Scabies Nodules: Questions and Concerns for Parents

Scabies nodules

Hello, Doctor.
I apologize for the interruption! My daughter is currently one year and four months old.
Last month, she was diagnosed with scabies, and after two weeks of treatment (all family members who had contact were treated as well), the doctor said that the scabies mites should be dead.
She is currently applying a cream for eczema and allergies.
I have three questions I would like to ask you.

1.
Can we determine that the source of infection has been eliminated if no new nodules appear after applying the scabicide?
2.
She has six or seven nodules, most of which are slowly flattening and darkening in color, but there are still three nodules behind her knees that remain red and swollen.
Could this be an allergic reaction due to the remains or feces of the scabies mites? How long does it usually take for the nodules to stop being red, swollen, and inflamed?
3.
Whenever she gets hot or after a bath, she still develops red rashes.
Is this a normal allergic reaction? Although the doctor said the scabies should be dead, I am concerned because the nodules are still red and swollen, and rashes frequently appear.
I can't help but worry that there might still be scabies present, leading to a recurrence or re-infection of other family members.
Thank you for your response.

Lele Ma, 30~39 year old female. Ask Date: 2019/02/04

Dr. Wu Yuxin reply Dermatology

1.
In principle, it is 2.
The nodules may persist for several weeks to months, and it is important to monitor for any new lesions.
3.
Without visualizing the lesions, it is impossible to determine the issue.
If it is causing significant concern, please seek medical attention promptly.

Reply Date: 2019/02/04

More Info

Hello! Thank you for reaching out with your concerns regarding your daughter's recent scabies infection. It's understandable to have questions, especially when it comes to the health of your child. Let's address your questions one by one.

1. Determining Infection Clearance: After applying the scabicide treatment, the absence of new nodules can be a good indicator that the scabies mites have been effectively eliminated. However, it’s important to note that the scabies treatment does not immediately resolve all symptoms. The existing nodules or lesions may take time to heal, and the absence of new lesions is a positive sign. If your daughter has not developed any new nodules after treatment, it is likely that the infection source has been addressed.

2. Understanding the Nodules: The nodules you are observing on your daughter's skin, particularly those that remain red and swollen, could indeed be a result of an allergic reaction to the scabies mites' remains (dead mites and their feces). This is a common post-scabies reaction known as "post-scabetic pruritus," where the body continues to react to the remnants of the mites even after they have been killed. The duration for these nodules to resolve can vary significantly from child to child. Generally, it may take several weeks to months for the inflammation to subside completely. Keeping the affected areas moisturized and following your doctor's advice on topical treatments can help alleviate symptoms.

3. Post-Treatment Reactions: It is not uncommon for children to experience redness or rashes after a hot bath or exposure to heat, especially if they have sensitive skin or are prone to allergies. This could be a normal allergic response, particularly if your daughter has a history of eczema or other skin sensitivities. However, if the rashes are persistent or worsening, it would be prudent to consult your pediatrician or a dermatologist for further evaluation. They may recommend additional treatments or adjustments to her current regimen.

In summary, while it sounds like your daughter is on the right path to recovery, it is essential to monitor her symptoms closely. If you notice any new lesions, increased redness, or if the existing nodules do not improve over time, please reach out to your healthcare provider for further assessment. They may consider additional treatments or tests to ensure that there is no ongoing infection or other underlying issues.

Lastly, it’s important to maintain open communication with your healthcare provider regarding any concerns you have about potential reinfection or the health of other family members. They can provide guidance on preventive measures to ensure that everyone remains healthy.

Thank you for your questions, and I hope your daughter feels better soon!

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