SELECTED ARTICLE
Author
Alla Gordina, MD, FAAP 
Article Title
Scabies in internationally adopted children 
Posted Date
6/27/2006 
 
    “I have heard that my son’s orphanage has a problem with scabies and that he is more than likely going to have them. What is the best way to be proactive about this? Should we treat him and us as soon as we meet (if he has them)? We may be traveling with our older daughter (4.5yrs) so we are worried that she would catch them.” ” My daughter came home from Russia last month with them, and after a delay in diagnosis I did the Nix treatment with her (and me, just in case). It seemed to work well and the sores disappeared, but now it's two weeks later and new ones are appearing. A friend told me she'd heard there was a different strain of scabies in Europe that our usual medications might not treat. “

There are several issues raised in those questions.

1. SCABIES IN ORPHANAGES
It is pretty common and unfortunately - frequently hard to treat. There are a lot of reasons for that, crowding, inadequate treatment before adoption, pre-treatment with steroid creams, and malnutrition to name a few. Underlying conditions (eczema, allergies) and complications (bacterial infections) are making child's condition worse and treatment ever harder. Scabies is known to affect kids with eczema more frequently and the bi-products of the mite are causing severe skin allergies, which can persist for weeks and months after appropriate treatment.

2. DIAGNOSIS
Delay in diagnosis, resulting in use of multiple, some times very strong, cortico-steroid creams, can make the things only worse. Please remember, that scabies is a common infectious disease that can be seen in any population, in any country of the world. Poverty, malnutrition, and underlying health problems are INCREASING the risk of infection, rather then causing it. Said that – the diagnosis of scabies can be very hard to make so adoptive parents have to have a high degree of suspicion and educate their doctors (pediatricians, internists, and dermatologists) accordingly. Special tests (attempts to visualize the mite and/or its by-products) are often false negative and should not be used to prove that a patient does not have scabies at all. This means (as with many tests) that in the presence of suspicious skin lesions positive test would prove the fact of infection and negative test would not have ANY diagnostic value at all. It is completely legitimate to initiate the full-pledged scabies treatment protocol based on suspicion of the disease.

3. TREATMENT OF POTENTIALLY AFFECTED CHILD
It should be started immediately after you will receive him and should start with (1) changing his clothing ASAP, followed by (2) generously applying special prescription medication literally "head to toes", and (3) repeating such application 2 weeks after initial treatment. Over the counter medications – both Russian and American do not work and should not be used in this situation. Simultaneously you should attend to the allergic and bacterial components of the problem too with special topical and oral medications. The best people to coordinate such treatment would be IA doctors, as we are familiar with the problem and solutions. You can send your doctor pictures and specific questions that will help to create a specific treatment plan, geared to the needs of your family.

4. PROTECTION OF THE ADOPTIVE FAMILY
It is definitely a priority in this situation. Children and people with decreased skin protection (eczema, allergies, immune deficiencies) are at higher risk. Stress (of travel and adoption) is definitely making the things only worse. The one important thing you need to accept - is that it is almost impossible to prevent spread of scabies in this situation. You will have to do everything to protect yourself, but you have to be ready to face the disease. Therefore, all people, who were in the close contact with the affected child, should be treated once as a precaution at the same time with the patient.

And the last, but not the least. Hand washing, hand washing and hand washing - that is the paramount of the scabies prevention. Plan to dispose your clothing after arriving home. Make sure that your daughter is not in close contact with her brother until he is properly treated.

This information is intended for educational purposes only. It should not be used as a substitute for professional medical advice tailored to your child's individual needs. If you have questions or concerns regarding your child's physical or mental health, please seek assistance from a qualified healthcare provider.

References
Alla Gordina, MD, FAAP
Global Pediatrics
International Adoptions Medical Support Services
7 Auer Court, East Brunswick, NJ 08816, USA
732-432-7777 (voice)
732-432-9030 (fax)
www.globalpediatrics.net
drgordina @globalpediatrics.net
 
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