Background. Scabies epidemics are not uncommon in nursing homes. Effective
treatment is enhanced by prompt clinical diagnosis and early intervention.
The clinical presentation of scabies may vary in older, immunocompromised o
r cognitively impaired persons.
Methods. We performed a retrospective study of all residents diagnosed with
scabies in a multilevel long-term care geriatric facility. The duration of
the outbreak was from May to September 2000.
Results. Fifteen residents contracted scabies during the outbreak. All affe
cted residents had predominantly truncal lesions. Twelve residents had diff
use erythematous, papulosquamous lesions. Pruritus occurred in only 5 resid
ents. Three residents with severe dementia and notably impaired functional
status failed to respond to Permethrin cream (5%). All 3 residents responde
d to treatment with oral Ivermectin.
Conclusion. Older nursing home residents with scabies may present with atyp
ical skin lesions. Residents with cognitive impairment and restricted mobil
ity may be treatment resistant. The diagnosis of scabies should be consider
ed in any nursing home resident with an unexplained generalized rash. Resid
ents with dementia and severe functional impairment that fail to respond to
Permethrin cream (5%) may benefit from treatment with oral Ivermectin.