What is the treatment for scabies?

From the Guidelines

Scabies treatment should prioritize a combination of topical and oral medications, with permethrin 5% cream and ivermectin 200 mcg/kg being the most effective options, as recommended by the 2015 sexually transmitted diseases treatment guidelines 1. The treatment of scabies involves the use of scabicides that kill the mites and their eggs.

Treatment Options

• Permethrin 5% cream is a first-line treatment, which should be applied from the neck down to the entire body, left on for 8-14 hours, and then washed off 1.
• Alternative treatments include ivermectin (oral medication, 200 mcg/kg, repeated after 1-2 weeks) 1.
• It's crucial to treat all household members and close contacts simultaneously, even if they don't have symptoms, to prevent reinfestation 1.

Management of Scabies

• All bedding, clothing, and towels used within 3 days before treatment should be washed in hot water and dried on high heat 1.
• Itching may persist for 2-4 weeks after successful treatment due to allergic reactions to the dead mites, and can be managed with antihistamines or topical steroids 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, with an alternative regimen recommended for those who do not respond initially to the recommended treatment 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Adults and children Thoroughly massage Permethrin Cream, 5% into the skin from the head to the soles of the feet. Scabies rarely infests the scalp of adults, although the hairline, neck, temple, and forehead may be infested in infants and geriatric patients. Usually 30 grams is sufficient for an average adult. The cream should be removed by washing (shower or bath) after 8 to 14 hours. Infants should be treated on the scalp, temple, and forehead. ONE APPLICATION IS GENERALLY CURATIVE. Patients may experience persistent pruritus after treatment. This is rarely a sign of treatment failure and is not an indication for retreatment. Demonstrable living mites after 14 days indicate that retreatment is necessary. INDICATIONS AND USAGE Permethrin Cream, 5% is indicated for the treatment of infestation with Sarcoptes scabiei (scabies).

The recommended treatment for scabies is to apply Permethrin Cream, 5% from the head to the soles of the feet, leaving it on for 8 to 14 hours before washing off.

• One application is generally curative 2.
• Retreatment is necessary if living mites are still present after 14 days 2.
• Permethrin Cream, 5% is indicated for the treatment of scabies 2.

From the Research

Scabies Treatment Options

• 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 3
• Ivermectin is also a viable treatment option, with a cure rate of 62.4% with a single dose and 92.8% with two doses at a two-week interval 3
• Topical permethrin and oral ivermectin have similar efficacy in treating scabies, with little to no difference in complete clearance rates after four weeks of follow-up 4

Treatment Application and Duration

• Permethrin 5% cream should be applied to the entire skin surface, including the scalp and head, and left on for 24 hours 5, 6
• The treatment should be repeated 7-10 days later to ensure complete clearance of the scabies infestation 5
• Ivermectin can be administered orally or topically, with a standard dose of 200 μg/kg for oral administration 4

Safety and Adverse Events

• Both permethrin and ivermectin are generally well-tolerated, with few and mild adverse events reported 4
• The most common adverse events associated with permethrin and ivermectin include mild irritant contact dermatitis and gastrointestinal symptoms 5, 4
• No withdrawals due to adverse events occurred in the studies comparing permethrin and ivermectin 4

Special Considerations

• Scabies outbreaks in nursing homes and other institutional settings require a special treatment strategy, including the treatment of all individuals, regardless of symptoms, and the use of permethrin or ivermectin 7
• Crusted scabies, a severe form of the disease, may require more aggressive treatment, including the use of ivermectin and permethrin cream 7