From the Guidelines
The recommended treatment for scabies is permethrin 5% cream applied to the entire body from the neck down, left on for 8-14 hours, then washed off, and repeated after 7-10 days. This treatment is effective in killing the scabies mites and relieving symptoms. Alternative treatments include ivermectin (oral medication, 200 mcg/kg, repeated after 1-2 weeks) 1, crotamiton 10% cream, or sulfur ointment. It is essential to treat all household members and close contacts simultaneously, even if they don't have symptoms, to prevent reinfestation 1. Clothing, bedding, and towels used in the past 3 days should be washed in hot water and dried on high heat to prevent the spread of the mites. Some key points to consider when treating scabies include:
- Permethrin works by paralyzing the nervous system of the mites, while ivermectin disrupts their nerve and muscle function 1.
- Treatment failure usually occurs due to incorrect application, reinfestation from untreated contacts, or rarely, resistance to the medication 1.
- Itching may persist for 2-4 weeks after successful treatment due to an allergic reaction to the dead mites.
- Retreatment 2 weeks after the initial treatment regimen can be considered for those persons who are still symptomatic or when live mites are observed 1.
- Use of an alternative regimen is recommended for those persons who do not respond initially to the recommended treatment 1.
From the FDA Drug Label
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. PRECAUTIONS General Scabies infestation is often accompanied by pruritus, edema, and erythema. Treatment with Permethrin Cream, 5% may temporarily exacerbate these conditions.
The recommended treatment for scabies is:
- Permethrin Cream, 5%: Apply to the whole body, from the chin down, paying particular attention to all folds and creases. A second application is advisable 24 hours later.
- Crotamiton (TOP): 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. Key points to consider:
- Treatment may temporarily exacerbate pruritus, edema, and erythema.
- Patients should be advised to avoid contact with eyes during application and to flush with water immediately if the medication gets in the eyes.
- A cleansing bath should be taken 48 hours after the last application 2, 3.
From the Research
Recommended Treatment for Scabies
The recommended treatment for scabies includes:
- Permethrin 5% cream 4, 5, 6, 7, 8
- Oral ivermectin 4, 7, 8
- Benzyl benzoate 25% lotion 4 Alternative treatments are:
- Malathion 0.5% aqueous lotion 4
- Ivermectin 1% lotion 4
- Sulphur 6-33% cream, ointment or lotion 4
Treatment for Crusted Scabies
Crusted scabies therapy requires a topical scabicide and oral ivermectin 4
Mass Treatment and Partner Management
Mass treatment of large populations with endemic disease can be performed with a single dose of ivermectin (200 micrograms/kg of bodyweight) 4 Partner management needs a look-back period of 2 months 4 Patients and close contacts should avoid sexual contact until completion of treatment and should strictly observe personal hygiene rules when living in crowded spaces 4
Efficacy of Permethrin and Ivermectin
Permethrin 5% cream has been shown to be more effective than crotamiton 10% cream in the treatment of scabies in children 5 A single dose of ivermectin provided a cure rate of 62.4%, which increased to 92.8% with 2 doses at a 2-week interval 7 Two applications of permethrin with a one week interval was effective in 96.9% of patients 7 Permethrin has a rapid onset of action compared to ivermectin 8