topical antibiotics generally are not as effective as systemic therapy in eradicating or
preventing the spread of streptococci from the respiratory tract, thereby increasing the
risk of developing glomerulonephritis.
• When topical therapy is prescribed, lesions are soaked or washed with soap solution
to remove the central site of bacterial growth, giving the topical antibiotic an
opportunity to reach the infected site. After the crusts are removed, a topical antibiotic
cream is applied. Gloves are worn when providing patient care. An antiseptic
solution, such as povidone iodine (Betadine), may be used to clean the skin,
Nursing Management
1. The nurse instructs the patient and family members to bathe at least once daily with
bactericidal soap. Cleanliness and good hygiene practices help prevent the spread of
the lesions from one skin area to another and from one person to another.
2. Each person should have a separate towel and washcloth.
3. Because impetigo is a contagious disorder, infected people should avoid contact with
other people until the lesions heal.
FURUNCULOSIS (BOILS) & CARBUNCLE
FURUNCULOSIS (BOILS)
Infection of hair follicle that results in pustule formation.
Causes
Generally it is as a result of a staphylococci infection.
Usually, the cause is bacteria such as staphylococci that are present on the skin.

4. Signs and Symptoms
• Pustule that becomes reddened and enlarged as well as hard from internal pressure
• Pain and tenderness increase with pressure
• Most will mature and rupture
Medical Management
• In treating staphylococcal infections, it is important not to rupture or destroy the
protective wall of induration that localizes the infection. The boil or pimple should
never be squeezed
• Systemic antibiotic therapy, selected by culture and sensitivity study, is generally
indicated. Oral dicloxacillin and cephalosporins are first-line medications. If MRSA is
suspected, antibiotic agents selected may include clindamycin
• Warm compress is applied to promote circulation
.
Nursing Management.
• Intravenous (IV) fluids, fever reduction, and other supportive treatments are indicated
for patients who are acutely ill from infection
• Warm, moist compresses hasten resolution of the furuncle.
• The surrounding skin may be cleaned gently with antibacterial soap, and an
antibacterial ointment may be applied.
• Soiled dressings are handled according to standard precautions. Nursing personnel
should carefully follow standard precautions to avoid becoming carriers of
staphylococci.
CARBUNCLE
A carbuncle is an abscess of the skin and subcutaneous tissue that represents an extension of
a furuncle that has invaded several follicles and is large and deep .The infected material
forms a lump, which occurs deep in the skin and may contain pus.

5. Causes
Most commonly Staphylococcus aureus, or Streptococcus pyogenes.
Signs and Symptoms
• Larger and deeper than furuncle and has several openings in the skin.
• May produce fever and elevation of WBC count.
• Starts hard and red and over a few days emerges into a lesion that discharges
yellowish pus.
Management
• In treating staphylococcal infections, it is important not to rupture or destroy the
protective wall of induration that localizes the infection. The boil or pimple should
never be squeezed
• Systemic antibiotic therapy, selected by culture and sensitivity study, is generally
indicated. Oral dicloxacillin and cephalosporins are first-line medications. If MRSA is
suspected, antibiotic agents selected may include clindamycin
• When the pus has localized and is fluctuant, a small incision with a scalpel can speed
resolution by relieving the tension and ensuring direct evacuation of the pus and
debris. The patient is instructed to keep the draining lesion covered with a dressing.
• Warm compress is applied to promote circulation.
Nursing Management
• Intravenous (IV) fluids, fever reduction, and other supportive treatments are indicated
for patients who are acutely ill from infection.
• Warm, moist compresses hasten resolution of the carbuncle
• The surrounding skin may be cleaned gently with antibacterial soap, and an
antibacterial ointment may be applied.
• Soiled dressings are handled according to standard precautions. Nursing personnel
should carefully follow standard precautions to avoid becoming carriers of
staphylococci.

