A 2-month-old infant presents with intensely itchy, erythematous, crusted papules and vesicles predominantly on the face, scalp, and extensor surfaces. The mother reports similar itching. Microscopy of skin scrapings reveals mites, eggs, and fecal pellets. Which of the following is the preferred treatment in this infant?
- A Topical permethrin 5% cream applied from neck to toes
- B Oral ivermectin 200 micrograms/kg single dose
- C Topical permethrin 5% applied from head to toe (including scalp and face) ✓
- D Topical malathion 0.5% lotion
Correct answer: C. Topical permethrin 5% applied from head to toe (including scalp and face)
Explanation
In infants under 2 years with scabies, permethrin 5% cream is the preferred first-line treatment and should be applied from head to toe (including scalp, face, and neck), unlike in older children and adults where application is from the neck down. This is because infants commonly have scalp and facial involvement. Oral ivermectin is not approved for children under 15 kg or under 5 years of age. Treatment should be repeated after 1 week, and all close contacts and family members must be treated simultaneously. Bedding and clothing should be washed in hot water.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.