When should I consider referring a patient with scabies for specialist evaluation?

Consider referring a patient with scabies for specialist evaluation in the following situations:

• If the patient is a child under 2 months of age requiring treatment, as scabies is rare in this age group and specialist advice (e.g., from a paediatric dermatologist) is needed before treatment initiation.
• If crusted scabies is suspected, because this may require hospital admission, isolation, combination treatment (topical insecticide plus oral ivermectin), and investigation for underlying immunodeficiency.
• If nodular scabies persists despite treatment, referral to a dermatologist is recommended for possible treatment with high-potency topical steroids, intralesional steroids, oral steroids, or oral ivermectin.
• If resistant scabies is suspected after re-treatment, consider referral or discussion with a dermatologist to determine subsequent treatment options.

These referral considerations ensure appropriate management of complex, severe, or treatment-resistant scabies cases.