Differential Diagnosis of Chosidow for Pruritus After Therapy for Scabies

Description

Chosidow listed the differential diagnosis for persistent itching in a patient following therapy for scabies. Identifying the cause can help guide further therapy to reduce the risk of secondary infection and complications. The author is from the Assistance Publique-Hopitaux de Paris.

Differential diagnosis of persistent pruritus after scabicide therapy:

(1) chemical dermatitis caused by the scabicide

(2) irritation of eczema associated with severe scabies (crusted, Norwegian)

(3) allergic reaction to the scabicide (contact dermatitis)

(4) persistent or recurrent scabies infection

(4a) poor compliance

(4b) drug resistance

(4c) re-infection

(5) psychiatric disease (delusion of parasitosis, psychosis, other)

(6) pruritus caused by other disease (cholestasis, etc.)

Problem	Management
chemical irritation	apply an emollient with or without topical steroids; use a less-irritating scabicide; use a lower dose or concentration
allergic reaction	topical steroids; use of non-allergic scabicide
poor compliance	retreatment; education; observed treatment
drug resistance	susceptibility testing and retreatment
reinfection or relapse	identification of cause; retreatment
psychiatric disorder	psychiatric therapy
other cause(s) for pruritus	treatment of all causes for pruritus

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Differential Diagnosis of Chosidow for Pruritus After Therapy for Scabies

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