Permethrin and ivermectin for scabies

In a remote aboriginal community in tropical northern Australia, a mother comes to the health center with her 4-year-old son, who has multiple sores on the skin of his arms and legs. He is treated with a single dose of intramuscular penicillin G benzathine and with the application of topical 5% permethrin cream over his whole body. A week later, the pyoderma has substantially resolved, but the boy continues to scratch his hands and feet. The clinic nurse visits the family house and finds that skin sores are present on both infants who live in the household, three of the six young children, and one of the three adolescents. Some also have scratches and small interdigital excoriations, which are consistent with scabies. An infirm elderly aunt living in the house is found to have widespread areas of extensively crusted and scaly skin, which are especially prominent on her hands, elbows, armpits, knees, and buttocks. All the household members are given topical permethrin, and the aunt is referred to the hospital for oral ivermectin therapy.