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, with a repeat application after 7 days. This treatment is based on the guidelines from the MMWR Recommendations and Reports 1. Alternative treatments include ivermectin (oral medication, 200 mcg/kg, repeated after 1-2 weeks), benzyl benzoate 25% lotion, or crotamiton 10% cream. It is essential to treat all clothing, bedding, and towels by washing them in hot water and drying them on high heat to kill any remaining mites, as suggested by 1. Close contacts should be treated simultaneously, even if asymptomatic, to prevent reinfestation, as recommended by 1. In cases of outbreaks in communities or institutional settings, ivermectin can be considered, especially if treatment with topical scabicides fails, according to 1. Antihistamines or topical steroids may help manage itching, which can persist for 2-4 weeks after successful treatment due to the body's immune response to dead mites.
Some key considerations in the management of scabies include:
- Decontaminating bedding and clothing by washing or dry cleaning them, or removing them from body contact for at least 72 hours, as advised by 1
- Keeping fingernails closely trimmed to reduce injury from excessive scratching, as suggested by 1
- Examining and treating sex partners and household contacts who have had close contact with the patient within the month preceding scabies infestation, as recommended by 1
- Managing outbreaks in communities or institutional settings in consultation with a specialist, with consideration of ivermectin treatment, as advised by 1
Overall, the goal of treatment is to eliminate the scabies infestation, prevent recurrence, and manage symptoms, with a focus on minimizing morbidity, mortality, and improving quality of life.
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%. The treatment involves thoroughly massaging the cream into the skin from the head to the soles of the feet and removing it by washing after 8 to 14 hours. One application is generally curative 2 2.
From the Research
Recommended Treatment for Scabies
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
- Oral ivermectin, which has been compared to topical permethrin and found to be equally efficacious in some studies 5, 6, 7
- Topical ivermectin, which has been compared to permethrin 2.5% cream and found to be equally effective 7
Treatment Regimens
Different treatment regimens have been studied, including:
- A single application of topical permethrin 5% cream, which has been shown to be effective in some studies 3
- Two applications of topical permethrin 5% cream, one week apart, which has been shown to be more effective than a single application 4, 5, 6
- A single dose of oral ivermectin, which has been shown to be less effective than two doses 5
- Two doses of oral ivermectin, one week apart, which has been shown to be as effective as two applications of topical permethrin 5% cream 5, 6
Efficacy and Safety
The efficacy and safety of these treatments have been studied, with results showing:
- Topical permethrin 5% cream to be safe and effective in treating scabies in children and adults 3, 4, 5, 6
- Oral ivermectin to be equally efficacious to topical permethrin in some studies, but with a slower onset of action 5, 6
- Topical ivermectin to be equally effective to permethrin 2.5% cream in one study 7