ATSI – Scabies

Scabies, a skin condition caused by the mite Sarcoptes scabiei, is a significant health issue, particularly in Aboriginal and Torres Strait Islander (ATSI) communities. The management of scabies in these populations involves both pharmacological and non-pharmacological approaches.

  • Pharmacological Management
    • Topical Permethrin Cream (5%)
      • First-line treatment for scabies.
      • Applied to the entire body from the neck down and washed off after 8-14 hours.
      • A second application is usually recommended after 7 days to ensure all mites and eggs are eradicated.
      • Safe for use in adults, children, and infants older than 2 months.
    • Benzyl Benzoate (25%)
      • An alternative to permethrin, particularly in cases of treatment failure.
      • It is applied similarly to permethrin but may cause skin irritation.
    • Ivermectin (Oral)
      • Recommended in cases where topical treatments are not feasible or have failed.
      • Particularly useful in treating crusted scabies or in managing outbreaks in communities.
      • Dosage is based on body weight and is usually given as a single dose, which may be repeated after 7-14 days.
    • Antihistamines and Topical Steroids
      • Used to manage pruritus and inflammation associated with scabies.
      • Important for symptom relief.
  • Non-Pharmacological Management
    • Personal Hygiene and Environmental Control
      • Wash all clothing, bedding, and towels used by the affected individual in hot water and dry in the sun or a hot dryer.
      • Vacuuming furniture and floors to remove mites and eggs.
    • Contact Management and Community Education
      • Treating all close contacts simultaneously to prevent re-infestation.
      • Community education about scabies, its transmission, and prevention.
    • Isolation Precautions
      • In severe cases or outbreaks, isolation measures might be necessary to prevent the spread, especially in community settings like schools and healthcare facilities.
    • Health Education
      • Educating ATSI communities about the importance of early treatment and adherence to treatment regimens.
      • Cultural sensitivity and community-specific strategies should be employed.
    • Regular Skin Checks and Surveillance
      • Regular community health checks to identify and treat scabies early.
      • Monitoring for complications such as secondary bacterial infections.
  • Special Considerations for ATSI Communities
    • Cultural Sensitivity: Understanding and respecting cultural practices and beliefs in ATSI communities is crucial for effective management.
    • Community-Based Programs: Implementing community-wide treatment programs can be effective in controlling scabies in endemic areas.
    • Access to Healthcare: Improving access to healthcare services and medications in remote ATSI communities.
    • Collaboration with Community Leaders: Working with community leaders to facilitate education and treatment programs.

Conclusion

Managing scabies in ATSI communities requires a comprehensive approach that includes both pharmacological treatment and non-pharmacological strategies. Cultural sensitivity, community involvement, and education are key to the successful management and control of scabies in these populations. Regular monitoring and community-based interventions can help reduce the incidence and re-infestation rates of scabies.