A patient presented with itchy lesions over the wrist,(itching is worse at night).Which of the following drug can be used orally as a treatment in this case?
Correct Answer: Ivermectin
Description: SCABIES Epidemiology: Infestation caused by Acarus hominis/Sarcoptes scabie. Incubation period is 2-4 weeks. Itching worse at night is most common symptom. Family history of similar itchy eruptions in close contact On an average, an adult has 12 mites and an infant 20 mites. Primary lesions: Serpentine (S-shaped) burrows traversed by parasite in stratum corneum (pathognomic lesion) Most common sites involved: Inter digital space, Anterior wrist, Ulnar border of hand An imaginary circle intersecting the main sites of involvement--axillae, elbow flexures, wrists and hands and groins - 'circle of Hebra'. In infants and elderly: Scalp, Face, Neck, Palms & Soles, Penis also involved Papules & papulo-vesicles: due to hypersensitivity to the mite. Fine pin head size follicular papules Secondary lesions: Pustules due to 2deg infection is one of commonest form of presentation. Eczematized crusted lesion, in infants & children are predominant lesions. Nodular lesions are seen on scrotum (most common), groin, and anterior axillary fold (Nodular scabies). Treatment Drug of choice : 5% Permethrin (1st ) BHC (2nd ). Oral drug (Only): Ivermectin. Other drugs : Benzyl benzoate 25%, Crotamiton 10%, Malathion, Monosulfiram. Scabicides should be applied to the whole body (below jaw line in adults) to all members of family whether symptomatic or not. ref : harrisons 20th ed
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