Scabies: Application of the Novel Identify-Isolate-Inform Tool for Detection and Management

Cheng, Tabitha A.; Mzahim, Bandr; Koenig, Kristi L.; Alsugair, Abdulrahman; Al-Wabel, Abdussalam; Almutairi, Bandar Saad; Maysa, Eshmawi; Kahn, Christopher A.

Scabies: Application of the Novel 3I Tool for Detection and Management − Implement contact precautions − Avoid direct skin-to-skin contact until 8 hours after scabicide administration − Wash clothing and items used in hot water − Treat close contacts within the preceding month − Notify household and/or close contacts − Encourage post-exposure prophylaxis − For an outbreak, report to local health department, if required − Report Norwegian scabies (given high transmissibility) to hospital infection prevention A substitute for the burrow ink test is the tetracycline fluorescence test, where tetracycline is used instead of ink. 28, 29 This method allows for colorless identification of the burrows. Similar to the ink, the topical tetracycline solution is applied over an affected area, and is wiped with alcohol to remove any excess solution on the surface. Then a Wood's lamp is used to visualize the tetracycline that tracked into the burrows. 28 Other scabies diagnostic techniques unlikely to be used in the emergency department include video dermatoscopy, polymerase chain reaction (PCR) and enzyme-linked immunosorbent assays (ELISA), and IgE antibody testing. Video dermatoscopy is especially useful in cases with atypical distribution or appearance of the lesions. 30 Serological tests are emerging for both diagnosis and monitoring of treatment efficacy. One study showed that real-time PCR and ELISA tests are useful for monitoring treatment efficacy. 31 Another study reported a 100% sensitivity and a specificity of 93% using IgE antibody against Sarcoptes scabiei. 32