Is scabies an indication for hospital admission?

Is Scabies an Indication for Hospital Admission?

Uncomplicated scabies is not an indication for hospital admission, as it can be effectively treated on an outpatient basis with topical permethrin 5% cream or oral ivermectin. 1, 2

Treatment Approach for Different Scabies Presentations

Uncomplicated Scabies

• First-line treatment is topical permethrin 5% cream applied from neck down, left on for 8-14 hours, then washed off 1, 3
• Oral ivermectin (200 μg/kg, repeated in 2 weeks) is an effective alternative first-line treatment 1, 2
• One application of permethrin is generally curative, though pruritus may persist for up to 2 weeks after successful treatment 3, 4
• All household members and close contacts should be treated simultaneously to prevent reinfection 1, 2

Crusted (Norwegian) Scabies

• Crusted scabies is an aggressive infestation that occurs primarily in immunodeficient, debilitated, or malnourished persons 4
• Combination therapy is recommended: topical 5% permethrin cream applied daily for 7 days then twice weekly until cure, plus oral ivermectin 200 μg/kg on days 1,2,8,9, and 15 1, 4
• Additional ivermectin treatment on days 22 and 29 might be required for severe cases 4
• While more intensive treatment is required, even crusted scabies can typically be managed without hospitalization unless there are complications 1, 5

Special Populations

Children

• Permethrin is the preferred treatment for infants and young children 2
• Ivermectin is not recommended for children weighing less than 15 kg 2
• Children under 10 years should not be treated with lindane due to risk of neurotoxicity 4, 6

Pregnant/Lactating Women

• Permethrin is the preferred treatment for pregnant or lactating women 2
• Lindane should be avoided during pregnancy due to association with neural tube defects and mental retardation 4, 6

Environmental Management

• Bedding and clothing should be decontaminated by machine washing/drying using hot cycle, dry cleaning, or removing from body contact for at least 72 hours 4, 1
• Fumigation of living areas is unnecessary 4

Institutional Outbreaks

• Scabies outbreaks in healthcare facilities can be managed without ward closure through proper identification of cases, contact tracing, and mass prophylaxis 5
• All residents, staff, and frequent visitors should be treated simultaneously even if asymptomatic 7
• Early recognition of crusted scabies is essential to prevent outbreaks in institutional settings 5

When to Consider Referral or Higher Level of Care

• Diagnostic uncertainty or atypical presentation 8
• Treatment failure after two courses of different scabicides 8
• Crusted scabies with complications such as secondary bacterial infection 4, 9
• Immunocompromised patients with severe disease 4, 1

Common Pitfalls to Avoid

• Failure to treat all close contacts simultaneously 1, 7
• Inadequate application of topical treatments 1
• Using lindane after bathing or in contraindicated populations 4, 6
• Not repeating ivermectin dose after 2 weeks 1
• Expecting immediate resolution of symptoms (pruritus may persist for up to 2 weeks after successful treatment) 4, 3

In conclusion, while scabies requires prompt and thorough treatment, hospitalization is generally not necessary for management of uncomplicated or even crusted scabies unless there are significant complications or comorbidities that require inpatient care.