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[5 min read] Australian healthy skin guidelines
The Australian Healthy Skin Consortium has published the inaugural ‘National Healthy Skin Guideline: for the Prevention, Treatment and Public Health Control of Impetigo, Scabies, Crusted Scabies and Tinea for Indigenous Populations and Communities in Australia.’ The aim of the guidelines is to help healthcare providers recognise, diagnose, treat and prevent skin infections in Indigenous communities.
Aboriginal children are hospitalised for skin infections at 15 times the rate of non-Aboriginal children, with nearly half of all children living in remote communities having a skin infection at any one time. If skin infections are left untreated they can lead to serious, life-threatening morbidities such as chronic heart and kidney disease. Impetigo, scabies, crusted scabies and tinea have been identified as priority conditions needing guidelines.
Impetigo should be identified and treated promptly, due to the serious consequences if left untreated.
Recommended treatment for impetigo is oral co-trimoxazole or intramuscular benzathine penicillin G.
If co-trimoxazole and benzathine penicillin G are not suitable or unavailable, oral amoxicillin and oral erythromycin may be used instead. Topical antibiotic creams are not recommended due to the development of resistance.
Washing hands with soap is effective in the treatment and prevention of impetigo, with antibacterial soap having no benefits over regular soap. In resource-limited areas, a satisfactory water supply may decrease the incidence of impetigo and scabies. Mass drug administration for impetigo alone is not recommended, but where scabies is prevalent oral ivermectin mass drug administration along with permethrin treatment may decrease the impact of impetigo.
There may be a role for community-based screening and referral for treatment for impetigo. Children with impetigo should not attend school until treatment has started; open sores should be covered with watertight dressings.
Scabies should be identified and treated promptly, due to the serious consequences if left untreated.
Recommended treatment for scabies in all age groups and in pregnant women is topical permethrin 5% covering the entire body from head to toe, repeated after one week. Oral ivermectin is recommended if topical treatments fail. Ivermectin is contraindicated in pregnant or breastfeeding women, and children under five years of age or less than 15kg. Topical crotamiton is safe to use in infants.
Mass drug administration to prevent scabies may be useful in resource-limited communities. Programs involving education and hygiene practices may be of benefit when combined with standard scabies treatment. Screening may also add benefit. In resource-limited areas, and in scabies outbreak situations, treatment of household contacts is recommended. In resource-limited areas, a satisfactory water supply may decrease the incidence of impetigo and scabies. Programs to control dogs are of no benefit to the control of human scabies outbreaks. As with impetigo, children with scabies should not attend school until treatment has started and open sores should be covered with watertight dressings.
Crusted scabies is extremely infectious and leads to additional scabies outbreaks. Therefore, prompt treatment and control are important. Recommended treatment is oral ivermectin with topical keratolytics and topical antiparasitics, along with intensive supportive treatment which may include case management in the home.
Regarding preventing crusted scabies, wide-ranging community skin control programs are likely to be of benefit.
Fungal infections (tinea)
Fungal infections should be identified and treated as a priority. Recommended treatments for ringworm are topical miconazole for small patches or oral terbinafine or fluconazole for widespread infections.
Recommended treatments for scalp ringworm are oral terbinafine, oral griseofulvin or oral fluconazole. Antifungal shampoo in combination with oral treatment may reduce the spread of scalp ringworm.
Recommended treatment for nail tinea is oral terbinafine. Combinations of topical and oral therapy are not recommended nor is surgical avulsion before treatment of nail tinea.
Soap is recommended as a preventive measure against all tinea.