Norwegian (crusted) scabies is seen in immunocompromised patients and is characterised by hyperkeratotic plaques with thousands to millions of mites. In a dermatology ward outbreak, the single most appropriate management step is:
- A Treat patient with oral ivermectin and simultaneously treat all contacts and healthcare workers, plus deep clean the environment ✓
- B Apply 1% lindane lotion to the patient only
- C Isolate the patient; no treatment for contacts needed
- D Apply 25% benzyl benzoate emulsion to the patient's head only
Correct answer: A. Treat patient with oral ivermectin and simultaneously treat all contacts and healthcare workers, plus deep clean the environment
Explanation
Norwegian/crusted scabies is highly contagious due to the massive mite burden (thousands to millions vs. 10–20 in ordinary scabies). Ward outbreaks require simultaneous treatment of ALL contacts (staff, fellow patients), environmental decontamination (laundering bedding, cleaning surfaces), and treatment of the index patient with oral ivermectin (often repeated at 2-week intervals) combined with topical scabicidal agents. Treating the patient alone will fail to control the outbreak. Lindane is no longer recommended due to neurotoxicity.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.