Diplomate, Board Certification of Emergency Medicine
We continue on evidence-based medicine. Everyone has heard
about head lice and we have written many times on the
terrible Mediterranean louse which is resistant to almost
everything.
There is another disease that can cause a wealth of misery
called scabies. This is an infestation of an almost invisible
mite that likes to burrow into skin folds, especially the
wrist and between fingers, causing an intensely itching rash.
This commonly affects people in close contact in less-than-
sanitary environments such as day care centers and nursing
homes. People who are weakened by disease and have impaired
disease fighting ability are also commonly affected. Many
medications are available to treat these pests, but I will
focus on three.
Ivermectin works very well, and as well kills our pesky lice,
but is unavailable in Israel. It is safe in children and I
arranged for some pills to be brought to me from the USA.
Malathion works well here as well. This is also used for
lice. It is a powerful insecticide that is short-acting.
Lindane used to be used and is effective but side effect
fears limit its use.
Herbal preparations may or may not work. There is no concrete
evidence of any success with these products for this disease.
However, petroleum jelly -- with or without sulfur -- does
seem to suffocate both bugs, but it is messy.
While we are on skin disorders, let's speak about eczema
which also likes skin creases. It is often found in kids and
is probably due to allergic causes. Most cases do resolve by
the early teens. This condition is unsightly and
bothersome.
Evidence definitely exists for steroid creams; usually the
most mild is the best. Indeed, Glaxo has products in this
area, of which Betnovate is the mildest. Seven days of a mild
steroid may be equal to three days of a strong steroid. There
are no ill effects from these creams. Other beneficial
actions include control of dust in the house and emollients,
which are moisturizing skin creams, may help. There is no
evidence that exclusion of milk or eggs, either by pregnant
mother or by baby, nor avoidance of certain fabrics or use of
wet wraps, helps. Antibiotic creams add nothing.
Write me in care of the Yated.
GlaxoSmithKline is the sponsor of this column.
