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Suggest Treatment For Re-infestation Of Scabies
Question: I NEED HELP KNOWING IF WHAT I HAVE IS POST SCABIES OR REINFESTATION. I have treated the symptoms in one cycle of invermectin, washing bedding and clothes, symptoms returned, then two cycles of invermectin and permetrin lotion 8 days apart with even more attention to washing bedding, towels, clothing etc. I went to one dermatologist that did't know what it was, the second was better but took a scraping for positive diagnosis. I probably know more than both after studying on the internet. The scabies appeared in XXXXXXX and were finally diagnosed in March.
Brief Answer:
I doubt it is only scabies; Need more information plus images
Detailed Answer:
Hello. Thank you for writing to us.
I have read your query and I understand your concern.
I really doubt that the skin condition which you had was Scabies Or only Scabies.
You have been treated adequately for scabies, not once but twice, since it was diagnosed in march.
Reinfection after adequate treatment is unlikely unless of course there are close contacts Or family members with similar symptoms.
Were there any affected family members at anytime?
If it is post-scabies it is unusual that it would last for 3 months after treatment! (its july now) unless of course there was reinfestation from others who are affected.
Was second dermatologist able to see the mite?
I would like to know the distribution of your skin lesions? Now that you have read about scabies on internet I would like to know does the distribution of skin lesions matches that of scabies?
Can you upload a few images of skin lesions as well?
Regards
I doubt it is only scabies; Need more information plus images
Detailed Answer:
Hello. Thank you for writing to us.
I have read your query and I understand your concern.
I really doubt that the skin condition which you had was Scabies Or only Scabies.
You have been treated adequately for scabies, not once but twice, since it was diagnosed in march.
Reinfection after adequate treatment is unlikely unless of course there are close contacts Or family members with similar symptoms.
Were there any affected family members at anytime?
If it is post-scabies it is unusual that it would last for 3 months after treatment! (its july now) unless of course there was reinfestation from others who are affected.
Was second dermatologist able to see the mite?
I would like to know the distribution of your skin lesions? Now that you have read about scabies on internet I would like to know does the distribution of skin lesions matches that of scabies?
Can you upload a few images of skin lesions as well?
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your reply.
the second round of treatment, ivermectin and permetrin was in May. Both my husband and I did the medicine and lotion repeating 8 days later. He had no apparent symptoms ever.
The second dermatologist in March did not see the mite on the slide of the scraping. A skin/bite sample was sent to a lab for analysis where they confirmed it was an insect bite and most likely scabies.
When the bites first appeared in XXXXXXX they were on my hands, fingers, breasts, elbows, waist line, bottom, chest, jawline, knees and ankles. Pre-diagnosis I did some homeopathic treatments which diminished the distribution a lot but didn't kill them. They do resemble the images i see on line. The tunnel between bites I cannot confirm that I have detected.
For about two weeks after the first treatment I was clear, as well after the second treatments in early XXXXXXX We live in a semiarid climate. For the last two weeks of XXXXXXX we visited a hot humid climate. A few itchy bumps occurred on my elbows in pairs about 1/2 inch apart, jawline, chin, neck, and bottom.
Thus my question about post scabies. ..on line I have read that it can go on for 6 months or more (god forbid). These spots appear to be different from the original bites. They are itchy bumps.
By the way, I have gotten really good about not itching them. In frustration we are prepared to do another round of ivermectin and permetrin.
I hope these details help you. I'm working on photos for upload.
Thank you.
the second round of treatment, ivermectin and permetrin was in May. Both my husband and I did the medicine and lotion repeating 8 days later. He had no apparent symptoms ever.
The second dermatologist in March did not see the mite on the slide of the scraping. A skin/bite sample was sent to a lab for analysis where they confirmed it was an insect bite and most likely scabies.
When the bites first appeared in XXXXXXX they were on my hands, fingers, breasts, elbows, waist line, bottom, chest, jawline, knees and ankles. Pre-diagnosis I did some homeopathic treatments which diminished the distribution a lot but didn't kill them. They do resemble the images i see on line. The tunnel between bites I cannot confirm that I have detected.
For about two weeks after the first treatment I was clear, as well after the second treatments in early XXXXXXX We live in a semiarid climate. For the last two weeks of XXXXXXX we visited a hot humid climate. A few itchy bumps occurred on my elbows in pairs about 1/2 inch apart, jawline, chin, neck, and bottom.
Thus my question about post scabies. ..on line I have read that it can go on for 6 months or more (god forbid). These spots appear to be different from the original bites. They are itchy bumps.
By the way, I have gotten really good about not itching them. In frustration we are prepared to do another round of ivermectin and permetrin.
I hope these details help you. I'm working on photos for upload.
Thank you.
Brief Answer:
Would consider a possibility of Scabies; topical and oral steroids for LP
Detailed Answer:
Hi.
Thank you. I have reviewde the Image, though I would have preferred an Image of an area with a multitude of lesions.
I can see a single violaceous, smooth, raised bump in this Image.
I would like to consider a diagnosis of Generalized Lichen Planus (LP). A skin biopsy and routine histopathology would be confimatory.
Scabies is a common differential diagnosis of generalized Lichen planus.
Treatment of Lichen planus would be with topical potent steroid cream e.g clobetasol propionate 0.05% twice daily. Of course, scabicidal remedies that you were using would not be of much benefit.
Oral steroids may also be started since the involvement is generalized.
An OTC oral antihistamine e.g cetrizine 10 mg once daily will provide you symptomatic rlief from itching.
