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Clinical Review

Scabies: diagnosis and treatment

BMJ 2005; 331 doi: (Published 15 September 2005) Cite this as: BMJ 2005;331:619

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Management of fomites is essential for scabies treatment

Dear Editor,

The article on scabies by Graham Johnston and Mike Sladden is quite
elaborate and interesting [1]. Role of fomites is usually not being given
the due consideration that it deserves vis a vis scabies. The mite finds
a hiding place within the skin, but for time being may wander around on
the bed linen. Sharing of beds and bed linen, blankets, sleeping bags etc
are yet another source of catching scabies. While Permethrin will take
care of the mites on the skin, simultaneous treatment is required for the
‘wandering’ mites left on the fomites. At the very first opportunity
these ‘wanderers’ have the propensity to infect anyone who comes in their

Travel is frequent now-a-days and travelers may inadvertently share
bed linen. For example, an airborne traveler may request for a blanket
that might have been recently used by an infected patient before it gets a
chance to be laundered. Bed linen unless properly laundered, can also
help a snooping mite find a fresh burrowing place in the skin of an
unsuspecting user. Hence proper laundering and hot ironing of fomites
(and undergarments also) is a must in order to clear the scabies
infection, along with simultaneous treatment of all members of the family
with permethrin or any other substitute, to eradicate the infection. If
fomites are left unattended, the infection may remain stubborn and re-
infections may continue occurring despite appropriate permethrin
applications on the skin.

With regards.


1. Graham Johnston and Mike Sladden. Scabies: diagnosis and
treatment. BMJ 2005; 331: 619-622

2. Iain M Inglis. Washing bedlinen - does this blunt the message
about compliance with permethrin application? BMJ 19 September 2005.

Competing interests:
None declared

Competing interests: No competing interests

21 September 2005
Dr. Rajesh Chauhan
GP & Consultant, Communicable Diseases
Dr. Akhilesh Kumar Singh, MD; Dr. Parul Kushwah, MBBS, MISCD
309/9 A.V. Colony, Sikandra, Agra-282007. India