In cases of crusted scabies, entire wards of patients may require treatment. 16 Demodicidosis usually responds to treatment with topical application of metronidazole gel two to three times daily, with or without the addition of topical benzoyl benzoate. Systemic metronidazole at doses of 250 mg to 750 mg orally three times per day is also effective and may be required in cases not responsive to topical measures. Pneumocystosis responds to the usual treatments for P. carinii pneumonia, namely, intravenous pentamidine. Amebiasis responds to metronidazole at a dosage of 750 mg orally twice per day for 10 days but, as these patients are often quite immunocompromised, response to therapy may be poor.
Adjunctive therapies are also important, as pruritus is often severe.
Topical application of corticosteroid preparations as well as antipruritic agents containing menthol and phenol, pramorine, and antihistamines may be required. Ten percent doxepin in aquaphor ointment is a valuable antipruritic agent that may be used in patients with refractory pruritus.