Beyond the Standard: Targeted Reapplication in Palmoplantar Scabies of Infants.

Infantile scabies can be challenging to treat, particularly due to behavioural and anatomical factors that reduce the efficacy of topical therapies. In this small prospective cohort study there were 22 neonates and infants (11 in either intervention group) with persistent palmar-plantar 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. Eleven infants received an intensified regimen with three additional nights of targeted application to the hands and feet, while eleven continued with the standard regimen only. Complete resolution was observed in all 11 (100%) of cases in the intervention group, compared with none (0%) in the control group. Frequent infant behaviours, including spontaneous kicking, leg movements, and habitual fist clenching, likely reduced drug contact time on 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.