What is the treatment for scabies?

From the Guidelines

Scabies treatment should prioritize permethrin 5% cream as the first-line treatment, applied from the neck down to the entire body, left on for 8-14 hours, and then washed off, with a second application recommended one week later. This approach is based on the most recent guidelines from 2015, as outlined in the MMWR Recommendations and Reports 1. The treatment regimen may vary depending on the patient's age, weight, and health status. For instance, infants and young children should be treated with permethrin, while ivermectin may be considered for adults and children weighing over 15 kg 1.

Key Considerations

• Permethrin 5% cream is the preferred treatment for scabies, especially for infants, young children, and pregnant or lactating women 1.
• Ivermectin (200 mcg/kg, repeated after 1-2 weeks) can be used as an alternative treatment for adults and children weighing over 15 kg 1.
• Crusted scabies, a more aggressive form of the disease, requires combination treatment with a topical scabicide (e.g., 5% topical permethrin cream) and oral ivermectin 1.
• All household members and close contacts should be treated simultaneously to prevent reinfestation 1.
• Bedding, clothing, and towels used by infected persons should be washed in hot water and dried on high heat, while items that cannot be washed should be sealed in plastic bags for at least 72 hours 1.

Special Considerations

• Persons with HIV infection or other immunosuppressed conditions are at increased risk for crusted scabies and should be managed in consultation with a specialist 1.
• Retreatment 2 weeks after the initial treatment regimen can be considered for those persons who are still symptomatic or when live mites are observed, using an alternative regimen if necessary 1.

From the FDA Drug Label

Permethrin Cream, 5% is indicated for the treatment of infestation with Sarcoptes scabiei (scabies). Thoroughly massage Permethrin Cream, 5% into the skin from the head to the soles of the feet. ONE APPLICATION IS GENERALLY CURATIVE. Demonstrable living mites after 14 days indicate that retreatment is necessary. In Scabies: Thoroughly massage into the skin of the whole body, from the chin down, paying particular attention to all folds and creases. A second application is advisable 24 hours later.

The treatment for scabies includes:

• Permethrin (TOP): Apply from head to soles of the feet, one application is generally curative 2 2.
• Crotamiton (TOP): Apply from chin down, a second application is advisable 24 hours later 3. Key points:
• Permethrin is generally curative with one application.
• Crotamiton may require a second application.
• Retreatment with permethrin may be necessary if living mites are present after 14 days.

From the Research

Treatment Options for Scabies

• Permethrin 5% cream is considered an effective treatment for scabies, with a cure rate of 96.9% when applied twice with a one-week interval 4
• Oral ivermectin is also an effective treatment, with a cure rate of 62.4% with a single dose and 92.8% with two doses at a two-week interval 4
• Crotamiton 10% cream is less effective than permethrin 5% cream, with a cure rate of 45% at the 2-week follow-up and 65% at the 4-week follow-up 5
• A new treatment regimen with permethrin, applied once daily for two consecutive days, has shown to be more effective than a single application, with a recovery rate of 87.2% 6

Application and Administration

• Permethrin 5% cream should be applied to all external surfaces of the body, including the scalp and head, for optimal treatment 7
• The cream should be left on the skin for 24 hours and repeated 7-10 days later 6
• Cold cream application and storage in the refrigerator may enhance the effectiveness of permethrin treatment 6

Comparison of Treatments

• Permethrin 5% cream is superior to crotamiton 10% cream and oral ivermectin in terms of cure rate and speed of recovery 4, 5
• Oral ivermectin may be an effective treatment for populations with endemic disease, but its effectiveness is lower than that of topical permethrin 8
• Topical lindane and benzyl benzoate are inferior to permethrin but may be equivalent to crotamiton and oral ivermectin 8