6. Viral Skin Disorders.
HERPES ZOSTER
Herpes zoster, also called shingles, is an infection caused by the varicella-zoster viruses
(VZVs), members of a group of DNA viruses. The viruses that cause chickenpox (varicella)
and herpes zoster are indistinguishable, hence the two-part name.
The disease is characterized by a painful vesicular eruption along the area of distribution of
the sensory nerves from one or more posterior ganglia. After a case of chickenpox runs its
course, the VZV responsible for the outbreak lies dormant inside nerve cells near the brain
and spinal cord.
Later, when these latent viruses are reactivated because of declining cellular immunity, they
travel by way of the peripheral nerves to the skin, where the viruses multiply and create a red
rash of small, fluid-filled blisters.
It is thought that during the aging process, natural immunity to the varicella wanes, allowing
the virus to reactivate and maintaining it in the population.
Predisposing Factors
Weakened immune systems, including those with human immunodeficiency virus (HIV)
infection and in those with cancer.
Clinical Manifestations
• Pain which may be burning, lancinating (tearing or sharply cutting), stabbing, or
aching. Some patients have no pain, but itching and tenderness may occur over the
area.
• Malaise and gastrointestinal disturbances may precede the eruption.
• The patches of grouped vesicles appear on the red and swollen skin. The early
vesicles, which contain serum, later may become purulent, rupture, and form crusts.
• Blisters are usually confined to a narrow region of the face or trunk. The clinical
course varies from 1 to 3 weeks.
• If an ophthalmic nerve is involved, the patient may have eye pain. Inflammation and a
rash on the trunk
Medical Management
The goals of herpes zoster management are to relieve the pain and to reduce or avoid
complications.
• Herpes zoster infection can be arrested if oral antiviral agents such as acyclovir
(Zovirax), valacyclovir (Valtrex), or famciclovir (Famvir) are administered within 24
hours of the initial eruption. IV acyclovir, if started early, is effective in significantly
reducing the pain and halting the progression of the disease. In older patients, the pain
from herpes zoster may persist as postherpetic neuralgia for months after the skin
lesions disappear.
• Pain is controlled with analgesics because adequate pain control during the acute
phase helps prevent persistent pain patterns. Systemic corticosteroids may be
prescribed for patients older than 50 years of age to reduce the incidence and duration
of postherpetic neuralgia (persistent pain of the affected nerve after healing). Healing

7. usually occurs more quickly in those who have been treated with corticosteroids.
Triamcinolone injected subcutaneously under painful areas is effective as an anti-
inflammatory agent.
• Ophthalmic herpes zoster occurs when an eye is involved. This is considered an
ophthalmic emergency, and the patient should be referred to an ophthalmologist
immediately to prevent the possible sequelae of keratitis, uveitis, ulceration, and
blindness.
• People who have been exposed to varicella by primary infection or by vaccination are
not at risk for infection after exposure to patients with herpes zoster.
• A vaccination for childhood varicella developed in the 1970s has been used
successfully to decrease the incidence of childhood disease.
Complications
• Infection,
• Scarring, and
• Postherpetic neuralgia
• Eye complications
Nursing Management
• The patient and family members are instructed about the importance of taking
antiviral agents as prescribed and in keeping follow-up appointments with the health
care provider. The nurse assesses the patient’s discomfort and response to medication
and collaborates with the physician to make necessary adjustments to the treatment
regimen.
• The patient is taught how to apply wet dressings or medication to the lesions and to
follow proper hand hygiene techniques to avoid spreading the virus.
• Diversionary activities and relaxation techniques are encouraged to ensure restful
sleep and to alleviate discomfort.
• A caregiver may be required to assist with dressings, particularly if the patient is
elderly and unable to apply them.
• Food preparation for patients who cannot care for themselves or prepare nourishing
meals must be arranged.

8. Herpes zoster summary
Risk factors
Age
common in
people older
than 50.
Diseases
that weaken the
immune system,
such as HIV/AIDS
and cancer.
Cancer
treatments
Undergoing
radiation or
chemotherapy can
lower the resistance
to diseases and may
trigger shingles.
Immunosuppres
sant Drugs
prolonged use of
steroids, such as
prednisone.

9. Clinical Symptoms
Initial prodromal stage
The first signs of shingles may include
Headache
Feeling generally unwell
Myalgia
Fever

10. Acute stage
 A rash will begin to develop, often causing a
pain.
 Itching or tingling sensation in the area of the
affected nerve.
 A fluid filled painful rash then develops a few
days after and commonly occurs either on one
side of the face or body.
 Fluid-filled blisters that break open and crust
over
in 7-10 days and this clears within 2-4 weeks.

