What is the treatment for scabies?

From the Guidelines

Scabies treatment should prioritize a combination of topical scabicide and oral ivermectin for severe or crusted cases, with permethrin 5% cream being the first-line topical treatment, applied from neck to toes and left on for 8-14 hours before washing off, and repeated after 7 days, while oral ivermectin is used at a dose of 200 mcg/kg, with a second dose given 7-14 days later, as recommended by the 2015 sexually transmitted diseases treatment guidelines 1. The treatment approach may vary depending on the severity of the case, with crusted scabies requiring a more aggressive treatment plan, including the use of both topical and oral medications, as well as careful consideration of the patient's overall health and potential for treatment failure 1. Some key points to consider in the treatment of scabies include:

• The importance of treating all household members and close contacts simultaneously, even if they do not have symptoms, to prevent reinfestation 1
• The need to wash bedding, clothing, and towels used by infected persons in hot water and dry them on high heat to prevent the spread of the mites 1
• The potential for itching to persist for 2-4 weeks after successful treatment due to an allergic reaction to the dead mites, and the use of antihistamines or topical steroids to manage this itching 1
• The consideration of alternative treatment regimens, such as the use of ivermectin, in cases where the initial treatment is not effective, or in settings such as nursing homes or other institutional settings where outbreaks may occur 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). DOSAGE AND ADMINISTRATION: SHAKE WELL BEFORE USE. 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. Clothing and bed linen should be changed the next morning. A cleansing bath should be taken 48 hours after the last application

The recommended treatment for scabies includes:

• Permethrin Cream, 5%: apply from head to soles of the feet, leave on for 8-14 hours, and one application is generally curative 2
• Crotamiton (TOP): apply from chin down, paying attention to folds and creases, with a second application 24 hours later 3 Key points:
• Permethrin Cream, 5% is indicated for the treatment of scabies 2
• Demonstrable living mites after 14 days indicate that retreatment is necessary 2

From the Research

Scabies Treatment Options

• Topical permethrin is considered the most effective treatment for scabies, with a cure rate of 70-85% after two applications 4, 5, 6
• Permethrin 5% cream is more effective than crotamiton 10% cream in treating scabies, with a higher cure rate at 2-week and 4-week follow-ups 7, 6
• Oral ivermectin is an effective treatment for scabies, especially in populations with endemic disease, but its effectiveness is lower compared to topical permethrin 5, 7

Application and Administration

• Topical permethrin 5% cream should be applied to the entire skin surface, including the scalp and head, for optimal results 4, 8
• The cream should be stored in the refrigerator and applied cold to the skin, left on for 24 hours 4
• Treatment should be repeated 7-10 days later, with follow-up evaluations at 2-week and 4-week intervals 4, 7, 6

Safety and Efficacy

• Topical permethrin and ivermectin are generally safe and well-tolerated, with mild side effects such as irritant contact dermatitis 4, 7
• Crotamiton 10% cream is less effective than permethrin 5% cream, but may still be used as an alternative treatment option 7, 6
• The choice of treatment should be based on individual patient needs and medical history, with consideration of the potential risks and benefits of each treatment option 5