Scabies

April 12, 2012
Ted Rosen, MD

Any itchy penile rash should immediately suggest scabies. The latter also typically involves the hands, especially the interdigital webspaces and the volar aspect of the wrist.



A young man presented for evaluation of an intensely pruritic rash involving the penis (Figure A) and hands (Figure B). The problem arose about a month after a party where he had anonymous sexual contact with multiple women.

Key point: Any itchy penile rash should immediately suggest scabies. The latter also typically involves the hands, most notably in the interdigital webspaces and on the volar aspect of the wrist. A scraping from one of the penile papules disclosed an adult scabies mite, which confirmed the diagnosis.

Treatment: The patient was treated with 2 doses of oral ivermectin (each dose 200 μg/kg), taken 2 weeks apart.

Note: The CDC now recommends oral ivermectin as equally efficacious as topical permethrin for first-line scabies therapy. Note, however, that ivermectin tablets are often in short supply, and the drug remains off-label when used for scabies management, according to the FDA.