11. Complications
1. Post herpetic neuralgia
(PHN)
Post herpetic neuralgia can cause
severe nerve pain that persists after
the rash. PHN occurs most often in
elderly people and in people whose
immune systems have been
compromised.
2. Ophthalmic shingles
Shingles in or around an eye can
cause painful eye infections that

12.  Ramsay Hunt syndrome
Otherwise known as herpes zoster oticus,
inflammation of several of the nerves that
come out of the brain. The symptoms of
Ramsay Hunt syndrome are facial
ear pain.
 Encephalitis
 Hearing problems
 Bacterial infections on the

13. HERPES SIMPLEX
• Herpes simplex is a common skin infection. There are two types of the causative
virus, which are identified by viral typing. Generally, herpes simplex type 1 occurs on
the mouth and type 2 occurs in the genital area, but both viral types can be found in
both locations. About 85% of adults worldwide are seropositive for herpes type 1. The
prevalence of type 2 is lower; type 2 usually appears at the onset of sexual activity.
Serologic testing shows that many more people are infected than have a history of
clinical disease.
• Herpes simplex is classified as a true primary infection, a nonprimary initial episode,
or a recurrent episode. True primary infection is the initial exposure to the virus. A
nonprimary initial episode is the initial episode of either type 1 or type 2 in a person
previously infected with the other type. Recurrent episodes are subsequent episodes of
the same viral type.
Types of Herpes Simplex
Orolabial Herpes
• Orolabial herpes, also called fever blisters or cold sores, consists of erythematous-
based clusters of grouped vesicles on the lips. A prodrome of tingling or burning with
pain may precede the appearance of the vesicles by up to 24 hours.
• Certain triggers, such as sunlight exposure or increased stress, may cause recurrent
episodes. Fewer than 1% of people with primary orolabial herpes infections develop
herpetic gingivostomatitis. This complication occurs more often in children and
young adults than in people of other ages. The onset is often accompanied by high
fever, regional lymphadenopathy, and generalized malaise.
Genital Herpes
• Genital herpes, or type 2 herpes simplex, manifests with a broad spectrum of clinical
signs. Minor infections may produce no symptoms at all; severe primary infections
with type 1 can cause systemic flulike illness. Lesions appear as grouped vesicles on
an erythematous base initially involving the vagina, rectum, or penis. New lesions can
continue to appear for 7 to 14 days. Lesions are symmetric and usually cause regional
lymphadenopathy. Fever and flulike symptoms are common. Typical recurrences
begin with a prodrome of burning, tingling, or itching about 24 hours before the
vesicles appear.
Assessment and Diagnostic Findings
• Generally, the appearance of the skin eruption is strongly suggestive.
• Viral cultures and rapid assays are available, and the type of test used depends on
lesion morphology.
• Acute vesicular lesions are more likely to react positively to the rapid assay, whereas
older, crusted patches are better diagnosed with viral culture. In all cases, it is
imperative to obtain enough viral cells for testing, and careful collection methods are
therefore important.

14. Complications
• Eczema herpeticum is a condition in which patients with eczema contract herpes that
spreads throughout the eczematous areas. Eczema herpeticum is managed with oral or
IV acyclovir.
• Herpetic whitlow is an infection of the pulp of a fingertip with herpes type 1 or 2.
• In mothers who have primary infections during pregnancy, intrauterine neonatal
infections can occur. Most cases of neonatal infection with herpes occur during
delivery by contact of the infant with the mother’s active ulcerations.
• Fetal anomalies include skin lesions, microcephaly, encephalitis, and intracerebral
calcifications.
Medical Management
• In more severe outbreaks or in patients with identified triggers, intermittent treatment
with 200 mg acyclovir administered five times each day for 5 days is often started as
soon as the earliest symptoms occur.
• Treatment of genital herpes depends on the severity, the frequency, and the
psychological impact of recurrences and on the infectious status of the sexual partner.
For people who have mild or rare outbreaks, no treatment may be required.
• Use of intermittent oral medication has been shown to reduce the duration of herpes
genital infections by only 24 to 36 hours. If a patient is using intermittent treatment
for infrequent episodes, the medication should be initiated within the first 24 hours
after the infection is identified.

