From the Guidelines
Scabies treatment should involve permethrin 5% cream as first-line therapy, applied from neck to toes and left on for 8-14 hours before washing off, with a repeat application after 7 days, as recommended by the 2015 guidelines 1. The treatment of scabies is crucial to prevent further complications and reduce the risk of transmission to others.
- Permethrin 5% cream is the preferred treatment due to its high efficacy and safety profile.
- Alternative treatments, such as ivermectin (oral medication, 200 mcg/kg, repeated after 1-2 weeks), benzyl benzoate 25% lotion, or crotamiton 10% cream, can be used in cases where permethrin is not effective or tolerated.
- It is essential to treat all household members and close contacts simultaneously, even if asymptomatic, to prevent reinfestation 1.
- Bedding, clothing, and towels used within 3 days before treatment should be washed in hot water and dried on high heat to reduce the risk of reinfestation 1.
- Intense itching may persist for 2-4 weeks after successful treatment due to ongoing immune response to dead mites; antihistamines or topical steroids can help manage this symptom 1.
- Scabies spreads through prolonged skin-to-skin contact, with mites burrowing into the skin to lay eggs, causing intense itching especially at night.
- Common sites of infestation include finger webs, wrists, elbows, armpits, belt line, and genitals.
- Crusted (Norwegian) scabies is a severe form occurring in immunocompromised individuals that requires more aggressive treatment, including combination therapy with a topical scabicide and oral ivermectin 1.
From the FDA Drug Label
Permethrin Cream, 5% is indicated for the treatment of infestation with Sarcoptes scabiei (scabies). Permethrin cream is indicated for the treatment of scabies caused by the mite Sarcoptes scabiei 2.
- The drug is used to treat infestations with this mite.
- Permethrin is the active ingredient in this cream.
From the Research
Treatment Options for Scabies
- Permethrin 5% cream is considered an effective treatment for scabies, with studies showing high cure rates 3, 4, 5
- Ivermectin is also used to treat scabies, with oral and topical forms available 4, 5, 6
- The efficacy of permethrin and ivermectin may vary depending on the treatment regimen and patient population 4, 5, 6
Treatment Regimens
- A single application of permethrin 5% cream may not be as effective as multiple applications 3, 4, 5
- Twice application of permethrin with a one-week interval may be more effective than a single dose of ivermectin 4, 5
- The use of ivermectin at a standard dose of 200 μg/kg may lead to slightly lower rates of complete clearance after one week compared to permethrin 5% cream 6
Safety and Adverse Events
- Adverse events reported in studies were generally mild and rare 4, 5, 6
- There is probably little or no difference in the proportion of participants treated with systemic ivermectin or permethrin cream who experienced at least one adverse event 6
- Topical ivermectin may lead to a slightly larger proportion of participants with at least one adverse event compared to permethrin 6