Beyond the standard: targeted reapplication in palmoplantar scabies of infants

Infantile scabies can be challenging to treat because of behavioural and anatomical factors that reduce the efficacy of topical therapies. In this small prospective cohort study, there were 22 neonates and infants with persistent palmoplantar scabies. Patients were treated exclusively with permethrin 5% cream. All patients initially failed the standard regimen consisting of one full-body application, followed by a second application after 7 days. In 1 group, 11 infants received an intensified regimen with 3 additional nights of targeted application to the hands and feet (intervention group), while in a second group, 11 continued with the standard regimen only (control group). Complete resolution was observed in all 11 patients in the intervention group, compared with none in the control group. Frequent infant behaviours, including spontaneous kicking, leg movements and habitual fist clenching, probably reduced drug contact time on the palms and soles. These findings indicate that standard topical regimens may be insufficient in this population and that targeted reapplication, combined with caregiver education, can optimize treatment outcomes in infants.Standard scabies treatment often fails in infants because of behavioural factors and palmoplantar occlusion. In this small cohort study, a modified permethrin protocol with targeted hand and foot reapplication achieved complete resolution, suggesting the need for site-specific retreatment in this population.