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Crusted scabies in remote Australia, a new way forward: lessons and outcomes from the East Arnhem Scabies Control Program


Case record

An 8-year-old girl had received treatment for scabies at a health centre in a remote Northern Territory Arnhem Land community on 32 occasions since her birth. Seventeen of these occasions required treatment with parenteral antibiotics for secondary infection. Many episodes were noted to involve the “whole body” and on two occasions she had required hospitalisation. During this time, she was also found to have a low body mass index and failure to thrive.

The girl was often found crying from pain and itch and had been excluded from school for extended periods because of her infectivity. Her family reported that she was bullied by her peers because of the disfigurement of her skin. Her frequent bouts of disfiguring scabies, skin sores and weight loss had led to referrals to child and family services over concerns of parental neglect.

The girl was brought to the attention of East Arnhem Scabies Control Program staff in 2011. Contact tracing was initiated, and a senior member of the family, with whom the girl shared a room, was found to have Grade 2 (moderate) crusted scabies. Clinical audits showed that the senior family member had repeatedly presented with crusted scabies since 1996. After a hospital admission in 2006, she had avoided contact with health services, even though her skin condition deteriorated, reportedly due to fear of the treatment regimen involving extended isolation…