A 24-year-old man presents with itchy lesions on the hands and in the groin for two weeks. A photograph shows the rash. Which therapy is most appropriate?

• A. Topical Permethrin
• B. Oral fluconazole
• C. Topical mupirocin
• D. Oral metronidazole

Answer: (A)

This item tests recognizing scabies and knowing the best first-line therapy for it. The intense itching and a rash that involves the hands and groin areas fit classic scabies, an ectoparasitic infestation caused by Sarcoptes scabiei. The photograph in such questions typically shows the papules and burrows characteristic of scabies, which explains why a treatment that directly targets the mites is chosen.

Topical permethrin 5% cream is the recommended first-line therapy. It’s specifically effective against the mites and their eggs. The usual approach is to apply the cream to the entire body from the neck down (and include hands, feet, and genital area), leave it on for about 8–14 hours, then wash off. Because scabies spreads readily in close contacts and through shared bedding and clothing, all household or close contacts should be treated at the same time, and contaminated items should be laundered or sealed in plastic bags for several days. A second dose may be considered if symptoms persist or if the infestation is heavy.

The other options don’t address the underlying parasite. Fluconazole is for fungal infections, mupirocin targets bacteria, and metronidazole targets anaerobic bacteria or certain protozoa, not scabies.