I suggest that you seek another appointment with a dermatologist for a review of diagnosis and biopsy confirmation, if required
Regards
Would consider a possibility of Scabies; topical and oral steroids for LP
Detailed Answer:
Hi.
Thank you. I have reviewde the Image, though I would have preferred an Image of an area with a multitude of lesions.
I can see a single violaceous, smooth, raised bump in this Image.
I would like to consider a diagnosis of Generalized Lichen Planus (LP). A skin biopsy and routine histopathology would be confimatory.
Scabies is a common differential diagnosis of generalized Lichen planus.
Treatment of Lichen planus would be with topical potent steroid cream e.g clobetasol propionate 0.05% twice daily. Of course, scabicidal remedies that you were using would not be of much benefit.
Oral steroids may also be started since the involvement is generalized.
An OTC oral antihistamine e.g cetrizine 10 mg once daily will provide you symptomatic rlief from itching.
I suggest that you seek another appointment with a dermatologist for a review of diagnosis and biopsy confirmation, if required
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello,
I studied many images and read descriptions of lichen planus on the Internet. I don't think so. I will keep that in mind though.
About scabies--in the beginning there were lots of lesions. Now there are only a few, three of four, like the images I sent. My question is: could these be post scabies bumps/lesions? Could these be that my body is ridding itself of the decaying dead mites and their excrement? These few do show up in places where there were many at the beginning.
Thank your for your consideration.
I studied many images and read descriptions of lichen planus on the Internet. I don't think so. I will keep that in mind though.
About scabies--in the beginning there were lots of lesions. Now there are only a few, three of four, like the images I sent. My question is: could these be post scabies bumps/lesions? Could these be that my body is ridding itself of the decaying dead mites and their excrement? These few do show up in places where there were many at the beginning.
Thank your for your consideration.
Brief Answer:
Use a potent topical steroid and oral antihistamine i.e cetrizine
Detailed Answer:
Hi.
I don't think these are post scabies bumps.
Lichen Planus is a possibility. Images on internet are not always representative of condition and moreover every patients may not present with a typical clinical picture.
Anyways, fortunately the management of both these conditions is almost the same i.e potent topical steroid cream e.g clobetasol propionate 0.05% cream Or betamethasone dipropionate 0.05% cream, twice daily. Use it for 2- 4weeks and then follow up with me.
An OTC oral antihistamine e.g cetrizine 10 mg once daily in evening will provide you symptomatic relief from itching.
Regards
Use a potent topical steroid and oral antihistamine i.e cetrizine
Detailed Answer:
Hi.
I don't think these are post scabies bumps.
Lichen Planus is a possibility. Images on internet are not always representative of condition and moreover every patients may not present with a typical clinical picture.
Anyways, fortunately the management of both these conditions is almost the same i.e potent topical steroid cream e.g clobetasol propionate 0.05% cream Or betamethasone dipropionate 0.05% cream, twice daily. Use it for 2- 4weeks and then follow up with me.
An OTC oral antihistamine e.g cetrizine 10 mg once daily in evening will provide you symptomatic relief from itching.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you.
Ironically the original dermatologist prescribed what you suggest above, although she thought the lesions were bug bites like mosquitos. She observed the symptoms when there were lots of them.
Please tell me if I can infect another with whatever this is. I am very concerned because in 6 weeks I go to visit grandchildren and am concerned about introducing scabies into their home.
Addendum.. .since we cannot be completely sure these are not scabies, that is my concern about my grandchildren.
Okay...I will try the clobetasol. Hope i can end this what ever it is.
Thank you.
Ironically the original dermatologist prescribed what you suggest above, although she thought the lesions were bug bites like mosquitos. She observed the symptoms when there were lots of them.
Please tell me if I can infect another with whatever this is. I am very concerned because in 6 weeks I go to visit grandchildren and am concerned about introducing scabies into their home.
Addendum.. .since we cannot be completely sure these are not scabies, that is my concern about my grandchildren.
Okay...I will try the clobetasol. Hope i can end this what ever it is.
Thank you.
Brief Answer:
Follow up after a few days of using clobetasol propionate 0.05% cream
Detailed Answer:
Hi.
You have already been treated empirically for Scabies, not once but thrice, even though I really don't think that this was actually Scabies.
If it were Scabies it would have been over long before. Therefore you may feel free about spending a good time with grandchildren.
In my view you must try a topical steroid cream, like the ones I had suggested in my previous replies, after consultation with your dermatologist and then follow up after a few days.
I also suggest an OTC oral antihistamine e.g cetrizine 10 mg once daily for symptomatic relief from itching.
Regards
Follow up after a few days of using clobetasol propionate 0.05% cream
Detailed Answer:
Hi.
You have already been treated empirically for Scabies, not once but thrice, even though I really don't think that this was actually Scabies.
If it were Scabies it would have been over long before. Therefore you may feel free about spending a good time with grandchildren.
In my view you must try a topical steroid cream, like the ones I had suggested in my previous replies, after consultation with your dermatologist and then follow up after a few days.
I also suggest an OTC oral antihistamine e.g cetrizine 10 mg once daily for symptomatic relief from itching.
Regards
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank you. I will proceed with your recommendations.
Brief Answer:
You are welcome
Detailed Answer:
Thank you for writing to us. Keep me updated.
Regards
You are welcome
Detailed Answer:
Thank you for writing to us. Keep me updated.
Regards
Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation
Above answer was peer-reviewed by :
Dr. Prasad
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