Scabies Treatment: When Symptoms Persist and What to Do

Scabies treatment

Hello, Doctor.
Two weeks ago, I had six nodules on my scrotum and one nodule under my right armpit, along with itchy red papules on parts of my arms and thighs.
After treatment, during the first week, I applied two tubes of scabicide ointment all over my body and used Ulesfia lotion on the affected areas daily, while also bathing with sulfur soap.
I simultaneously disinfected my clothing and environment.
During the first week of treatment, my symptoms significantly improved; the rashes subsided, and the nodules shrank and softened.

After seven days, in the second week, I used a third tube (only one tube) of scabicide ointment to apply all over my body again and continued using Ulesfia on the affected areas.
However, on the ninth day, I noticed that my arms and previously affected areas of my legs reappeared with some itchy red papules (the symptoms fluctuate; sometimes they fade and then return with redness and itching).
However, I have not noticed any new nodules, and the existing nodules have flattened with some hyperpigmentation (slightly itchy upon touch).

My question to the doctor is: Could this situation indicate a failure in scabies treatment? What should I do? Thank you for your response, Doctor.

wu, 20~29 year old female. Ask Date: 2019/04/06

Dr. Wu Yuxin reply Dermatology

It seems that the treatment steps are appropriate, but without actually seeing the lesions, it is impossible to confirm.
Regarding this issue, you should consult your attending physician, as they are the most familiar with your condition.

Reply Date: 2019/04/06

More Info

Scabies, caused by the Sarcoptes scabiei mite, can lead to significant discomfort and distress. The treatment typically involves topical medications, such as permethrin cream (often referred to as "scabicide") or oral ivermectin in more severe cases. Your experience of initial improvement followed by a resurgence of symptoms raises several important considerations regarding the effectiveness of treatment and potential misdiagnosis.

Firstly, it is crucial to understand that while scabies treatment can be effective, there are instances where symptoms may persist or recur. This can happen for several reasons:
1. Incomplete Treatment: If the scabicide was not applied thoroughly or left on for the recommended duration, it may not have eradicated all the mites. It's essential to ensure that the medication covers all areas of the skin, including under fingernails and in skin folds, as mites can hide in these areas.

2. Reinfestation: Scabies is highly contagious, and reinfestation can occur if you come into contact with an infested person or contaminated items (like bedding or clothing) after treatment. It's crucial to wash all clothing, bedding, and towels in hot water and dry them on a hot cycle to kill any remaining mites.

3. Post-Scabietic Itch: After successful treatment, some individuals experience persistent itching due to skin irritation or an allergic reaction to the mites or their waste products. This condition, known as post-scabetic itch, can last for weeks or even months after the mites have been eradicated.

4. Misdiagnosis: It's also possible that the symptoms you are experiencing are not solely due to scabies. Other skin conditions, such as eczema, contact dermatitis, or even secondary infections, can mimic scabies symptoms. A thorough examination by a healthcare professional is necessary to rule out these possibilities.

Given your situation, here are some steps you can take:
- Consult Your Healthcare Provider: Since your symptoms have returned, it is essential to revisit your healthcare provider for a follow-up examination. They may recommend a second round of treatment or consider alternative diagnoses if scabies is ruled out.

- Review Treatment Application: Ensure that you are applying the scabicide correctly. Follow the instructions carefully, and consider having a healthcare professional demonstrate the application if needed.

- Environmental Measures: Continue to wash and disinfect your living environment. This includes vacuuming carpets and furniture, as well as treating any shared spaces to prevent reinfestation.

- Symptom Management: If itching persists, your doctor may recommend antihistamines or topical corticosteroids to alleviate discomfort.
- Follow-Up: Schedule a follow-up appointment to monitor your progress and adjust treatment as necessary. If symptoms do not improve, further investigation into other potential skin conditions may be warranted.

In conclusion, while your initial treatment for scabies seemed effective, the recurrence of symptoms suggests that further evaluation is necessary. Persistent symptoms can be due to several factors, including incomplete treatment, reinfestation, or other skin conditions. Engaging with your healthcare provider for a comprehensive assessment and tailored treatment plan is the best course of action to ensure effective resolution of your symptoms.

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