From the Guidelines
Scabies treatment should involve applying permethrin 5% cream from neck to toes, leaving it on for 8-14 hours, then washing it off, and repeating the application after 7 days, as this approach has been shown to be effective in managing the condition 1.
Treatment Approach
The treatment of scabies involves a combination of topical and oral medications, as well as measures to prevent reinfestation.
- Topical permethrin 5% cream is the preferred treatment, applied from neck to toes, left on for 8-14 hours, and then washed off 1.
- For severe cases, oral ivermectin may be prescribed at 200 mcg/kg, with a second dose given 1-2 weeks later 1.
- All household members and close contacts should be treated simultaneously, even if they don't have symptoms, to prevent reinfestation 1.
Management of Symptoms
Symptoms of scabies, including intense itching and a pimple-like rash, may persist for 2-4 weeks after successful treatment due to the body's allergic response to the dead mites 1.
- Over-the-counter antihistamines and prescribed corticosteroids can help manage the itching during recovery 1.
Prevention of Reinfestation
To prevent reinfestation, bedding, clothing, and towels should be washed in hot water and dried on high heat to kill any remaining mites 1.
- Fumigation of living areas is unnecessary, but persons with scabies should be advised to keep fingernails closely trimmed to reduce injury from excessive scratching 1.
From the FDA Drug Label
Permethrin Cream, 5% is indicated for the treatment of infestation with Sarcoptes scabiei (scabies). For eradication of scabies ( Sarcoptes scabiei) and for symptomatic treatment of pruritic skin.
- Permethrin (TOP) and crotamiton (TOP) are indicated for the treatment of scabies.
- The FDA-approved treatments for scabies include permethrin and crotamiton 2 3.
- Both drugs are used for the eradication of scabies.
From the Research
Treatment Options for Scabies
- Topical permethrin is considered the most effective treatment for scabies, with a cure rate of 70-85% after two applications 4.
- Permethrin 5% cream is more effective than crotamiton 10% cream, with a higher cure rate at the 4-week follow-up 4.
- Topical ivermectin is also an effective treatment for scabies, with a cure rate of 64.7-82.3% after two applications 5.
- Ivermectin is superior to crotamiton 10% cream at the 4-week follow-up, with a higher cure rate and fewer side effects 5.
Application Methods for Permethrin
- Permethrin 5% cream should be applied to the entire skin surface, including the scalp and head, for optimal results 6.
- Applying permethrin cream once daily for two consecutive days is more effective than a single application 7.
- The cream should be stored in the refrigerator and applied cold to the skin, and left on for 24 hours 7.
Comparison of Treatment Options
- Topical permethrin is the most effective treatment for classic scabies, with a strength of recommendation of A 8.
- Oral ivermectin is an effective treatment for scabies, but may not be as effective as topical permethrin 8.
- Crotamiton 10% cream and benzyl benzoate are inferior to permethrin, but may be effective in some cases 8.