From the Guidelines
The recommended treatment for scabies is permethrin 5% cream, applied from neck to toes and left on for 8-14 hours before washing off, as it is the most effective treatment for killing both adult mites and their eggs. This treatment should be repeated after 7-10 days to ensure that all mites are eliminated 1. Alternative treatments include ivermectin (oral medication, typically 200 mcg/kg, repeated after 1-2 weeks), crotamiton 10% cream, or sulfur ointment. It is essential to note that crusted scabies, a more aggressive form of the infestation, requires combination treatment with a topical scabicide and oral ivermectin 1.
Key Considerations for Treatment
- All clothing, bedding, and towels used by the infected person should be washed in hot water and dried on high heat to prevent reinfestation 1.
- Close contacts should be treated simultaneously, even if they don't show symptoms, as scabies is highly contagious through direct skin-to-skin contact 1.
- Antihistamines and topical steroids may help relieve itching, which can persist for 2-4 weeks after successful treatment due to ongoing immune response to dead mites.
- In cases of outbreaks in communities, nursing homes, and other institutional settings, ivermectin can be considered, especially if treatment with topical scabicides fails, and epidemics should be managed in consultation with a specialist 1.
Additional Management Considerations
- Bedding and clothing should be decontaminated or removed from body contact for at least 72 hours 1.
- Fumigation of living areas is unnecessary.
- Persons with scabies should be advised to keep fingernails closely trimmed to reduce injury from excessive scratching 1.
From the FDA Drug Label
Permethrin Cream, 5% is indicated for the treatment of infestation with Sarcoptes scabiei (scabies). Thoroughly massage Permethrin Cream, 5% into the skin from the head to the soles of the feet. The cream should be removed by washing (shower or bath) after 8 to 14 hours. ONE APPLICATION IS GENERALLY CURATIVE.
The recommended treatment for scabies is Permethrin Cream, 5%. It should be applied from the head to the soles of the feet and removed after 8 to 14 hours.
- One application is generally curative.
- Retreatment is necessary if demonstrable living mites are present after 14 days 2 2.
From the Research
Scabies Treatment Options
- The recommended treatment for scabies includes topical permethrin 5% cream, which has been shown to be effective in treating scabies in children and adults 3, 4, 5, 6.
- Permethrin 5% cream is considered a safe and efficacious treatment for scabies, with a cure rate of 89% after four weeks of treatment 3.
- A study comparing permethrin 5% cream with crotamiton 10% cream found that permethrin was more effective in reducing pruritus and secondary bacterial infections 3.
- Another study found that applying permethrin 5% cream once daily for two consecutive days was more effective than a single application in adult immunocompetent patients with scabies 4.
Comparison with Other Treatments
- Oral ivermectin has also been shown to be effective in treating scabies, with a cure rate of 90% after a single dose and 92.8% after two doses at a 2-week interval 5, 6.
- A study comparing topical ivermectin with permethrin 2.5% cream found that two applications of ivermectin were as effective as two applications of permethrin 2.5% cream at the 2-week follow-up 7.
- However, permethrin 5% cream has been shown to have a rapid onset of action and is considered a more effective treatment option than oral ivermectin in some studies 5, 6.
Treatment Regimens
- The recommended treatment regimen for scabies includes applying permethrin 5% cream to the entire skin surface, leaving it on for 24 hours, and repeating the treatment 7-10 days later 4.
- Oral ivermectin can be given as a single dose or in a two-dose regimen, with a 2-week interval between doses 5, 6.
- Topical ivermectin can be applied to the affected skin at a dose of 400 microg/kg, repeated once the following week 7.