What is the recommended treatment for scabies in a child?

Scabies Treatment in Children

Permethrin 5% cream is the first-line treatment for scabies in children, applied from head to toe (including scalp, hairline, neck, temple, and forehead in infants) and washed off after 8-14 hours. 1, 2

First-Line Treatment

• Permethrin 5% cream (Elimite):
  • Safe and effective for children as young as 2 months of age 2
  • Application technique:
    • Thoroughly massage into skin from head to soles of feet
    • Include scalp, temple, and forehead in infants (scabies can infest these areas in children) 2
    • Leave on for 8-14 hours before washing off
    • One application is generally curative 2
  • Approximately 30 grams is sufficient for an average adult (adjust accordingly for children)

Important Considerations

• Treatment of all household members:

  • All household members and close contacts should be treated simultaneously, even if asymptomatic, to prevent reinfestation 1

• Environmental decontamination:

  • Wash bedding and clothing in hot water and dry using hot cycle
  • Items that cannot be washed should be removed from body contact for at least 72 hours 1

• Post-treatment pruritus:

  • Itching may persist for several weeks after successful treatment
  • This is rarely a sign of treatment failure and not an indication for retreatment 2
  • Topical corticosteroids and oral antihistamines may help relieve symptoms

Alternative Treatments

• Ivermectin (oral):

  • Consider when topical treatment has failed or in cases of severe/crusted scabies 1, 3
  • Dosage: 200 μg/kg, repeated in 2 weeks 1
  • Not recommended for children weighing less than 15 kg 1
  • Take with food to increase bioavailability 1

• Combination therapy:

  • For severe or crusted scabies, combination of oral ivermectin and permethrin 5% cream may be considered 1
  • Antibiotics may be necessary if secondary bacterial infection is present

Treatment Failure

• Retreatment is necessary if:
  • Living mites are demonstrable after 14 days 2
  • New lesions appear
  • Symptoms persist beyond 2-4 weeks 1

Medications to Avoid

• Lindane (1%):
  • Not recommended due to potential neurotoxicity and risk of seizures 4
  • Contraindicated in children under 10 years 1
  • No longer recommended by the American Academy of Pediatrics 4

Treatment Efficacy

• Studies show permethrin 5% cream has cure rates of 89-95% at 4 weeks after treatment 5, 6
• Permethrin has demonstrated greater effectiveness than alternatives like crotamiton in reducing pruritus and secondary bacterial infections 5

Safety Profile

• Permethrin has low mammalian toxicity and minimal allergic side effects 7
• Adverse effects are typically limited to mild local reactions:
  • Temporary exacerbation of itching, edema, or erythema
  • Mild burning or stinging sensation 2, 8
• Permethrin is absorbed percutaneously in only small amounts, rapidly metabolized in the skin, and excreted in urine 7

Remember that successful treatment depends on proper application technique, treating all close contacts simultaneously, and appropriate environmental decontamination to prevent reinfestation.