Scabies should always be suspected in any generalized rash in an institutionalized or nursing home patient.
a) True _ _ _ _ _ _ _ _ _ _ Correct ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ b) False _ _ _ _ _ _ _ _ _ _ Wrong answer ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ Answer and Commentary _ _ _ _ _ _ _ _ _ _ Scabies once thought to be rare in the elderly is now recognized as an increasing problem in nursing home patients. In a nursing home, scabies is often atypical because many elderly residents have impaired immune responses and the prevalence of incontinence is high. The warm, moist skin of an incontinent resident favors mite replication. The ability to mount an immune response to the mite and to scratch are often impaired in the elderly. Adult female mites may be viable off the skin for as long as 3 days. Transmission can occur through handling clothing, linens or multiple use of walking belts. Nursing aides can acquire and transmit the infection to other residents quite easily through direct skin contact and inadequate hand-washing. The patient’s scalp may be involved as well. Unless suspected, a diagnosis can easily be missed by primary care physicians and dermatologists. ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯ ¯
