Persistent Scabies: Symptoms and Treatment Challenges

Scabies won't heal?

Since mid-November, after being discharged from surgery, I have developed a rash on my body.
(I suspect it was during my hospitalization when a nurse helped me tie my hair; she had just changed the bed linens for the patient next door and didn't remove her gloves before coming to assist me.) At that time, I consulted a dermatologist who diagnosed me with scabies.
Since then, I have applied Permethrin almost ten times.
In the initial visits, the doctor did not believe that I had scabies on my scalp and advised me not to apply the treatment there, so I refrained from doing so.
The doctor prescribed me to apply Permethrin for two consecutive days and to use FUCIORT CREAM for itching.
Although my body showed some improvement, during my follow-up visit, my scalp was unbearably itchy, and the lymph nodes in my neck were swollen.
Only then did the doctor take a closer look and instruct me to start applying the treatment to my scalp.
I wonder if it is because I have long hair and a thicker volume, which may have prevented thorough application on my scalp.
Now, nearly three months have passed, and my condition has been fluctuating.
In the meantime, I have also experienced persistent itching around my anus, and every time I apply Permethrin, after two days (with a week in between), I develop several red bumps in different areas.
Currently, I have a ring of red bumps on my abdomen that is quite alarming when I look in the mirror.

1.
I have already washed my clothes and bedding on a 60-degree wash cycle; what could be the reason for my condition not improving?
2.
Is it that Permethrin is ineffective, or am I experiencing a recurrence? Or could I be developing resistance to Permethrin?
3.
Is it possible that I do not actually have scabies? (Considering that it has been three months and I am the only one in my household with this issue.)
4.
Although I have asked my attending physician whether I should self-isolate, he said it is not necessary.
However, I am scheduled to travel abroad at the end of the month; is it really safe for me to do so in my current condition?

Hui, 20~29 year old female. Ask Date: 2019/02/12

Dr. Wu Yuxin reply Dermatology

Without actually seeing the lesion, it is impossible to make a definitive diagnosis.
If it is causing significant distress, please seek medical attention as soon as possible.

Reply Date: 2019/02/12

More Info

Persistent scabies can be a frustrating and distressing condition, especially when symptoms persist despite treatment. Scabies is caused by the Sarcoptes scabiei mite, which burrows into the skin, leading to intense itching and a characteristic rash. Your situation, where you have been treating what you believe to be scabies for several months without significant improvement, raises several important considerations.

1. Treatment Efficacy: Permethrin is a commonly prescribed topical treatment for scabies and is generally effective when applied correctly. However, it is crucial to ensure that the application is thorough and that all affected areas, including the scalp, are treated. Given your long hair, it is possible that some areas were missed during application. Additionally, scabies mites can survive off the human body for a short period, so it is essential to wash all clothing, bedding, and towels in hot water and dry them on high heat to eliminate any potential mites.

2. Reinfestation vs. Resistance: If you are experiencing recurrent symptoms after treatment, it could be due to reinfestation rather than resistance to Permethrin. Resistance to topical treatments is rare, but it can occur. If you suspect that the treatment is not working, it may be worth discussing alternative treatments with your healthcare provider, such as oral ivermectin, which can be effective in cases of crusted scabies or when topical treatments fail.

3. Misdiagnosis: It is also possible that your symptoms may not be due to scabies. Conditions such as eczema, contact dermatitis, or other skin infections can mimic the symptoms of scabies. If you have not seen improvement after multiple treatments, it may be beneficial to seek a second opinion or further evaluation from a dermatologist. They may perform a skin scraping or biopsy to confirm the diagnosis.

4. Isolation and Contagion: Regarding your concern about traveling and potential contagion, scabies is highly contagious through prolonged skin-to-skin contact. However, casual contact, such as sitting next to someone or sharing a space, is less likely to spread the mites. If your doctor has advised that you do not need to isolate yourself, it may be based on the understanding that your condition is being treated. However, if you have ongoing symptoms, it is wise to take precautions, such as avoiding close contact with others until you have a clearer diagnosis and treatment plan.

5. Next Steps: Given the persistence of your symptoms, I recommend the following steps:
- Schedule a follow-up appointment with a dermatologist for a thorough examination and possibly a different treatment approach.

- Ensure that you are applying Permethrin correctly, covering all affected areas, and consider using an oral medication if recommended.

- Continue to wash all clothing and bedding in hot water and dry them on high heat to prevent reinfestation.

- Monitor your symptoms closely, and if they worsen or new symptoms arise, seek medical attention promptly.

In summary, persistent scabies symptoms can be challenging to manage, and it is essential to ensure proper treatment and diagnosis. By taking these steps, you can work towards finding relief from your symptoms and preventing further complications.

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