What is the recommended treatment for scabies in an 8-year-old according to American Academy of Pediatrics (AAP) guidelines?

Treatment of Scabies in an 8-Year-Old According to AAP Guidelines

Permethrin 5% cream applied from the neck down (and including the scalp in young children) and washed off after 8-14 hours is the recommended first-line treatment for scabies in an 8-year-old child. 1, 2

First-Line Treatment

• Permethrin 5% cream:
  • Apply thoroughly to all areas of the body from neck down
  • For children, special attention should be paid to the scalp, temple, and forehead 1, 3
  • Leave on for 8-14 hours before washing off 2
  • Usually one application is curative 2
  • Safe and effective in children older than 2 months 4

Administration Considerations

• Approximately 30 grams is sufficient for an average adult; adjust accordingly for a child 2
• Ensure complete coverage of all skin surfaces
• Pay special attention to areas commonly affected in children:
  • Between fingers and toes
  • Wrists
  • Axillae
  • Belt line
  • Scalp (in young children) 3

Environmental Measures

• Machine wash and dry (using hot cycle) all bedding and clothing used by the child 5, 1
• Dry clean items that cannot be washed
• Remove items from body contact for at least 72 hours 5
• Fumigation of living areas is not necessary 5

Management of Contacts

• All household members and close contacts should be treated simultaneously, even if asymptomatic 1
• This prevents reinfestation and breaks the transmission cycle

Follow-Up and Retreatment

• Pruritus may persist for up to 2 weeks after successful treatment 1
• Persistent pruritus alone is not an indication for retreatment 2
• Consider retreatment only if:
  • Live mites are observed after 14 days 2
  • New lesions appear 1
  • Symptoms persist beyond 2 weeks 1

Alternative Treatments

• Ivermectin: Not recommended as first-line for children under 15 kg 1
• Lindane: Should NOT be used in children under 10 years due to risk of neurotoxicity, seizures, and aplastic anemia 5, 1

Important Cautions

• Avoid contact with eyes during application 2
• Temporary exacerbation of pruritus, edema, and erythema may occur after treatment 2
• Secondary bacterial infections may require antibiotic therapy 1

Treatment Success

• Approximately 75% of patients treated with permethrin 5% cream who continue to have pruritus at 2 weeks will have resolution by 4 weeks 2
• Evaluate for treatment success 2-4 weeks after initial treatment 1
• If treatment fails, consider an alternative regimen 1

Permethrin has been shown to be more effective than alternative treatments like crotamiton, with studies showing cure rates of 85% at 4 weeks after treatment with permethrin versus 65% with crotamiton 6.