15. HERPES SIMPLEX SUMMARY
INTRODUCTION
Human herpes simplex virus (HSV) causes contagious infection
with a large reservoir in the general population.
HSV has a potential for significant complications in the
immunocompromised host.
HSV-1 is normally associated with orofacial infections and
encephalitis.
HSV-2 usually causes genital infections and can be transmitted
from infected mothers to neonates
Both viruses establish latent infections in sensory neurons and,
upon reactivation, cause lesions at or near point of entry into the
body.

16.  Transmission of both HSV types is by
direct contact with virus-containing
secretions or with lesions on mucosal
or cutaneous surfaces
 HSV-1 is spread by contact, usually by infected saliva
 HSV-1 primarily infects skin above the waist
 HSV-2 is transmitted sexually or from a maternal genital
infection to a newborn
 HSV-2 primarily infects skin below the waist

17.  Ballooning of infected cells
 Production of Cowdry type
A intranuclear (Lipschutz)
inclusion bodies
 Margination of chromatin
 Formation of
multinucleated giant cells

18.  Primary infections of the upper body
Fig. Herpes simplex gingivostomatitis
Fig. Herpetic whitlow
Fig. Recurrent herpes labialis
(cold sores) Fig. Keratoconjunctivitis
Herpes Simplex Type 1 Clinical manifestations

19.  Primary infections of the genital tract
Fig. Genital herpes simplex infections
Herpes Simplex Type 2 Clinical manifestations

20. A. Cytopathology:
 A rapid cytologic method
 Scrapings obtained from the base
of a vesicle is stained with 1% aq.
solution of toluidine blue ‘0’ for
15 seconds
 Presence of multinucleated giant
cells or ‘Tzanck cells’ = + HSV
 Intranuclear inclusion bodies with
Giemsa-stained smears

21. B. Isolation and identification:
 Inoculation of tissue cultures in human diploid
fibroblasts is preferred for viral isolation
 Typical cytopathic changes may be seen in 24-48 hrs
C. Polymerase chain reaction:
D. Serology:
 Antibodies appear in 4–7 days after infection; reach a
peak in 2–4 weeks
 Rise in Ab titre may be demonstrated by ELISA or
complement fixation tests

22.  Aciclovir, Valaciclovir, Famciclovir
 Asymptomatic shedding is
frequent in patients with genital
herpes
 Transmission can be reduced
by:
 avoidance of contact with
potential virus-shedding lesions
 safe sexual practice
 antiviral therapy

23. Fungal (Mycotic) Skin Infections
Fungi, tiny members of a subdivision of the plant kingdom that thrive on organic matter,
cause various common skin infections. In some cases, they affect only the skin and its
appendages (hair and nails). In other cases, internal organs are involved, and the diseases may
be life threatening
The most common fungal skin infection is tinea, which is also called ringworm because of its
characteristic appearance of a ring or rounded tunnel under the skin. Tinea infections affect
the head, body, groin, feet, and nails.

24. RINGWORM

25. Introduction:
 It is a fungal infection.
 Also known as tinea or
dermatophytosis.
 The causative agent feeds
on keratin.
 It is caused by
dermatophytes(Trichophy
ton and microsporum).

26. It gets transmitted from an –
a) Infected person
b) Animal
c) Inanimate object
d) Soil
Mode of transmission:

27. 
 Ringworm that affects the-
a)Skin (Tinea Corporis).
b)Scalp (Tinea Capitis).
c)Feet (Tinea pedis or athlete’s foot).
d)Nails (Tinea Unguium).
e)Face (Tinea Faciei).
f)Beard area (Tinea Barbae).
g)Hands and palm areas(Tinea manuum).
Types of ringworm:

28. Symptoms:
Skin ( Tinea Corporis ):
 Itchy , raised , ring shaped
scaly patches that may blister
and ooze,hair loss.
Scalp(Tinea Capitis):
 Patches , scaling bald spots
on the scalp , dandruff or
seborrhea .

