A 28-year-old man completed treatment for scabies with permethrin 5% cream four weeks ago. His partner was also treated. His generalized pruritus resolved, but he still has persistent pruritic reddish-brown nodules on the penis and inguinal region. There are no burrows or new papules. The most appropriate management is:

• A Repeat permethrin 5% cream to both partners
• B Oral ivermectin 200 mcg/kg stat
• C Oral antihistamines and topical antibiotics
• D Intralesional triamcinolone injection into the nodules ✓

Explanation

This represents nodular scabies, a persistent hypersensitivity reaction to mite antigens that can last weeks to months after successful eradication. The nodules do not contain live mites, so retreatment with scabicides is unnecessary. Intralesional corticosteroids (triamcinolone) or cryotherapy are the mainstay of treatment. The absence of burrows and new papules confirms successful eradication.

Reference: Rook's Textbook of Dermatology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.