Scabies is caused by a mite infection that burrows under the skin. Female mites burrow and lay eggs that hatch in 3-5 days, causing intense itching. Secondary infections like impetigo and cellulitis are common. Treatment involves applying permethrin cream to the entire body for 8-12 hours and treating family members preventively. Bedding and clothing should be washed in hot water.

1. Scabies
Chansathit TAIKEOPHITHOUN MD.,FMD
18 Jan 18

2. Scabies
• Mite infection-burrow under skin
• Female mite burrows under skin and lays egg
• hatch in 3-5 days and cause severe intense itching
• Secondary infections (impetigo, cellulitis) common

3. Clinical Manifestations
• Intense, severe pruritus especially at night
• Papule-vesicular rash mainly in wrists,
fingers, elbows, axilla and groin
• May see a faint burrow pattern

4. Scabies rash distribution

6. Management
• Permethrin 5% cream (Elimite) apply entire body from neck
down and left on the skin 8-12 hours
(if necessary it may reapply again) +- oral ivermectin +- topical
corticosteroid
• Family members even if asymptomatic and day time contacts
should be treated
• Wash all bedding, clothing in hot water similar to that for
pediculosis

7. Candidiasis (thrush)
•Superficial fungal infection
(Candida albicans) of the oral
mucous membranes
•May also present in diaper
area

8. Etiology
Neonate
• can be acquired during delivery if
mother has infection
Older infant
• Immunosupression
• during antibiotic therapy,
• exposure to mother’s infected breasts
• unclean bottles and pacifiers

9. Candidal Diaper Dermatitis
• Diaper area lesions are bright
red
• Sharp Border
• Satellite lesions

10. Management
•Nystatin oral suspension applied to
mucous membranes
•Diaper area treated with topical
Nystatin cream

11. Parental Education
• Good hand washing
• Thoroughly wash pacifier, bottles
• Apply oral Nystatin after feeding to promote
increased absorption
• Breasts should be treated with Nystatin cream if
breast feeding
• Watch for spread to GI tract: fever, refusal to eat

12. Cellulitis

13. Cellulitis
• Bacterial infection of skin of connective tissue
• Infected area will be edetamous, erythematous,
very tender, warm-hot
• May have discharge
• Usually associated with elevated WBC
• Can progress into bacterima
• Aggressive antibiotics

14. Etiology
• Streptococcus pyogenes
• S. aureus
• If immunocompromised or DM patient, Pseudomonas
aeruginosa, cryptococcus are common found

15. Diagnosis method
• Aspirate on the site of inflammation
• Skin biopsy
• Blood culture

16. Treatment
• If neonate: full sepsis evaluation and Empirical IV need
(B-lactamase anti staphylococcal ATB (Methicilin, vancomycin )
and aminiglycoside or cephalosporine (cefotaxim…)
• OPD: could be treat by penicillinase resistant (dicloxacilline,
cloxacilline) or 1 st generation of cephalosporine
(cephalexine) and clindamycin
• Duration of treatment 10 days course

17. For your kind attention