Course of Treatment for Scabies

Background:  I recently saw a doctor for a very itchy "rash", which started in one area and then spread over the course of a month.  It began with very itchy areas with no visible signs of the cause.  Eventually the sites bled, and as new areas developed I could see small bumps precede the symptoms already mentioned. My doctor said it was scabies and treated me with Lindane.  I washed all the clothes, sheets, sprayed the chairs with insecticide and followed the treatment recommendations.

Question(s):  I read that scabies sometimes needs to be retreated 1 week after first treatment.  My doctor did not prescribe a refill for follow up treatment.  Should he have?  

My condition cleared up, but I appear to have gotten it again (2.5 weeks after 1st treatment).  It looks like the same thing as before.

What should I do now?  I am afraid to follow through with my plans to visit over the upcoming holidays for fear of spreading it.  I know I need to clear this up, but what is the next step?

[Alan Rockoff, MD]

YM:

I see this scenario all the time.  Basically, if this were scabies, you wouldn't have "it" back.  I suppose it's possible, but not likely.  You need a definitive diagnosis, which could be something as banal (and noncontagious) as eczema.  Meantime, I would apply the lindane again (all over from the neck down, left on overnight and washed off in the AM.)  It is not necessary to wash everything, just underwear and bedclothes which were just used (the mite, even if present, only lives for an hour off a warm body.)  Also, scabies is quite hard to translit--it requires intimate physical contact (hugging, sex), not just shaking hands or hanging coats near each other.  So you should consider yourself safe for the holidays, even if you can't engineer another doctor's visit in time.  Scabies exists, but is often overdiagnosed.

Best.

Dr. Rockoff