Part 4: When to refer

If the patient has a rash that is not improving or worsening despite treatment.

If the itching is severe and disrupting sleep or daily activities.

If there are signs of a secondary infection, such as increased redness, swelling, pain, or oozing from affected areas.

If the patient is pregnant or breastfeeding and requires scabies treatment.

If the patient is under 12 years of age and scabies is suspected.

If there is uncertainty about the diagnosis or the best course of treatment.

If the patient reports that scabies symptoms have returned after completing treatment.