Scabies in older adults: What Is New in Diagnosis and Treatment?

Scabies is a common and disabling ectoparasitic infestation of the skin that can clinically present in 'classical' or 'crusted' forms. Diagnosis can often be made on the basis of clinical history and careful dermoscopic examination of the skin. The International Alliance for the Control of Scabies (IACS) diagnostic criteria can support the diagnosis and management of patients with suspected scabies. Older adults are a vulnerable population; the clinical presentation of scabies can be atypical in this group and treatment can be challenging. Institutional scabies outbreaks, such as in care homes, are typically challenging to identify and, therefore, subject to diagnostic delay. These outbreaks are hard to control and an important source of morbidity, requiring simultaneous treatment of those affected, which can be complicated and time consuming. The management of scabies outbreaks involves repeated, contemporaneous (if multiple individuals) treatments with topical scabicide applications to the whole body, with decontamination of the environment(s). In some situations, topical treatment may be inappropriate and delay effective treatment.