Red Flags & When to Go In Person for Scabies - Triage

Audience: pediatric

Scabies is a skin condition caused by tiny mites that burrow into the skin, leading to intense itching and rash. It often spreads through close contact, especially among children. Early treatment can help relieve symptoms and prevent spreading to others. Telemedicine can help assess symptoms and guide care, but some situations require in-person visits. Watch for red flags like severe itching that doesn't improve, signs of skin infection, or if a child has a weakened immune system. These signs mean it’s important to see a healthcare provider in person. This guide helps families understand when to seek in-person care and what telemedicine can and cannot do for scabies in children.

Red flags — go in person / ER

• Severe itching that does not improve with treatment — see a healthcare provider in person promptly.
• Signs of skin infection such as redness, warmth, swelling, pus, or fever — urgent in-person evaluation needed.
• Child has a weakened immune system or other serious health problems — consult a healthcare provider in person for specialized care.

What telemedicine can do

• Initial assessment of mild scabies symptoms based on history and images.
• Providing education about scabies and treatment instructions.
• Follow-up visits to check treatment progress and answer questions.

What telemedicine cannot do

• Physical examination to confirm scabies diagnosis when unclear.
• Skin scraping or laboratory testing for mites.
• Management of severe symptoms, skin infections, or complications requiring urgent care.

What is Scabies?

Scabies is caused by tiny mites that burrow into the skin, causing itching and a rash. It spreads easily through close skin contact, such as hugging or sharing clothes. Children often get scabies because they play closely with others. The itching may be worse at night and can affect many parts of the body.

Common Symptoms of Scabies in Children

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Symptoms may take several weeks to appear after first contact with mites.

When to Use Telemedicine for Scabies

Telemedicine can help if your child has mild itching and rash that started recently, especially if you suspect scabies. A healthcare provider can ask questions, look at photos or video of the rash, and suggest treatment options. Telemedicine is useful for follow-up visits to check if treatment is working and to answer questions.

Red Flags: When to Go In Person

Seek in-person care if your child has:

In-person visits allow for physical exams, skin scrapings, and stronger treatments if needed.

How is Scabies Treated?

Treatment usually involves prescription creams or lotions that kill the mites. These are applied to the whole body from neck to toes and left on for several hours. Sometimes oral medications are needed. Family members and close contacts may also need treatment to prevent re-infestation. Washing clothes and bedding in hot water helps remove mites.

Preventing the Spread of Scabies

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How to prepare for your tele-visit

• Prepare clear photos of the child's rash from different angles.
• Note when symptoms started and any treatments tried.
• List any other health conditions or medications the child is taking.
• Be ready to describe the child's symptoms in detail, including itching severity and affected areas.
• Have questions ready about treatment and prevention.

After your tele-visit

• Follow the healthcare provider's instructions for applying treatment carefully.
• Treat all household members and close contacts as recommended.
• Wash clothing, bedding, and towels in hot water and dry on high heat.
• Avoid close skin contact with others until treatment is complete.
• Monitor the child's symptoms and seek in-person care if red flags appear.

FAQs

Can scabies go away without treatment?

Scabies usually does not go away on its own. The mites continue to live and reproduce under the skin, causing ongoing itching and rash. Treatment is needed to kill the mites and relieve symptoms.

How long does it take for scabies treatment to work?

It often takes a few days to a week after treatment for itching to improve. Sometimes itching can last longer even after the mites are gone. If symptoms worsen or do not improve after treatment, see a healthcare provider.

Can scabies spread to other family members?

Yes, scabies spreads easily through close skin contact. It is important to treat all household members and close contacts at the same time to prevent passing the mites back and forth.

Is it safe to use over-the-counter creams for scabies?

Over-the-counter creams are generally not effective against scabies. Prescription medications are usually needed. Always follow a healthcare provider's advice for treatment.

When should I seek emergency care for scabies?

Seek emergency care if your child develops a high fever, severe skin infection signs (redness, swelling, pus), or difficulty breathing. These are serious complications that need urgent treatment.

Sources

1. Scabies — Centers for Disease Control and Prevention (CDC).
2. Scabies - Patient Information — Mayo Clinic.
3. Scabies — MedlinePlus, U.S. National Library of Medicine.
4. Scabies: Diagnosis and Treatment — National Library of Medicine.

This telemedicine guidance is for educational purposes only and is not a substitute for in-person medical care. If your child has concerning symptoms or red flags, please seek evaluation by a healthcare provider in person promptly.