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External parasites

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Overall key points

Lice and mites are generally easily treated with OTC formulations.

Careful examination is needed to confirm diagnosis.

Bedding and clothing needs to be washed in hot water and tumble dried.

Items which cannot be washed need to be sealed in plastic bags until the parasites have died.

Treat the patient's contacts at the same time to minimise the risk of re-infestation.

Part 1 Scabies

Nurses should suspect scabies (pictured) in patients who present with intense, generalised itch that is worse at night and after a hot shower. Patients also show an erythematous, papulovesicular rash as well as hallmark skin nodules and mite burrows, which are usually between 1-10mm long.1 However, scabies can mimic several other diseases, including atopic eczema, contact dermatitis, folliculitis, impetigo and tinea corporis.2 In the developed world, scabies outbreaks are most common in hospitals, care homes and other such institutions.

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