Date:
Patient:
Reason for Visit:
Follow-up for scabies
Assessment of treatment response and symptom improvement
Evaluation for persistent itch or new lesions
Management plan discussion
History:
Presenting Illness:
Date of initial scabies diagnosis
Duration and characteristics of itch (particularly worse at night)
Presence of a rash with burrows (tiny,蜿蜒 (wān yán – winding) tunnels)
Household or close contacts with scabies symptoms
Past Medical History (PMH):
Underlying medical conditions (e.g., eczema, atopic dermatitis) that may mimic scabies
Social History:
Recent travel or close contact with individuals who might have scabies
Physical Exam:
Skin:
Inspect for pruritic (itchy) papules (small bumps), excoriations (scratches), and burrows (especially between fingers, toes, wrists, elbows, genitals, and buttocks) in typical scabies distribution.
Consider atypical presentations in infants (scalp, soles of feet) or immunocompromised patients (widespread rash).
Diagnostic Tests (not routinely needed, may be considered in atypical cases):
Skin scraping: Microscopic examination of skin flakes from a suspected burrow to identify scabies mites or mite eggs.
Assessment:
Treatment response: Evaluate for improvement in itching and reduction in rash since initial treatment.
Treatment adherence: Confirm completion of prescribed scabies medication regimen by both the patient and close contacts.
Persistent symptoms: Consider other skin conditions (eczema) or scabies treatment failure if itching and rash persist.
Plan:
Treatment reinforcement (if needed):
Reapply topical scabicide (e.g., permethrin cream) according to healthcare provider instructions if symptoms persist.
Consider oral ivermectin for widespread or crusted scabies (consult with healthcare provider).
Patient education:
Reiterate the importance of treating all close contacts simultaneously to prevent re-infection.
Emphasize proper hygiene practices, including washing clothes, bedding, and towels in hot water (at least 50°C or 122°F) and drying them on high heat.
Discuss strategies to manage itching (cooling baths, calamine lotion) and avoid scratching to prevent secondary skin infections.
Follow-up:
Schedule a follow-up visit one week after treatment completion to assess for persistent symptoms or recurrence.
Advise the patient to report any worsening of symptoms or development of new lesions.
Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of scabies.