29. Feet ( Tinea Pedis ) :
 Scaling inflammation in the
toe webs, itching, burning,
redness, stinging on the soles
of the feet.
Nail (Tinea Unguium ) :
 It make finger nails white,
thick, opaque and brittle.
 It make toenails
yellow,opaque and brittle.

30. Face (Tinea Faciei ) : Beard area (Tineabarbae):
 It causes ring shaped
red, scaly patches with
indistinct edges.
 It causes swellings and
marked crusting,
sometimes causes the
hair to break off.

31. Hands(Tinea Manuum):
 It typically causes thickening (hyperkeratosis) of
the areas often on hand.
 It causes itching,burning and scaling of the skins
on hands.

32. Skin biopsy
KOH examination
Diagnosis:

33. Prevention:
Don't share clothes, sports gear, or towels.
To wear slippers in locker rooms and public pool &
bathing areas.
To shower after any sport that includes skin-to-skin
contact.
To wear loose-fitting cotton clothes.
To keep skin clean and dry.
To take the pets to the veterinary if it has patches of
missing hair, which could be a sign of a fungal
infection.

34. Treatment:
Ringworm can be treated with antifungal creams
containing topical agents –
 Clotrimazole
 Miconazole
 Ketoconazole
 Fluconazole
 Terbinafine

35. PARASITIC SKIN INFESTATIONS
Parasitic skin infestations include those of the skin by lice (pediculosis) and the
itch mite (scabies).
Pediculosis: Lice Infestation
Lice infestation affects people of all ages. Three varieties of lice infest humans:
Pediculus humanus capitis (head louse), Pediculus humanus corporis (body
louse), and Pediculosis pubis (pubic louse or “crab”).
Lice are called ectoparasites because they live on the outside of the host’s body.
They depend on the host for their nourishment, feeding on human blood
approximately five times each day.
They inject their digestive juices and excrement into the skin, which causes
severe itching
Types of pediculosis
Pediculosis Capitis
Pediculosis capitis is an infestation of the scalp by the head louse. The female
louse lays her eggs (nits) close to the scalp. The nits become firmly attached to
the hair shafts with a tenacious substance.
The young lice hatch in about 10 days and reach maturity in 2 weeks. Head lice
may be transmitted directly by physical contact or indirectly by infested combs,
brushes, wigs, hats, helmets, and bedding.
Pediculosis Corporis and Pubis
Pediculosis corporis is an infestation of the body by the body louse. This is a
disease of those who live in close quarters. Pediculosis pubis is
extremely common. The infestation is generally localized in the genital region
and is transmitted chiefly by sexual contact.
Predisposing factors
Children and people with long hair
Clinical Manifestations
• Head lice are found most commonly along the back of the head and
behind
• the ears. To the naked eye, the eggs look like silvery, glistening oval
• bodies.
• The bite of the insect causes intense pruritus, and the resultant scratching
often leads to secondary bacterial infection, such as impetigo or
furunculosis.

36. • Its bites cause characteristic minute hemorrhagic points.
• Widespread excoriation may appear as a result of intense pruritus
and scratching, especially on the trunk and neck.
• Among the secondary lesions produced are parallel linear scratches
and a slight degree of eczema.
• In long-standing cases, the skin may become thick, dry, and scaly,
with dark pigmented areas
• Reddish-brown dust (i.e., excretions of the insects) may be found in
the patient’s underclothing.
• The pubic area should be examined with a magnifying glass for lice
crawling down a hair shaft or nits cemented to the hair or at the
junction with the skin.
• Infestation by
• There may also be infestation of the hairs of the chest, axillae, beard,
and eyelashes.
• Gray-blue macules may sometimes be seen on the trunk, thighs, and
axillae as a result of either the reaction of the insects’ saliva with
bilirubin (converting it to biliverdin) or an excretion produced by the
salivary glands of the louse.

