Davis et al reported a simple grading scale for crusted scabies. The clinical grade can help guide management. The authors are from Menzies School of Health Research, Royal Darwin Hospital, The Alfred Hospital and the University of the Sunshine Coast in Australia.
Patient selection: crusted scabies
Parameters:
(1) distribution and extent of crusting
(2) crusting/shedding
(3) past episodes
(4) skin condition
Parameter
Finding
Points
distribution and extent
wrists, web spaces, feet only
1
plus forearms, lower legs, trunk
2
plus scalp
3
< 10%
1
10 to 30%
2
> 30%
crusting/shedding
mild crusting, minimal skin shedding
1
moderate crusting, moderate skin shedding
2
severe crusting, with profuse skin shedding
3
past episodes
none
1
1 to 3 OR depigmentation of elbows and knees
2
>= 4 OR more extensive depigmentation or ichthyosis
3
skin condition
no cracking or pyoderma
1
multiple pustules or weeping sore or superfical skin cracking
2
deep skin cracking with bleeding; widespread purulent exudates
3
total score =
= MAX(points for distribution) + SUM(points for the other parameters)
Interpretation:
• minimum score: 4
• maximum score: 12
Score
Grade
Number of Ivermectin Doses
4 to 6
1
3 (day 0, 1 and 7)
7 to 9
2
5 (day 0, 1, 7, 8, 14)
10 to 12
3
7 (day 0,1,7,8,14,21,28)
dose of ivermectin =
= (200 µg/kg) * (body weight), rounded up to nearest 3 mg
Additional therapy:
(1) benzyl benzoate
(2) 5% tea tree oil 2nd daily alternating with keratolytic cream
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