Persistent scabies in nursing home patients.

Persistent scabies outbreaks in extended care facilities result from multiple factors: atypical presentations in the elderly, leading to delayed or inaccurate diagnosis; incomplete or ineffective treatment of the patient and exposed population; and failure to coordinate notification, education, treatment, and disinfection. A case report of scabies in an elderly resident of an extended care facility illustrates various types of scabies manifestations, the advisability of obtaining diagnostic scrape preparations, and the efficacy and safety of permethrin. Guidelines for an aggressive and comprehensive effort for eradication are offered.