A more severe form of scabies that is more common among immunocompromised persons is called Norwegian scabies, characterized by vesicles and formation of thick crusts over the skin, accompanied by abundant mites but only slight itching. Complications due to infestation are usually caused by secondary bacterial infections from scratching. Whenever possible scabies should be confirmed by isolating the mites, ova or feces in a skin scraping. Scrapings should be made at the burrows, especially on the hands between the fingers and the folds of the wrist. Alternatively, mites can be extracted from a burrow by gently pricking open the burrow with a needle and working it toward the end where the mite is living.
Several lotions are available to treat scabies.
The treatment of choice is the topical use of permethrin. All clothes, bedding, and towels used by the infested person during the 2 days before treatment should be washed in hot water, and dried in a hot dryer. A second treatment with the same lotion may be necessary 7-10 days later. See recommendations in The Medical Letter for complete information. This drug is approved by the FDA, but considered investigational for this purpose.