From the Guidelines
For treating scabies on a child's feet, permethrin 5% cream is the first-line treatment, as it is the most effective and safest option, especially for infants as young as 2 months 1. When applying permethrin 5% cream, it is essential to cover the entire body from the neck down, including all areas of the feet, and leave it on for 8-14 hours before washing off. For infants, the cream should also be applied to the scalp, face, and neck, while avoiding the eyes and mouth. A second application is typically recommended 7-10 days later to kill newly hatched mites. Oral ivermectin may be used for children weighing over 15 kg if topical treatment fails, typically given as a single dose of 200 mcg/kg, repeated in 7-10 days 1. It is crucial to treat all household members simultaneously, even if asymptomatic, as scabies spreads through prolonged skin-to-skin contact 1. Additionally, washing all bedding, clothing, and towels in hot water and drying them on high heat can help prevent reinfestation. Itching may persist for 2-4 weeks after successful treatment due to the body's allergic response to dead mites, and antihistamines or topical steroids may help reduce itching. Some key points to consider when treating scabies on a child's feet include:
- Applying permethrin 5% cream to all areas of the body, including the feet
- Leaving the cream on for 8-14 hours before washing off
- Treating all household members simultaneously
- Washing and drying all bedding, clothing, and towels in hot water and high heat
- Considering oral ivermectin for children weighing over 15 kg if topical treatment fails
- Being aware that itching may persist for 2-4 weeks after successful treatment.
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. The treatment for scabies on the feet in pediatric patients involves applying Permethrin Cream, 5% from the head to the soles of the feet 2.
- The cream should be left on for 8 to 14 hours before being washed off.
- One application is generally curative, but patients may experience persistent pruritus after treatment, which is not usually a sign of treatment failure 2.
From the Research
Scabies Treatment on Feet in Pediatrics
- Scabies is a common dermatological infection that affects more than 200 million people worldwide, including infants and children 3.
- In pediatric populations, scabies lesions can appear on various parts of the body, including the face, scalp, palms, soles, ankles, and chest 3.
- Treatment for scabies aims to eliminate the parasite and relieve symptoms, with options including topical 5% permethrin, benzyl benzoate, sulfur sulfate, or systemic ivermectin 3.
- Permethrin is recommended as the first-line treatment for children over two months, while ivermectin is used in more severe cases 3, 4.
Treatment Options for Scabies
- Topical 5% permethrin cream has been shown to be effective in treating scabies, with a cure rate of 70% at the 2-week follow-up and 85% at the 4-week follow-up after repeating the treatment 5.
- Ivermectin has also been found to be effective in treating scabies, with a cure rate of 64.7% at the 2-week follow-up and 82.3% at the 4-week follow-up after repeating the treatment 6.
- Crotamiton 10% cream has been compared to permethrin and ivermectin, and has been found to be less effective, with a cure rate of 45% at the 2-week follow-up and 65% at the 4-week follow-up after repeating the treatment 5, 6.
Considerations for Pediatric Treatment
- Permethrin is considered a safe and effective option for children, and is recommended as a first-line therapy for patients older than 2 months of age 4.
- For infants younger than 2 months of age, 7% sulfur preparation is recommended instead of permethrin due to theoretical concerns regarding percutaneous absorption 4.
- Treatment must be adapted case-by-case, according to feasibility, and it is still important to treat contacts, with the modality of this treatment remaining to be specified 7.