What is the treatment for scabies?

From the Guidelines

Scabies is treated with prescription medications called scabicides that kill the mites and their eggs, with the first-line treatment being permethrin 5% cream or oral ivermectin. The treatment approach may vary depending on the severity of the infestation, with crusted scabies requiring a combination of topical and oral treatments 1. For typical scabies, permethrin 5% cream is applied from neck to toes and left on for 8-14 hours before washing off, and this treatment should be repeated after 7 days 1. Alternatively, oral ivermectin can be used at a dose of 200 mcg/kg, with a second dose given 7-14 days later.

Key Considerations

• For severe or crusted scabies, both permethrin 5% cream and oral ivermectin may be used simultaneously, with the oral ivermectin dose repeated on days 1,2,8,9, and 15, and additional doses on days 22 and 29 if necessary 1.
• All household members and close contacts should be treated at the same time, even if they don't have symptoms, to prevent reinfestation 1.
• Clothing, bedding, and towels used within 3 days before treatment should be washed in hot water and dried on high heat.
• Itching may persist for 2-4 weeks after successful treatment due to an allergic reaction to the dead mites, and antihistamines and topical steroids can help manage this itching.
• Scabies spreads through prolonged skin-to-skin contact, so prompt treatment of all contacts is essential to break the transmission cycle. Some key points to consider when treating scabies include:
• The importance of treating all household members and close contacts simultaneously to prevent reinfestation 1.
• The need to wash and dry clothing, bedding, and towels in hot water to kill the mites.
• The potential for persistent itching after treatment, which can be managed with antihistamines and topical steroids.
• The risk of crusted scabies in immunodeficient or debilitated individuals, which requires more aggressive treatment with a combination of topical and oral scabicides 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 treatment for scabies is Permethrin Cream, 5% applied topically from the head to the soles of the feet, left on for 8 to 14 hours, and then removed by washing.

• A single application is generally curative 2 2.
• Retreatment is necessary if demonstrable living mites are present after 14 days 2.

From the Research

Treatment Options for Scabies

• Topical treatments include 5% permethrin cream, 1% lindane lotion, 6% precipitated sulfur in petrolatum, crotamiton, malathion, allethrin spray, and benzyl benzoate 3
• Ivermectin is the only oral treatment, but it is not approved for scabies in the US 3
• Permethrin 5% cream is considered the most effective treatment for scabies, with a higher efficacy rate compared to lindane 1% lotion 4
• A combination of benzyl benzoate 10% and sulfiram 2% is commonly used in France, while permethrin 5% cream is widely used in the US and UK 5

Treatment Regimens

• Topical permethrin applied once daily for two consecutive days is more effective than a single application 6
• Treatment with permethrin 5% cream for 8-12 hours is recommended for common scabies 7
• Crusted scabies is preferentially treated with a combination of topical permethrin and oral ivermectin 7
• Ivermectin is useful in treating patients with Norwegian or crusted scabies, or who are debilitated 3

Special Considerations

• In institutional outbreaks, residents, staff, and frequent visitors should all be treated, even if they are not symptomatic 3
• Treatment must be adapted case-by-case, according to feasibility, and it is still important to treat contacts 5
• Permethrin can be considered for off-label use in infants of less than 3 months of age and pregnant women 7
• Oral ivermectin is indicated for patients with immunosuppression, severe dermatitis, and low adherence 7