What is the appropriate treatment for scabies in these patients?

Treatment for Scabies in the Jenkins Family

For all three members of the Jenkins family, permethrin 5% cream is the first-line treatment for scabies, applied from head to toe and washed off after 8-14 hours. 1, 2

Weight-Based Treatment Recommendations

For Joe Jenkins (230 lbs/104.3 kg):

• Apply permethrin 5% cream from head to toe, including hairline, neck, temple, and forehead
• Leave on for 8-14 hours then wash off
• One 30-gram tube is typically sufficient for an average adult 2
• Alternative if topical treatment fails: Oral ivermectin at 200 μg/kg (approximately 21 mg) as a single dose, repeated in 2 weeks 1

For Lauren Jenkins (150 lbs/68 kg):

• Apply permethrin 5% cream as directed above
• One 30-gram tube should be sufficient
• Alternative if topical treatment fails: Oral ivermectin at 200 μg/kg (approximately 14 mg) as a single dose, repeated in 2 weeks 1

For Riley Jenkins (140 lbs/63.5 kg, 6 years old):

• Apply permethrin 5% cream from head to toe, including scalp, hairline, neck, temple, and forehead (children should include scalp treatment) 1, 2
• Leave on for 8-14 hours then wash off
• Alternative if topical treatment fails: Oral ivermectin at 200 μg/kg (approximately 13 mg) as a single dose, repeated in 2 weeks 1

Important Treatment Guidelines

Application Instructions

• Thoroughly massage permethrin cream into the skin from head to soles of feet 2
• For children, include the scalp, temple, and forehead in treatment 1, 2
• Remove by washing (shower or bath) after 8-14 hours 2

Follow-up and Expectations

• One application is generally curative 2
• Persistent itching after treatment is common and rarely indicates treatment failure 1, 2
• If living mites are still present after 14 days, retreatment is necessary 2
• Approximately 75% of patients who still have itching at 2 weeks will have resolution by 4 weeks 2

Environmental Control

• Machine wash all bedding and clothing using hot water and dry on hot cycle 1
• Items that cannot be washed should be removed from body contact for at least 72 hours 1
• All household members and close contacts should be treated simultaneously, even if asymptomatic 1

Treatment Efficacy and Considerations

• Permethrin 5% cream has cure rates of 89-95% at 4 weeks after treatment 1
• Permethrin appears more effective than oral ivermectin, topical crotamiton, and topical lindane 3
• Permethrin has low mammalian toxicity and minimal allergic side effects 1

Potential Side Effects

• Temporary exacerbation of itching, mild burning, or stinging may occur after application 2
• Permethrin may be mildly irritating to the eyes; avoid contact during application 2
• Serious adverse events are rare with permethrin 2, 3

Alternative Treatment

If permethrin fails or is not tolerated, oral ivermectin at 200 μg/kg as a single dose, repeated in 2 weeks, is recommended 1. However, permethrin has shown superior efficacy compared to a single dose of ivermectin 4.