Treatment for Scabies in a 30-Year-Old Female
The recommended first-line treatment for scabies in a 30-year-old female is permethrin 5% cream applied to all areas of the body from the neck down and washed off after 8-14 hours. 1, 2
Prescription Details
- Medication: Permethrin 5% cream
- Quantity: 30 grams (usually sufficient for an average adult)
- Directions: Thoroughly massage into the skin from the neck down to the soles of the feet. Remove by washing (shower or bath) after 8-14 hours.
- Refills: None (one application is generally curative)
Application Instructions
- Take a routine bath or shower before application
- Apply permethrin 5% cream to clean, dry skin
- Massage thoroughly into all skin areas from the neck down, paying special attention to:
- Skin folds and creases
- Between fingers and toes
- Under fingernails (trim nails short first)
- Wrists
- Axillae (armpits)
- External genitalia
- Buttocks
- Leave on for 8-14 hours (typically overnight)
- Wash off completely with water after the treatment period
Additional Management
- Decontaminate bedding and clothing by machine washing and drying using hot cycle, or remove from body contact for at least 72 hours 1
- Treat all household members and close contacts simultaneously, even if asymptomatic, to prevent reinfection 1
- Treat sexual contacts from the previous month 1
- Patients may experience persistent pruritus after treatment, which is rarely a sign of treatment failure and not an indication for retreatment 2
- Evaluate after 1 week if symptoms persist; retreatment may be necessary if living mites are found after 14 days 2
Alternative Treatments
If permethrin is unavailable or contraindicated:
Oral ivermectin: 200 μg/kg as a single dose, potentially repeated in 2 weeks 1, 3, 4
- Note: While effective, permethrin has a more rapid onset of action 4
Crotamiton lotion: Thoroughly massage into the skin from chin down, with particular attention to folds and creases. Apply a second application 24 hours later. Take a cleansing bath 48 hours after the last application 5
Important Considerations
- While traditional guidelines recommend neck-down application for adults, consider scalp-to-toes application if there is any suspicion of head involvement 6
- Permethrin has low mammalian toxicity with minimal side effects, typically limited to mild local reactions 1
- Recent research suggests potential decreasing efficacy of permethrin in some regions, with cure rates as low as 29-31% reported in an Austrian study 7. If treatment failure occurs, consider alternative treatments like oral ivermectin.
- Some studies suggest that applying permethrin for two consecutive days may improve efficacy (87.2% vs 61.8% for single application) 8, though this is not part of standard guidelines
Remember that one application of permethrin 5% cream is generally curative, but demonstrable living mites after 14 days indicate that retreatment is necessary 2.