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ABSTRACT
Background Ivermectin is an anthelmintic agent that has been a safe, effective treatment for onchocerciasis (river blindness) when given in a single oral dose of 150 to 200 microg per kilogram of body weight. Anecdotal reports of improvement in patients who suffered from infestation with the mite Sarcoptes scabiei suggest that the ectoparasitic disease scabies might be treated with ivermectin.
Methods We conducted an open-label study in which ivermectin was administered in a single oral dose of 200 microg per kilogram to 11 otherwise healthy patients with scabies and to 11 patients with scabies who were also infected with the human immunodeficiency virus (HIV), 7 of whom had the acquired immunodeficiency syndrome. All patients received a full physical and dermatologic examination; scrapings from the skin of all patients tested positive for scabies. Patients were reexamined two and four weeks after treatment, when the scrapings for scabies were repeated. The patients used no other scabicides during the 30 days before ivermectin treatment or during the 4-week study period. Results None of the 11 otherwise healthy patients had evidence of scabies four weeks after a single dose of ivermectin. Of the 11 HIV-infected patients, 2 had less/equal 10 scabies lesions before treatment, 3 had 11 to 49 lesions, 4 had greater/equal 50 lesions, and 2 had heavily crusted skin lesions. In eight of the patients the scabies was cured after a single dose of ivermectin. Two patients received a second dose two weeks after the first. Ten of the 11 patients with HIV infection (91 percent) had no evidence of scabies four weeks after their first treatment with ivermectin. Conclusions The anthelmintic agent ivermectin, given in a single oral dose, is an effective treatment for scabies in otherwise healthy patients and in many patients with HIV infection.
Source Information
From the Department of Dermatology and Cutaneous Surgery (T.L.M., D.T., R.P., F.A.K.) and the Department of Epidemiology and Public Health (D.T., J.L.H.), University of Miami School of Medicine, Miami.
Address reprint requests to Ms. Meinking at the Department of Dermatology and Cutaneous Surgery, P.O. Box 016960, R-117, Miami, FL 33101.
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There are two common causes of 'new' itchy rashes in adults (as opposed to eczema which often starts in childhood) - allergy and infections.
Rashes caused by allergy are often triggered by something that has come into contact with the skin, such as perfumes, from fragrances, or in soaps and body lotions, metals (especially nickel) and chemicals - for instance biological enzymes found in washing powders.
Lanolin, which is found in many creams, and preservatives (different ones are in different body care products) can also be to blame. A common pattern is for the skin to gradually become more irritated by a product, so it's often after you've been using a new soap or washing detergent a few times that you start to itch.
And the more you scratch, the worse the itching. Infections that can cause itching include those caused by yeasts and other fungi, and also from insects, such as scabies (which can cause intense itching).
One per cent of hydrocortisone cream can generally help skin problems caused by allergy, but if there is an infection present it can make matters worse. So rather than try and sort this out yourself, go and see your GP, for a proper diagnosis, and appropriate treatment.
There are several possible explanations for your children's blisters. Your GP needs to see you children to decide which of these (if any) may be causing your children's rashes.
1. The fact that the rash affects the hands and arms of two of your children suggests that they may have touched or handled something to which they are both allergic.
At this time of year they are likely to be playing outside in the garden and may have come into contact with certain types of plants such as Euphorbia which could cause a rash with itchy blisters. New soaps, hand or sun creams are other possibilities.
2. They may have caught the type of virus which causes hand, foot and mouth disease (HFMD). This was first described in 1957 in a small outbreak in Toronto. It is a common illness in infants and children under 10, occurring especially in the summer months.
Quite often you would hardly know that your children were unwell as they might not have any other signs of illness. Alternatively, during the day or two before the spots appeared your children might have had a mild fever or sore throat or just felt off colour.
The rash appears over a couple of days. It can vary from child to child. It starts as small raised, red spots which become blisters and then burst. They can occur on the palms of the hands, soles of the feet and arms and legs. The blisters are not usually itchy as you describe.
However, if your children scratch them they will burst and can leave a mark, but scarring is unusual. At the same time if you look in your children's mouths you may see small blisters or ulcers.
HFMD is a different disease to the foot and mouth disease of cattle, sheep and pigs. Although the names are similar the two diseases are not related and are caused by different viruses.
HFMD is generally not a serious or dangerous illness. There is no specific treatment. It gets better on its own within a week.
It is moderately contagious. It is spread by sneezing, coughing, kissing, sharing food and drinks and also by the stools. You can prevent spread of the virus by frequent handwashing, especially after going to the toilet or changing nappies and disinfecting household eating and toilet areas with diluted bleach.
If your doctor agrees the rash looks like HFMD it would be sensible to keep your children away from school, nursery or other children for the first two to three days of the rash.
3. Your children could be showing the first signs of chickenpox. This causes itchy blisters to appear in crops over the body. The blisters burst leaving small scars.
It would be unusual for the blisters to appear on both sides in the same area of the body in both your children. Also most children have had chickenpox by the age of nine. If your children have already had chickenpox they are unlikely to catch it again.
Your GP needs to examine your children to see if their rash could be chickenpox as they would need to be kept off school or nursery. They also need to avoid contact with children or adults with low immunity and pregnant women who are not immune.
They will stop being contagious when the blisters have all formed scabs and no new blisters are appearing.
4. The spots may be caused by infection with scabies or by the bacterial skin infection called impetigo. Both of these cause itchy spots or blisters. Again it would be unusual for two of your children to develop these spots in exactly the same areas of their body but it is possible.
It is important that your GP detects these conditions as they need treatment with specific lotion for scabies and with antibiotics for impetigo. They are infectious until the spots have cleared up.
We recommend readers seek personal medical attention in appropriate circumstances.
Symptoms of scabies may include itching, especially at night, and irregular bumps on the skin that may occur between the fingers, under armpits, around the waist, along the inside of wrists and on the shoulder blades.
Since scabies usually affects many people at once, physicians recommend treating entire families or groups. Treatment includes medications such as permethrin and crotamiton. The itching, however, can last for several weeks.
To ensure scabies doesn't return, patients should wash their clothes and linens in hot water, and put items that cannot be washed in places that are far away from the daily living space to starve the mites.
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