Treatment Options for Scabies Nodules: A Patient's Journey

Treatment of scabies nodules?

I was diagnosed with scabies three weeks after the onset of my symptoms.
At that time, there were no nodular symptoms in the genital area.
After using permethrin and thorough disinfection, the itching significantly improved.
However, nodules began to appear on my testicles, and they have been increasing in number.
It has been almost three weeks since I started treatment for scabies, and I have been using permethrin and sulfur baths daily, but there has been little effect on the nodules.
It has been a while since any new nodules have appeared.
The doctor mentioned that they might be caused by the remains or feces of the scabies mites, leading to an allergic reaction.
However, the nodules on my testicles still appear bright red and show almost no signs of shrinking.

Could you please advise how long it typically takes for scabies nodules to resolve and what the appropriate treatment is? If the scabies mites are indeed dead, should I consider using medication specifically for the allergy caused by the nodules? Thank you for your response.

Mr. Lai, 20~29 year old female. Ask Date: 2015/08/19

Dr. Wu Yuxin reply Dermatology

Scabies granuloma is indeed an allergic reaction caused by the bodies or excretions of scabies mites, which may persist for several weeks to months.
The primary treatment principle remains the use of corticosteroid ointments; however, if the response is inadequate, localized lesion injections may be considered.

Reply Date: 2015/08/19

More Info

Scabies, caused by the Sarcoptes scabiei mite, is a common skin condition characterized by intense itching and a rash. The treatment typically involves topical medications such as permethrin (often referred to as "Scabicide") or oral medications like ivermectin. In your case, it seems that you have been using topical treatments effectively for the itching, but you are now dealing with nodules that have developed on your scrotum.

The appearance of nodules, especially after the initial treatment of scabies, can be concerning. These nodules are often referred to as "scabies nodules" or "nodular scabies," and they can occur as a result of an allergic reaction to the mites, their feces, or their dead bodies. This allergic response can persist even after the mites have been eradicated, leading to continued symptoms such as redness, swelling, and discomfort.

Duration of Treatment and Healing
The healing process for scabies nodules can vary significantly from person to person. In many cases, once the scabies mites are effectively treated, the nodules may take several weeks to months to resolve completely. The duration largely depends on the individual's immune response and the extent of the allergic reaction. It is not uncommon for nodules to remain for weeks after the mites have been eliminated, as the body continues to react to the remnants of the infestation.

Treatment Options for Nodules
1. Topical Corticosteroids: If the nodules are inflamed and causing discomfort, a topical corticosteroid cream may help reduce inflammation and itching. This can be particularly effective if the nodules are a result of an allergic reaction.

2. Oral Antihistamines: These can help alleviate itching and reduce the allergic response. They may not directly affect the nodules but can provide symptomatic relief.

3. Observation: In some cases, if the nodules are not causing significant discomfort and there are no new lesions, a watchful waiting approach may be appropriate. The body may eventually resolve the allergic reaction on its own.

4. Follow-Up with a Dermatologist: If the nodules persist or worsen, it may be beneficial to consult a dermatologist. They can provide a more thorough evaluation and may suggest additional treatments, such as stronger topical steroids or other medications.

When to Seek Further Medical Attention
If you notice any of the following, it is essential to seek further medical advice:
- The nodules become increasingly painful or show signs of infection (such as increased redness, warmth, or pus).

- New nodules continue to appear despite treatment.

- There is a significant change in the appearance of the nodules.

Conclusion
In summary, while the initial treatment for scabies may have effectively eliminated the mites, the resulting nodules can take time to resolve due to an allergic reaction. The use of topical corticosteroids and oral antihistamines can help manage symptoms. If the nodules do not improve or worsen, a follow-up with a healthcare provider, preferably a dermatologist, is advisable. They can provide tailored treatment options based on your specific condition and needs. Remember, patience is key in the healing process, and it is essential to continue monitoring your symptoms and seeking medical advice as necessary.

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