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DR5.1,DR6.1 | Ectoparasitic Infestations — Assignment
CLINICAL SCENARIO
You are a junior resident in a dermatology outpatient clinic. A 30-year-old woman presents with a 4-week history of intensely pruritic skin lesions. She lives in a one-room dwelling with her husband and two children (aged 4 and 8 years). The husband reports similar itching; the children have been scratching at night. Your examination reveals linear burrows in the finger web spaces, pruritic papules on the wrists and waist, and crusted nodules in the axillae.
In this assignment, you will construct and justify a complete treatment plan for this patient, address contact management, prescribe a specific scabicide with correct instructions, describe expected adverse drug reactions, and counsel the family appropriately. You will also briefly outline how you would approach a scenario in which itching persists 3 weeks after adequate treatment.
Instructions
Write a structured clinical management document as if you were preparing a patient education and clinical handover note. Use the section headings provided in the scaffolding. Your response should demonstrate application of pharmacological knowledge to a real clinical situation, not a list of facts. Write in plain language where addressing patient education; use clinical language for the treatment rationale sections. Cite the basis for your management decisions (IADVL guidelines / standard Indian dermatology references).
Length: 600-900 words total across all sections.
What to Submit
State the diagnosis and explain the clinical features that support it. Identify which finding is pathognomonic. What additional bedside test would you use to confirm the diagnosis, and how is it performed? (100-150 words)
Name the first-line scabicide you would prescribe for this adult patient. Provide precise application instructions (body area, duration of application, timing, need for repeat dose). Explain why correct application technique is critical. What modifications would you make if this patient were pregnant? (150-200 words)
List the adverse drug reactions (local and systemic) of permethrin 5% that you would counsel this patient about. Briefly compare with the ADR profile of the oral alternative (ivermectin). When would you choose oral ivermectin over topical permethrin in this case? (100-150 words)
Describe your contact management plan for this family. Who must be treated and when? What environmental decontamination measures are appropriate for their home? Explain WHY treating asymptomatic contacts is non-negotiable. (100-150 words)
At a 3-week follow-up visit, the woman reports that itching persists, but examination shows no new burrows and the husband and children have no active disease. Provide a differential reasoning framework: what are the two most likely explanations? How would you differentiate them clinically? What is the management of each? (100-150 words)
Draft four to five key counselling points in simple language for this patient and her family, covering: (a) why everyone in the house must be treated on the same day; (b) what to do with clothing and bedlinen; (c) how long itching may continue after successful treatment; (d) when to return to the clinic. (100 words)
Grading Rubric — Scabies Management Assignment Rubric
| Criterion | Points | Full-marks descriptor |
|---|---|---|
| Diagnosis and diagnostic reasoning: Correctly identifies scabies, names the pathognomonic feature (burrow), and describes dermoscopy/ink test or skin scraping confirmation | 20 pts | Correct diagnosis with pathognomonic feature named, confirmatory test described with technique, and clinical features fully accounted for including nodular scabies component |
| Scabicide selection and application instructions: Correct drug (permethrin 5%), correct body area (neck-down), correct duration (8-12 hours), repeat dose mentioned, correct pregnancy modification (permethrin 5% is safest; ivermectin avoided) | 25 pts | All four elements correct: drug + concentration, full body application, 8-12h duration, repeat dose; AND correct pregnancy modification (permethrin 5% safe; ivermectin contraindicated) |
| Adverse drug reactions and oral alternative: Lists local ADRs of permethrin (pruritis, burning, erythema); identifies that systemic ADRs are minimal; correctly notes ivermectin ADRs (Mazzotti-like reaction, headache, dizziness); states when oral route preferred (crusted scabies, non-compliant, pregnant contraindicated) | 15 pts | Local ADRs of permethrin clearly stated; systemic profile correctly characterised as minimal; ivermectin ADRs named; clinical indication for oral route clearly stated |
| Contact management and environmental decontamination: All household members treated simultaneously regardless of symptoms; correct environmental measures (hot wash ≥50°C or 72-hour bag-seal for non-washable items); rationale for treating asymptomatic contacts clearly stated | 20 pts | All contacts treated same day; correct environmental decontamination described; compelling rationale given for treating asymptomatic contacts (pre-sensitisation phase, mite survival, reinfestation risk) |
| Post-treatment itch differential reasoning: Correctly identifies post-scabetic itch vs reinfestation as two key differentials; gives distinguishing clinical features (no new burrows = post-scabetic; new burrows OR untreated contact = reinfestation); correct management of each | 20 pts | Both diagnoses named correctly; clear distinguishing criteria given; management of post-scabetic itch (antihistamine/topical steroid, NOT re-treatment) and reinfestation (re-treat + contact audit) correctly described |
PEER REVIEW
Review your peer's assignment using the rubric above. For each criterion, provide: (1) a score with brief justification, (2) one specific strength, and (3) one specific suggestion for improvement. Focus on clinical accuracy and reasoning — not writing style. Your peer review should be constructive and specific: avoid generic comments like 'good work' or 'more detail needed'. Aim for 300-400 words across all criteria.