What to counsel on scabies treatment using Benzyl Benzoate Emulsion @ EBB ?

Recently, the number of scabies infestation has been seen to increase drastically.

Scabies @ Kudis Buta infestation

is a condition caused by mites that burrow underneath the skin layer.

Female mites will lay the eggs in the burrow.  The mites, as well as the eggs, will make the infested to feel itching and, most of the times, rash will occur.

*Feeling the bugs move around your skin is really geli*

Scabies can be transmitted via skin contact. Do note that it can also be acquired through sexual intercourse or exposed to infested beddings.

Once infested, the bugs may have an incubation period over 2 to 6 weeks before the symptoms appear.

*Yes, it can be this long*

Benzyl Benzoate Emulsion (EBB) is one of the topical medication for antiscabitic treatment. It is widely accepted as it is inexpensive. The strength for this medication can be found at several concentrations.

For adults, EBB 25% is commonly used.

For children above 2 years of age up until 12, EBB 12.5% is recommended.

In some facilities, you may also find EBB 6.25%. This is indicated for pediatric 6 months up to 2 years old.

*Do note that 6.25% is not listed in BlueBook*

Encountered several times where patients seem to confused on the application method of Benzyl Benzoate emulsion (EBB).

So, what should patient know on the application of EBB? 

1. Rinse off after keeping on skin surface for 24 hours, reapply and repeat consecutively for 3 days.

*In some facilities, 12 hours may be practised.*

2. Application should be from jawline / neck downwards on all skin surfaces, including all skin foldings, armpits, groin region, external genitalia, in between nails and navel.

*For pediatric patients, face must be included to avoid transmission during breastfeeding*

3. Some may experience skin irritation such as stinging or burning sensation.

4. Once applied, if the medication is removed, at any time prior the required time, due to any reason, i.e hand-washing, it should be reapplied.

5. If application is performed by others without scabies, he / she should wear gloves as protection.

6. Family members or peers who are in close contact with the patient is recommended to be treated with antiscabitic as well.

7. Fomites (Contaminated clothes / beddings) must be washed using hot water at high temperature (>50°C). Carpets should be disinfected with heat steaming.

8. Item that cannot be washed should be left in a plastic bag for at least 72 hours.

9. For pediatric patients, parents may be advised to provide hand mitten for the kids to avoid EBB applied from being congested.

10. EBB is *CONTRAINDICATED* in pregnant & breastfeeding women.

References:

1. Strong M., Johnstone P. (2007). Interventions for treating scabies. Cochrane Database of Systematic Reviews; Issue 3(2).

2. Scott G. R. (2001). European Guideline For The Management Of Scabies, International Journal of STD & AIDS; 12 (Suppl. 3): p58 - 61.

3. Ministry of Health Malaysia. (2015). GUIDELINE FOR MANAGEMENT OF SCABIES IN ADULTS AND CHILDREN.