Scabies: Skin Peeling and Treatment Progress in Children

Scabies exfoliation

Hello, my child just turned one year old.
Four weeks ago, he started developing rashes on his hands and feet, which later became concentrated in the armpits, leading to severe allergic reactions with widespread redness and swelling.
It was only last week that he was diagnosed with scabies.
We have been following the doctor's advice to apply medication and disinfect clothing and bedding with hot water.
I would like to ask, after one week of applying the medication, the redness and swelling have improved, but the large rashes have not disappeared, and now his skin is starting to peel significantly.
Every time I take off his clothes, there are a lot of skin flakes.
Is this a sign of improvement, or could it be that the medication is causing the skin to become overly dry? Is there a possibility that it could be progressing to Norwegian scabies?

879, 20~29 year old female. Ask Date: 2012/02/05

Dr. Wu Yuxin reply Dermatology

The body starting to peel significantly is not a sign of improvement.
The cause of the peeling, whether it is controlled or improving, must be determined through a skin examination.
Since treatment has already begun, the likelihood of developing Norwegian scabies is low.
Additionally, please ensure that the entire family undergoes treatment to prevent the children from recovering while the adults become infected.

Reply Date: 2012/02/05

More Info

Scabies, also known as sarcoptic mange, is a highly contagious skin condition caused by the infestation of the skin by the Sarcoptes scabiei mite. It can lead to intense itching, redness, and the formation of rashes, particularly in children. In your case, it seems that your one-year-old child has been diagnosed with scabies and has been following a treatment regimen that includes topical medications and laundering of clothing and bedding.

Regarding your concerns about the skin peeling and the ongoing presence of rashes after a week of treatment, it is essential to understand the typical progression of scabies treatment and the skin's response to it.
1. Improvement of Symptoms: The fact that the redness and swelling have improved is a positive sign. This indicates that the treatment is likely effective in reducing the inflammatory response caused by the scabies mites. However, the presence of large patches of rash and ongoing peeling can be concerning.

2. Skin Peeling: The peeling of the skin you are observing can be attributed to several factors. It may be a result of the skin's healing process as it sheds the dead skin cells that were affected by the mites. This is often seen in conditions where there has been significant inflammation or irritation. However, excessive peeling could also indicate that the skin is becoming overly dry, potentially due to the topical medications used or the drying effects of hot water during bathing.

3. Dryness and Treatment: If the skin is becoming too dry, it is crucial to incorporate a good moisturizing routine. After bathing, apply a gentle, fragrance-free moisturizer to help maintain skin hydration. Avoid using hot water for baths, as it can strip the skin of its natural oils and exacerbate dryness. Instead, use lukewarm water and limit bath time.

4. Monitoring for Complications: While the symptoms you describe do not necessarily indicate a transition to Norwegian scabies (a more severe form of scabies characterized by crusted lesions and a higher mite burden), it is essential to monitor for any signs of secondary infections, such as increased redness, warmth, or pus. If the large patches of rash do not improve or worsen, or if new symptoms develop, it is advisable to consult your healthcare provider for further evaluation.

5. Follow-Up Care: Regular follow-up with your healthcare provider is essential to ensure that the treatment is effective and to make any necessary adjustments. If the condition does not improve as expected, your doctor may consider alternative treatments or additional interventions.

In summary, the peeling skin can be a part of the healing process, but it is essential to ensure that the skin remains moisturized and to monitor for any signs of complications. If you have any concerns about the treatment progress or the condition of your child's skin, do not hesitate to reach out to your healthcare provider for further guidance. They can provide tailored advice and ensure that your child receives the best possible care during this recovery phase.

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