From the Guidelines
Treatment of skin parasitic infections in infants should prioritize topical agents for primary cutaneous disease, with consideration of the infant's risk for acute bloodstream or visceral dissemination. For healthy, normal birth weight, term infants, therapy with topical agents is generally appropriate, as stated in the practice guidelines for the treatment of candidiasis by the Infectious Diseases Society of America 1.
Key Considerations
- The specific parasite involved and the infant's age are crucial factors in determining the treatment approach.
- For common parasitic infections like scabies, permethrin 5% cream is the first-line treatment, applied from neck to toes and left on for 8-14 hours before washing off.
- For infants under 2 months, physicians may recommend 5-10% sulfur in petrolatum instead due to safety concerns.
- Treatment should be repeated after 7 days to ensure elimination of newly hatched mites.
Treatment Options
- For head lice, wet combing with a fine-toothed comb every 3-4 days for two weeks is preferred for infants, as many pediculicides aren't approved for young babies.
- If medication is necessary, permethrin 1% is generally considered safe for infants over 2 months.
- For cutaneous larva migrans, oral antiparasitic medications like ivermectin may be prescribed by specialists at appropriate weight-based dosing, with a single dose of 200 or 400 μg/kg, and a second dose given after 9 to 10 days for infants weighing over 15 kg 1.
Prevention of Reinfestation
- All family members and close contacts should be treated simultaneously to prevent reinfestation.
- All bedding, clothing, and toys should be washed in hot water and dried on high heat.
- These parasites spread through direct contact, so prompt treatment helps prevent transmission to others and complications like secondary bacterial infections.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Adults and children Thoroughly massage Permethrin Cream, 5% into the skin from the head to the soles of the feet. Scabies rarely infests the scalp of adults, although the hairline, neck, temple, and forehead may be infested in infants and geriatric patients. Infants should be treated on the scalp, temple, and forehead.
- Treatment: Permethrin Cream, 5% should be thoroughly massaged into the skin of infants, including the scalp, temple, and forehead.
- Key consideration: Infants are at risk of scabies infestation on the scalp, and treatment should reflect this.
- Dosage and administration: The cream should be left on for 8 to 14 hours before being washed off.
- Expected outcome: ONE APPLICATION IS GENERALLY CURATIVE, but persistent pruritus after treatment is not uncommon and does not necessarily indicate treatment failure 2
From the Research
Treatment Options for Skin Parasitic Infections in Infants
- For head lice, optimal therapy includes malathion lotion 0.5% repeated in one week left on for 30 minutes to 8 hours, or spinosad topical suspension 0.9% repeated in one week left on for 10 minutes 3.
- For scabies, permethrin 5% cream to the body repeated in four days is often sufficient, but scalp treatment with malathion lotion 0.5% is helpful in crusted scabies and in infested children 3.
- Oral ivermectin 200 mcg/kg is another option for scabies, repeated in four days 3.
- Permethrin is a safe and effective option for children older than 2 months of age, but for infants younger than 2 months of age, 7% sulfur preparation is recommended instead of permethrin 4.
Considerations for Treatment
- Treatment of close contacts is necessary to control outbreaks and repeated infestations 3.
- Fomites should be placed in a dryer at 60 °C for 10 minutes to kill the arthropods, especially for scabies 3.
- Dimeticone is a better choice for head lice treatment due to its few known adverse effects and proven efficacy 5.
- Spinosad is an effective and well-tolerated agent for the treatment of head lice, with superior performance compared to permethrin 6.