37. Medical Management
• Washing the hair with a shampoo containing pyrethrin compounds
with piperonyl butoxide. Lindane (Kwell) is no longer recommended
because of its neurotoxic adverse effects. The patient is instructed to
shampoo the scalp and hair according to the product directions. After
the hair is rinsed thoroughly, it is combed with a fine-toothed comb
dipped in vinegar to remove any remaining nits or nit shells freed
from the hair shafts. They are extremely difficult to remove and may
have to be picked off one by one.
• The patient with body lice is instructed to bathe with soap and water.
• Typically, no medications are indicated because the lice live on the
patient’s clothing.
• Topical medications used to treat head and pubic lice may be applied
to the clothing, however, particularly in the seams of garments
• If eyelashes are involved, petrolatum may be thickly applied twice
daily for 8 days, followed by mechanical removal of any remaining
nits
• All articles of clothing, towels, and bedding that may have lice or
nits should be washed in hot water—at least 54°C (130°F)—or dry-
cleaned to prevent reinfestation.
• Combs, brushes, and helmets are disinfected or discarded. All family
members and close contacts are treated
Nursing Management
• The nurse informs the patient that head lice may infest anyone and
are not a sign of uncleanliness.
• Because the condition spreads rapidly, treatment must be started
immediately.
• Epidemics among those living in close quarters (e.g., dormitories,
military barracks) may be managed by having everyone shampoo
their hair on the same night. Cohabitants and family members should
be warned not to share combs, brushes, and hats; they should be
inspected for head lice daily for at least 2 weeks.
• Treatment is necessary for all family members and sexual contacts
of patients with body and/or pubic lice. The nurse educates them
about personal hygiene and methods to prevent or control
infestation.
• The patient and partner must also be scheduled for a diagnostic
workup for coexisting STIs.

38. Scabies
Scabies is an infestation of the skin by the itch mite Sarcoptes scabei. The
disease is most commonly found in people living in substandard hygienic
conditions and in people who are sexually active. The mites frequently
involve the fingers, and hand contact may produce infection.
Clinical manifestations
It takes approximately 4 weeks from the time of contact for the patient’s
symptoms to appear.
• The patient complains of severe itching caused by a
• delayed type of immunologic reaction to the mite or its fecal pellets
Increased itching that occurs during the evening hours, perhaps
because the increased warmth of the skin has a stimulating effect on
the parasite.
• Hypersensitivity to the organism and it products of excretion also
may contribute to the pruritus
• Burrows created by the mites which may be multiple, straight or
wavy, brown or black, threadlike lesions, most commonly observed
between the fingers and on the wrists.
• Red, pruritic eruptions usually appear between adjacent skin areas.
However, the burrow is not always visible.
• Secondary lesions are quite common and include vesicles, papules,
excoriations, and crusts. Bacterial superinfection may result from
persistent excoriation of the burrows and papules.

39. •
•
Assessment and Diagnostic Findings
• To diagnose scabies, doctor examines skin, looking for signs of
mites, including the characteristic burrows.
• When doctor locates a mite burrow, takes a scraping from that area
of skin to examine under a microscope to determine the presence of
mites or their eggs.

40. Medical Management
• The patient is instructed to take a warm, soapy bath or shower to
remove the scaling debris from the crusts and then to pat the skin dry
thoroughly and allow it to cool.
• A prescription scabicide, 5% permethrin, is considered the
medication of choice. It is applied thinly to the entire skin from the
neck down, sparing only the face and scalp (which are not affected
in scabies). The medication is left on for 12 to 24 hours, after which
the patient is instructed to wash thoroughly. One application may be
curative, but it is advisable to repeat the treatment in 1 week.
• Oral antihistamines such as diphenhydramine or hydroxyzine can
help control the pruritus.
• If a secondary infection is present, treatment with oral antibiotic
agents may be indicated.
Nursing Management
• The patient should wear clean clothing and sleep between freshly
• laundered bed linens.
• All bedding and clothing should be washed in hot water and dried on the
hot dryer cycle. If bed linens or clothing cannot be washed in hot water,
dry cleaning is advised.
• After treatment is completed, the patient may apply an ointment, such as a
topical corticosteroid, to skin lesions because the scabicide may irritate the
skin.
• All family members and close contacts should be treated simultaneously to
eliminate the mites. Some scabicides are approved for use in infants and
pregnant women.
• If scabies is sexually transmitted, the patient may require treatment for
coexisting STI. Scabies may also coexist with pediculosis.
REFERENCES
1. Hinkle, J. L., & Cheever, K. H. (2018). Medical-Surgical Nursing
(14th ed.). Philadelphia: Lippincott williams & wilkins